;+qmd0f /f]syfd tyf :jf:Yo

;+:yfhGo kmf]x/d}nf Joj:yfkgsf]

nflu ;Gbe{ k'l:tsf

t];|f] ;+:s/0f

g]kfn ;/sf/
:jf:Yo tyf hg;+Vof dGqfno
/fli6«o :jf:Yo tfnLd s]Gb|
l8;]Da/ @)!%
1–4 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
 l;+xfjnf]sg
g]kfndf ;g\ !((% b]lv ;+qmd0f /f]syfd ;DaGwL tfnLdx?sf] qmlds k|ult x'Fb} cfPsf] 5 . ;fy}
;+qmd0f /f]syfdsf l;4fGtx? / cg'ejsf] cfwf/df ;+;f/df g} k|ult x'Fb} cfPsf] 5 . :jf:Yo ;]jf
k|bfg ubf{ ;]jfk|bfos / ;]jfu|fxLnfO{ ;+qmd0fsf] vt/f lbgfg'lbg a9\b} cfPsf] 5 . o;}n] :jf:Yo
;+:yfx?sf] u'0f:t/Lo ;]jfsf] sfo{ ;Dkfbgsf] nflu klg ;a} txsf sd{rf/Lx?df ;+qmd0f /f]syfd
tyf :jf:Yo ;++:yfhGo kmf]x/d}nf Joj:yfkgsf] 1fg / l;k cfjZostfnfO{ Wofgdf /flv of] ;Gbe{
k'l:tsf tof/ kfl/Psf] 5 . h;n] ubf{ la/fdLnfO{ ;]jf k|bfg ubf{ :jf:YosdL{x?sf] ;fy} Ps la/fdLjf6
csf]{ lj/fdLnfO{ / ;d'bfonfO{ klg ;+qmd0f x'gaf6 arfpg ;lsG5 .
;dosf] dfu / b]zsf] cfjZostfcg';f/ kl/jf/ lgof]hg ;]jfdf dfq geO{ cGo lSnlgsn ;]jfdf
klg k|of]u x'g]ul/ ;a} lsl;dsf ;]jf k|bfosx?n] :jf:Yo ;+:yfx?df ;+qmd0f /f]syfd ug{ Jojxf/df
Nofpg' kg]{ sfo{x?sf] nflu cfjZos ;xof]u x'g] u/L of] ;Gbe{ k'l:tsfdf agfOPsf] xf] . of] k'l:tsf
P=eL=P;=;L= -AVSC_ af6 k|sflzt ;+qmd0f /f]syfdsf] kf7\of+z / lzIfs lgb]{lzsf tyf hkfOuf]
-Jhpiego_ sf ln08f 6]Oh]g, 8]af]/f af];]d]o/, lgn DoflsG6f]zaf6 n]lvPsf] kl/jf/ lgof]hg ;]jfdf
;+qmd0fsf] /f]syfd eGg] l/km/]G; k'l:tsfsf] ;fy} laZj :jf:Yo ;+u7g 4f/f k|sfl;t ;+qmd0fsf]
/f]syfd k'l:tsfdf cfwfl/t 5 h;n] ;+;f/sf w]/} :jf:YosdL{x?af6 k|fKt cg'ej, n]vx?, cEof;x?
/ s'/fx?af6 cg'ej k|fKt u/]sf 5g\ . :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf] af/]df Joj:yfkg
ljefuaf6 k|sfl;t :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkg lgb]{lzsfdf cfwfl/t 5 .
;a} txsf :jf:YosdL{x? Tfyf sd{rf/Ln] Pp6} k|sf/sf] 1fg / ;Lk l;Sg / cEof; ug{ d2t k'¥ofpg]
p2]Zon] ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkg ljifos hfgsf/L k|bfg ug{
of] ;Gbe{ k'l:tsfnfO{ cfwf/ agfOPsf] 5 . of] ;Gbe{ k'l:tsfdf !# efux? 5g\ . h;nfO{ @ v08df
ljefhg ul/Psf] 5 . v08 ‘s’ df efu ! b]lv !! ;Dd ;+qmd0f /f]syfd ;fy} o;sf] Joj:yfkg
/ ;+:yfut ;'b[l9s/0fsf] ;DaGwL hfgsf/L ;dfj]z ul/Psf] 5 . v08 ‘v’ df :jf:Yo ;+:yfhGo
kmf]x/d}nf Joj:yfkg / o;sf] ;+:yfut ;'b[l9s/0fsf] af/]df pNn]v ul/Psf] 5 . ;+qmd0f /f]syfd
tyf :jf:Yo ;+:yfhGo kmf]x/d}nfsf] ;+:yfut ;'b[l9s/0fsf] lgldQ ljleGg 6'nx? klg o; k'l:tsfsf]
kl/lzi7df ;dfj]; ul/Psf] 5 .
o; k'l:tsfdf ePsf] ;"rgf / ;'emfjx? ;fdfGo efiffdf, ;fwf/0f tl/sfaf6 a'‰g ;lhnf] ePsf]
x'gfn] :jf:YosdL{x?n] hxfF, h'g ;dodf cfjZos k/]tf klg x]g{ ;Sg] / k|of]u ug{ ;Sg] 5g\ . ;+qmd0f
/f]syfdsf] nflu s'g} ;fdfgsf] cfjZostf k/]tf klg :yflgo 7fpFdf kfpg] ;/–;fdfgx? k|of]u ug{
;Sg] 5g\ . h;n] ubf{ vr{sf] arfj6 x'g'sf ;fy} cfjZostf cg';f/ w]/} ;'/Iffsf] nflu dxTjk"0f{ /
dxFuf] ;/–;fdfgx? k|of]u ug'{ k/]df ;fdfgx?sf] 5gf}6 ug'{kg]{ x'G5 . To:t} of] ;Gbe{ k'l:tsf w]/}
ljz]if :jf:Yo ;]jf k|bfg ug]{ :jf:Yo ;+:yfsf] ;+qmd0f /f]syfdsf] nflu eGbf lhNnf :tl/o :jf:Yo
;+:yfx?df sfd ubf{ cfjzos x'g] ;+qmd0f /f]syfdsf] d'Vo ljifo j:t'x?df cfwfl/t 5 . h:t} M
 ;+qmd0f /f]syfdsf] Joj:yfkgn] la/fdL / la/fdL s'?jfnfO{ dfq /f]u ;g{af6 arfpg] xf]O{g ls
o;n] :Jff:YosdL{x? / ;d'bfonfO{ klg /f]u ;g{af6 arfpF5 .

