Kayakalp Guidelines for Hospitals: Enhancing Cleanliness and Hygiene

This guide explains the Kayakalp guidelines for hospitals: the thematic areas facilities are scored on, how the three levels of assessment work, what changed in the 2024 revision and the awards on offer.

What are Kayakalp Guidelines for Hospitals?

Kayakalp was launched to complement the Swachh Bharat Abhiyan. Its guidelines and assessment checklists are prepared by the Quality and Patient Safety Division of the National Health Systems Resource Centre (NHSRC).

Kayakalp began with district hospitals, sub-district hospitals, community health centres and primary health centres. It was extended to urban health facilities in 2017-18 and to sub-centre level health and wellness centres, now Ayushman Arogya Mandirs, from 2019-20. Private hospitals are not part of the award scheme, but they can use the Kayakalp checklists as a benchmark for their own cleanliness and infection control programmes.

Key Components of Kayakalp Guidelines for Hospitals

Kayakalp assessments are organised into thematic areas, which the guidelines call the pillars of Kayakalp. Each thematic area is split into criteria, and each criterion into checkpoints that assessors score. District hospitals, sub-district hospitals and community health centres are assessed on eight thematic areas; primary health centres and Ayushman Arogya Mandir sub-centres are assessed on seven.

1. Hospital or Facility Upkeep

This covers the general maintenance of the facility: pest and animal control, landscaping and gardening, open areas, facility appearance, infrastructure, illumination, furniture and fixtures, removal of junk material, water conservation and workplace management.

2. Sanitation and Hygiene

This area covers the cleanliness of all hospital areas, including wards, operation theatres, toilets and public spaces.

Hospitals must follow regular cleaning schedules, use standard cleaning materials, equipment and methods, monitor cleaning activities, and manage drainage and sewage.

3. Waste Management

This thematic area checks segregation, handling, storage, transport and disposal of different types of waste, with biomedical waste managed as per the Bio-Medical Waste Management Rules, 2016.

Hospitals must also manage general and liquid waste according to local regulations and environmental standards.

4. Infection Control

This area covers hand hygiene, use of personal protective equipment (PPE), decontamination, disinfection and sterilization of instruments, spill management, isolation and barrier nursing, and surveillance of hospital-acquired infections under an infection control programme.

5. Support Services

Support services such as laundry and linen management, water sanitation, kitchen services, security and outsourced services are checked to make sure they meet hygiene standards. The 2024 revision added a criterion on patient amenities under this area.

6. Hygiene Promotion

This area looks at how the facility promotes hygiene through community monitoring and patient participation, information, education and communication (IEC), leadership and teamwork, staff training, and staff hygiene and dress code.

7. Beyond Hospital Boundary

Kayakalp also assesses cleanliness outside the facility’s boundary wall, including promotion of Swachhata in the surrounding area, alternative financing and support, cleanliness and aesthetics of the surroundings, general waste management and maintenance of the surrounding area. This area was added within the scheme’s first few years, and the 2024 revision reduced its criteria and checkpoints.

8. Eco-friendly Facility

Since FY 2021-22, district hospitals, sub-district hospitals and community health centres are also assessed on an eco-friendly facility theme covering energy efficiency, air and noise pollution, reducing, reusing and recycling waste, protecting the environment, and health and wellbeing. Top-ranked facilities in each state can receive a separate Best Eco-Friendly award.

Water, Sanitation, and Hygiene (WASH) Score

WASH is not a separate thematic area. Since the 2024 revision, a WASH score is calculated from existing Kayakalp checkpoints on water, sanitation and healthcare waste management, hygiene, and management. It looks at things like piped and potable drinking water at all times, separate and accessible toilets, hand hygiene stations at all points of care and within 5 metres of toilets, and adequate cleaning staff.

Implementing Kayakalp Guidance for Hospitals

Facilities usually work through the guidelines in four steps:

1. Conducting Baseline Assessments

Hospitals should start by conducting a baseline assessment with the Kayakalp checklist for their type of facility to evaluate their current cleanliness and hygiene standards. Each checkpoint is scored 2 for full compliance, 1 for partial compliance and 0 for non-compliance. This assessment will help identify gaps and areas that need attention.

2. Training and Capacity Building

Run regular training on infection control, waste management, sanitation, PPE and hand hygiene, including for housekeeping and outsourced staff.