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf u
 xftsf] ;/;kmfOn] w]/}h;f] /f]ux? ;g{af6 arfpFb5 . olb xft w'g ;kmf kfgLsf] Joj:yf 5}g
eg] ;:tf] / e/kbf]{ lUnl;l/go'St P]lG6;]lK6s 3f]n nufP/ klg xftsf] ;/;kmfO{ ug{ ;lsG5 .
 zNos[of jf cGo sfo{ljlwdf -procedure_ k|of]u ePsf b"lift cf}hf/ tyf ;fdfgx? k'gM k|of]usf]
lgldQ ltgLx?nfO{ ;kmf ug'{eGbf cufl8 )=%Ü Snf]l/g 3f]ndf !) ldg]6 8''afPkl5, ;kmf u/]/,
pRr:t/Lo ;+qmd0f lgjf/0f cyjf lgd{nLs/0f u/]/ k|of]u u¥of] eg] ;+qmd0f /f]syfdsf] nflu
k|efjsf/L x'g]5 .
 zNolqmof ;DaGwL ;]jfsfo{ ug{ lgd{nLs/0f ug{ g;lsPsf] v08df tL ;fdfgx?nfO{ kfgLdf
pdfn]/ jf jfkmn] pRr:t/Lo ;+qmd0f lgjf/0f u/]sf] ;fdfg k|of]u ug'{ csf]{ pkfo xf] .
 ;fdfGo sfo{ljlw ubf{ zNolqmof ug]{ 7fpFdf xftn] g5'g] tl/sf (no touch technique) ckgfpg'
kb{5 .

# ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
 ;Gbe{ k'l:tsfsf] p2]Zo, ljifo j:t' tyf k|of]u
of] ;Gbe{ k'l:tsfsf] d'Vo p2]Zo sd ;|f]t / ;fwgsf] ;'ljwf ePsf] :jf:Yo ;+:yfx?df klg ;]jf
k'¥ofpFbf ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf] sfo{df Ps?ktf Nofpg' xf] .
o; k'l:tsfdf ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf] nflu Go"gtd
cfjZostf / k|dfl0ft eO;s]sf tl/sfx? l;4fGtx? / sfd ubf{ ePsf] cg'ej cg';f/ lbPsf]
;'emfjx? dfq ;dfj]z ul/Psf] 5, h'g cfhsf] kl/l:yltdf k|of]u ug{ clt cfjZos 5 . of] ;+qmd0f
/f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf] tl/sf k|of]u ugf{n] :jf:Yo ;+:yfx?df
la/fdLsf] ;]jf÷pkrf/ ubf{ tyf :jf:Yo ;+:yfx?sf] u'0f:t/ ;'lglirt ug{df ;'wf/ Nofpg ;lsG5 .
ljifo / o;sf] Joj:yfM
o; ;Gbe{ k'l:tsfdf ljleGg ljifodf !# efux? 5g\ . leGbfleGb} ljifosf] cfˆg} dxTj 5 h;n]
:jf:Yo ;]jf k'¥ofpFbf la/fdL, lj/fdLsf s'?jf, :jf:YosdL{ b'a}sf] ;fy} ;d'bfonfO{ klg ;+qmd0f
x'gaf6 arfpFb5 .
v08 !
efu ! b]lv !! ;Dd M
o; v08df ;+qmd0f /f]syfdsf] kl/ro, :t/Lo ;ts{tf, k'/fgf] ljZjJofkL arfj6 k|ljlwnfO{ abNg],
:jf:Yo ;+:yfdf cfPsf] la/fdLnfO{ :jf:Yo ;+:yfhGo ;+qmd0f x'gaf6 arfpg] cEof;, xftsf] ;/;kmfO,
k+hfsf] k|of]u tyf PlG6;]K;L; k|s[of, b"lift cf}hf/x?sf] b"if0f lgjf/0f ug]{, ;kmf ug]{, pRr:t/Lo
;+qmd0fsf] lgjf/0f ug]{, lgd{nLs/0f ug]{, xfp; lslkË, lSnlgsn k|of]uzfnfdf x'g ;Sg] ;+qmd0faf6
aRgsf ;fy} ;DalGwt ;+qmd0f /f]syfdaf6 aRgsf nflu Wofg lbg'kg]{ sfo{x?af/] klg j0f{g ul/Psf]
5 . o; v08df ;+qmd0f /f]syfdsf] ;+:yfut ;'b[l9s/0f k|s[of / sfo{ ;Dkfbg ;'wf/sf k|of;x? klg
;dfj]z ul/Psf] 5 .
v08 @
efu !@ b]lv !# ;Dd
o; v08df :jf:Yo ;+:yfhGo kmf]x/ d}nf Joj:yfkg, tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:Yffkgsf]
;+:yfut ;'b[l9s/0fsf] nflu hfgsf/L tyf sfo{ ;Dkfbg ;'wf/sf k|of;x? ;d]t ;dfj]z ul/Psf] 5 .
;Gbe{ k'l:tsfsf] k|of]u
of] ;Gbe{ k'l:tsf ;a} txsf :jf:Yo ;+:yfx?df ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nfsf]
Joj:yfkgsf] nflu k|of]u ug{ lglb{i6 ul/Psf] 5 . of] k'l:tsfdf 8fS6/, g;{, kf/fd]l8S; :6fkm /
:jf:Yo ;]jf;Fu ;DalGwt cGo sd{rf/L, lzIfs cflbnfO{ cfjZos ;"rgfx?, cEof;x?, sfd ug]{
tl/sfx? ;lhnf] / ;DalGwt ljifox? pknAw u/fOPsf] 5 . o;n] ubf{ :jf:Yo ;+:yfdf ;+qmd0f
/f]syfdsf] nflu cfjZos lgod, lgtL, k"jf{wf/ / lgb]{zgx?, d'NofÍg kmf/fdx? tof/ ug{ ;xof]uL
x'g]5 . o; k'l:tsfdf ePsf] ;a} efux? cfaZostf cg';f/ ;DjlGwt ;j}n] k|of]hg ug{ ;Sg]5g\ .