3. Monitoring and Evaluation

Kayakalp uses three levels of assessment:

• Internal assessment: a quarterly self-assessment by the facility to identify gaps and prepare an improvement plan.
• Peer assessment: mandatory for all facilities at least once a year, by a team from another facility in the district.
• External assessment: facilities scoring 70% or more in peer assessment are validated by an external team.

Within the facility, an infection control and cleanliness committee (at sub-centre level, the Jan Arogya Samiti) reviews progress between assessments.

4. Engaging Stakeholders

Kayakalp’s hygiene promotion area expects community monitoring and patient participation, so ask patients and visitors about cleanliness, especially of toilets and wards, and act on what they report.

Best Practices for Maintaining Cleanliness and Hygiene

Day to day, these practices carry most of the score:

1. Implementing Regular Cleaning Schedules

Set area-wise cleaning protocols and frequencies for patient rooms, operation theatres and public spaces.

High-touch surfaces, such as door handles and bed rails, should be cleaned frequently to reduce the risk of infection.

2. Promoting Hand Hygiene

Provide hand rub and handwashing stations at points of care and near toilets, and audit staff compliance.

3. Ensuring Proper Waste Disposal

Segregate waste at source into the colour-coded categories of the Bio-Medical Waste Management Rules, 2016, and keep general and hazardous waste separate.

4. Using Appropriate Disinfectants

Use disinfectants effective against a wide range of pathogens, at the manufacturer’s dilution and contact time.

5. Maintaining Clean Sanitation Facilities

Clean and restock toilets on a fixed schedule, and keep them accessible to all users.

Benefits of Adhering to Kayakalp Guidelines for Hospitals

1. Improved Patient Safety

Better cleanliness and infection control reduce the risk of hospital-acquired infections.

2. Enhanced Patient Experience

Patients feel more comfortable and confident in a visibly clean facility.

3. Recognition and Rewards

Under the 2024 scheme, the best district hospital in a state can receive ₹50 lakh, the best sub-district hospital or community health centre ₹15 lakh, and one primary health centre in each district ₹2 lakh. Every facility scoring more than 70% in the external assessment receives a commendation award, for example ₹3 lakh for a district hospital, along with a certificate.

4. Compliance with Regulations

Kayakalp is an award scheme, not a law, but many of its checkpoints are built on legal requirements such as the Bio-Medical Waste Management Rules, 2016. Following the guidelines therefore helps hospitals stay compliant with these rules and demonstrates their commitment to providing high-quality healthcare services.

Latest Kayakalp Guidelines for Hospitals

NHSRC revised the Kayakalp scheme in 2024. The main changes were:

• Fewer criteria and checkpoints: the tool for district hospitals, sub-district hospitals and community health centres now has 8 thematic areas, 61 criteria and 325 checkpoints, down from 65 criteria and 350 checkpoints. Most of the reduction is in the beyond hospital boundary area.
• WASH score: a water, sanitation and hygiene score is now part of the score card. A facility needs a WASH score of at least 70% in peer assessment to be eligible for external assessment, and a facility that is non-compliant on WASH indicators in the external assessment is not eligible for Kayakalp incentives.
• Urban facilities: assessment protocols for urban community and primary health centres were revamped, with municipal corporation level Kayakalp committees in the seven metro cities.
• Patient amenities: a new criterion on patient amenities was added under support services.

The current guidelines, checklists and score cards are published on the NHSRC Quality and Patient Safety website. See the revised Kayakalp scheme 2024 (PDF) and the Kayakalp guidelines with the eco-friendly theme (PDF).

Objectives of Kayakalp Guidelines for Hospitals

The main goals of the Guidelines for Kayakalp for Hospitals are to:

• Promote cleanliness, hygiene and infection control practices in public health facilities.
• Incentivise and recognise public health facilities that show exemplary performance in following standard protocols of cleanliness and infection control.
• Build a culture of ongoing assessment and peer review of performance on hygiene, cleanliness and sanitation.
• Create and share sustainable practices for improved cleanliness in public health facilities that are linked to positive health outcomes.

Conclusion

The Kayakalp guidelines for hospitals turn cleanliness and infection control into something that can be scored, compared and rewarded. Quarterly self-assessment, with gaps fixed before the peer assessment, gives a facility the best chance of reaching the 70% threshold for external assessment and awards. Kayakalp sits alongside the wider NQAS checklist for quality in public health facilities.

Frequently Asked Questions