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf ª
1–8 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf %
1–10 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
 ljifo–;"rL
v08 s k[i7
!= ;+qmd0f /f]syfdsf] kl/ro
 e"ldsf !–!
 c:ktfn / cGo :jf:Yo ;+:yfdf s:tf s:tf vt/fx? x'g ;S5g\ !–!
 kl/efiff !–@
 /f]usf] ;+qmd0f rqm !–#
 :jf:Yo ;+:yfhGo ;+qmd0f / o;sf] /f]syfd !–%
 :t/Lo ;ts{tfsf pkfox? !–&
 ;+qmd0fdf cfwfl/t ;ts{tfx? !–&
 la/fdLnfO{ cnu /fvL ckgfpg'kg]{ ;ts{tfx? !–&
@= :t/Lo ;ts{tf tyf ;'/Iffsf pkfox?
 e"ldsf @–!
 :t/Lo ;ts{tfsf d'Vo tTjx? / To;sf] k|of]u @–@
 ;'/Iffsf pkfox? @–$
 JolQmut ;'/Iffsf ;fdu|Lx? @–%
 8«]«K;sf] e"ldsf @–(
 sfd ug]{ 7fp“ ;'/lIft /fVg] @–(
#= xftsf] ;/;kmfO{
 e"ldsf #–!
 kl/efiff #–@
 xftsf] ;/;kmfOsf] cEof; #–#
 ;fwf/0f xft w'g] p2]Zo #–#
 lgoldt ?kdf xft w'g] qmdx? #–$
 PlG6;]lK6såf/f xftsf]] ;/;kmfO{ #–^
 zNolqmof ug'{ cufl8 xftsf] ;/;kmfO{ #–*
 xftsf] ;/;kmfO{sf] sfo{ ;'wf/ ug{ s] s] ug{ ;lsG5 #–(
 zNos[of cufl8 cNsf]xnn] xftsf] ;/;/kmfO ug]{ t/Lsf #–!)
 xftsf] ;/;kmfO{ /fVg] ;DaGwdf Wofg lbg'kg]{ c? s'/fx? #–!!
$= k~hfx¿
 e"ldsf $–!
 k~hf lgDg sfo{ ubf{ k|of]u ug'{k5{ $–@
 k~hfsf] k|sf/ $–@
 k~hfsf] cfk"lt{ sd x'Fbf $–@

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf em
  ljleGg k|sf/sf k~hfx?sf] kmfObf / a]kmfObfx? $–#
 lgd{lns/0f ePsf]] zNolqmof ubf{ k|of]u ug]{ k~hf nufpg] qmlds k|lqmofx? $–#
 ;]jfsfo{ ubf{ k~hfsf] cfjZostf $–*
 ;fdfGo pkrf/ / zNolqmof sfo{sf] nflu cfjZos k~hf $–*
 k~hf k|of]u ubf{ Wofg lbg'kg]{ s'/fx? $–(
%= P]lG6;]lK6s, P]lG6;]lK;;\ tyf ls6f0f'/lxt t/Lsf
 e"ldsf %–!
 kl/efiff %–@
 PlG6;]lK6ssf] 5gf}6 %–@
 P]lG6;]lK6ssf] k|of]u %–@
 PlG6;]lK6ssf] sfd / k|of]u %–#
 zNolqmof ug'{ cufl8 5fnfsf] tof/L %–$
 kf7]3/sf] d'v tof/ ug]{ lgb]{zg %–$
 ;"O{ lbgsf] nflu 5fnfsf] tof/L %–%
 PlG6;]lK6s afF+8\g] tyf e08f/0f ug]{ %–%
 P]lG6;]lK6ssf] k|of]udf ug]{÷gug]{ %–^
 ls6f0f' /lxt t/Lsf %–*
 zNos[of ul/Fbf ;'/Iffsf pkfox? k|of]u ug]{ %–*
 zNos[of ubf{ lgd{lns[t 7fpFsf] :yfkgf ug]{ / o;nfO{ sfod ug]{ %–*
 PseGbf a9L dfqf ePsf] efOnsf] k|of]udf Wofg lbg'kg]{ s'/fx?M %–!)
 l;of] / cGo wf/Lnf cf}hf/x?af6 x'g] rf]6k6ssf] Joj:yfkg %–!)
^= k|of]u ePsf cf}hf/x? tyf cGo ;fdfgx? k|zf]wg ug]{ ?k/]vf
 e"ldsf ^–!
 ;fdfgx? k|zf]wg ug{sf] nflu lgb]{zg ^–@
 b"if0f lgjf/0f k|lqmof ^–@
 cf}hf/x?, zNolqmofsf k~hfx? tyf cGo ;fdfgx?sf] k|zf]wg k|lqmof ^–#
 b"if0f lgjf/0f ul/g] tTjx? ^–#
 Snf]l/g sG;G6«]6]8 ;f]n'zgaf6 8fONo"6 ;f]n'zg agfpg] ;"q ^–$
 ;'Vvf Snf]l/g kfp8/af6 Snf]l/g 3f]n agfpg] ;"q ^–$
 b"if0f lgjf/0fsf l6K;\x? ^–^
 ;fdfgx? ;kmf ug]{ ^–&
 ;fdfgx? k|zf]wg ug{sf] nflu k|efjsf/L t/Lsfx? ^–*
 ;kmfO{sf l6K;\x? ^–(
 ;kmf ug]{ r/0fx? ^–(
&= lgd{nLs/0f
 e"ldsf &–!
 k|efjsf/Ltf &–!
 tfkåf/f lgd{nLs/0f ug]{ tl/sfx? &–@
 jfliko lgd{nLs/0f &–#
 ;'Vvf tfkåf/f lgd{nLs/0f &–%
 /f;folgs k|lqmofåf/f lgd{nLs/0f &–%

` ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
*= pRr:t/Lo ;+qmd0f lgjf/0f
 e"ldsf *–!
 pdfn]/ pRr:t/Lo ;+qmd0f lgjf/0f ug]{ tl/sf *–@
 ;fdfgx? lau|gaf6 arfpg] pkfox? *–#
 jfliks/0fåf/f pRr:tl/o ;+qmd0f lgjf/0f ug]{ tl/sf *–$
 /;fogsf] k|of]uåf/f pRr:t/Lo ;+qmd0f lgjf/0f ug]{ tl/sf *–%
 /f;folgs 3f]nsf] e08f/0f *–&
 k|of]u ul/;s]sf /f;folgs kbfy{ lj;h{g ug]{ tl/sf *–&
 /f;folgs ;+qmd0f lgjf/0f ug]{ 3f]n tof/ tyf k|of]u ug]{ *–*
(= ;/;kmfO{
 e"ldsf (–!
 ;/;kmfO{sf l;4fGtx? (–@
 ;/;kmfO{sf ;fdfgsf] 5gf}6 tyf k|of]u (–%
 ;kmfO{ ug]{ ljlw (–%
 kmf]x/x? jf8{af6 lgsfNg] (–^
 n'ufx?sf] ;/;kmfO{ / Joj:yfkg (–&
 n'ufsf] w'nfO{ (–&
 s]lGb|o lgd{lns[t ;fdfg ljt/0f zfvf (–*
!)= lSnlgsn k|of]uzfnfdf ;+qmd0f
 e"ldsf !)–!
 kl/efiffx? !)–!
 k|of]uzfnfaf6 pTkGg x'g] ;+qmd0fsf k|sf/x? !)–@
 ;+qmd0f /f]syfdsf ;fdfGo lgb]{zgx? !)–@
 /ut tfGg] !)–#
 /utsf] gd"gf ;°ng ubf{ Wofg lbg'kg]{ s'/fx? !)–#
 /St ;+rf/ s]Gb|df ;+qmd0f /f]syfd !)–#
 :jf:YosdLsf] ;'/Iffsf] nflu lgDg sfo{ ug'{kb{5 !)–$

!!= ;+qmd0f /f]syfd Joj:yfkg ;'b[l9s/0f

 e"ldsf !!–!
 ;+qmd0f /f]syfd Joj:yfkgsf] sfo{;Dkfbgdf ;'wf/ ug{ ckgfpg'kg{] r/0fx? !!–#
 sfo{ ;Dkfbg ;'wf/ ug]{ k|lqmof !!–#
 sfo{ ;Dkfbg ;'wf/sf] nflu ckgfpg'kg{] r/0fx? !!–$

v08 v
!@= :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkg
 e"ldsf !@–!
 kmf]x/ sd ug'{ !@–@

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf ^
  kmf]x/x?nfO{ ;|f]tdf g} s6f}tL ug'{ !@–@
 k'gr{lqmo / k'gM k|of]u ul/g] j:t'x?sf] k|of]udf k|fyldstf lbg' !@–#
 kmf]x/x?sf] k[ylss/0f -cnu ug]{_ !@–#
 kmf]x/ cf];f/ k;f/ !@–*
 ;+:yfleq cf];f/ k;f/ !@–(
 :jf:Yo ;+:yfaf6 aflx/ kmf]x/ cf];f/ k;f/ ug]{ !@–(
 kmf]x/sf] pkrf/ / lj;h{g !@–(
 ;fngfnnfO{ 7Ls tl/sfn] la;h{g !@–!$
 ;fngfnsf] lj;h{g ug{sf] nflu Joj:yfkg !@–!$
 ;fngfnnfO{ ;+sng If]qaf6 lj;h{g If]qdf cf];fg]{ tl/sf !@–!$
 ;fngfn lj;h{g ug]{ If]qsf] Joj:yfkg !@–!%
!#= :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkg ;'b[l9s/0f
 e"ldsf !#–!
 :jf:Yo ;+:yfhGo kmf]x/ d}nf Joj:yfkgsf] sfo{;Dkfbgdf ;'wf/ ug{ ckgfpg'kg{] r/0fx? !#–#
 sfo{ ;Dkfbg ;'wf/ ug]{ k|lqmof !#–#
 sfo{ ;Dkfbg ;'wf/sf] nflu ckgfpg'kg{] r/0fx? !#–%
 sfo{of]hgf tof/ ug]{ !#–&
 :jf:Yo ;+:yfdf u'0f:t/ ;'wf/ 6f]nL lgdf{0f !#–*

kl/lzi6 s
:jf:Yo ;]jf ;'b[9Ls/0fsf nflu u'0f:t/ ;'wf/ 6'n s–!

kl/lzi6 v
sfo{ ;Dkfbg dfkb08df b]lvPsf ;d:ofx? ;'wf/ ug{sf nflu k|of]u ug]{ sfo{ of]hgfsf] gd"gf v–!

& ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
v08 s
1–16 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
 ;+qmd0f /f]syfdsf] kl/ro
INTRODUCTION TO INFECTION
PREVENTION !
ljifoj:t'
 ;+qmd0f /f]syfdsf p2]Zox?
 ;+qmd0f x'g] cj:yf
 ;?jf /f]u ;g{af6 /f]syfd

;+qmd0f /f]syfdsf pkfo ckgfpg] t/Lsfx? ;lhnf], k|efjsf/L / lskmfolt 5g\ -ljZj :jf:Yo
;+u7g, Unf]an xft] k'l:tsf, @)!!_

e"ldsf
;+qmd0f /f]syfd u'0f:t/Lo :jf:Yo ;]jfsf] Ps cleGg cË xf] . :jf:Yo ;]jf k|bfg ug]{ :yfgdf ljleGg
lsl;dsf lj/fdLx? dfq} cfpg] xf]O{g sL pgLx¿sf ;fydf cGo JolQmx¿ klg cfpF5g\ . ;+qmd0f
/f]syfdsf] plrt t/Lsf ckgfOPg eg] Ps lj/fdLsf] ;+qmd0f csf]{ lj/fdL JolQmnfO{ jf :j:y
JolQmnfO{ ;g{ ;S5 .
;+qmd0f /f]syfdsf] d'Vo p2]Zo :jf:Yo ;]jf lbg] qmddf lj/fdL jf u|fxs / :jf:Yo ;]jf lbg] JolQm,
-lrlsT;s, g;{, :jf:Yo ;xfosx¿_ :jf:Yo ;+:yfsf ;xof]uL sd{rf/Lx¿ / :jf:Yo ;+:yfdf cfpg]
cGo JolQmx?nfO{ ;d]t ;+efljt ;+qmd0faf6 arfj6 ug'{ xf] . ;+qmd0f /f]syfdsf pkfo ckgfOPg
eg] dfly pNn]lvt JolQmx?nfO{ ljleGg k|sf/sf /f]ux?sf] ;+qmd0f x'g] ;Defjgf x'G5 . To;}n] :jf:Yo
;+:yfsf] u'0f:t/ j[l4 ug{sf] nflfu cGo kIfx?sf] ;fy;fy} ;+qmd0f /f]syfdsf pkfox?df klg plQs}
Wofg k'¥ofpg' dxTjk"0f{ 5 . oL pkfox? ;lhnf], k|efjsf/L / lskmfotL 5g\ .

c:ktfn / cGo :jf:Yo ;+:yfdf s:tf s:tf vt/fx? x'g ;S5g\

c:ktfn jf :jf:Yo ;+:yfx?df sfo{/t ;a} :jf:YosdL{x? tyf cGo sd{rf/Lx? ;a} ;+qmd0f x'g]
vt/fdf x'G5g\ . h:t} cd]/Lsfdf c6'6 ?kdf 1fg lzk lbP/ ;Sbf] ?kdf w]/}eGbf w]/} arfjsf pkfox?
k|of]u u/L d]x]gt ubf{ klg jif{df *)),))) eGbf a9L klxn] k|of]u eO;s]sf] l;of]n] 3f]Rg] (needle-
stick injuries) 36gf ePsf] kfOG5 -Rogers 1997_ . o:tf] vt/f /f]Sg ePsf k|of;x?, h:t}M

 Auto-Disable Syringes / Needles x?, Ps k6s k|of]u ul/g] Standard Disposable

/ Needles eGbf a9L ;'/lIft / laZj;gLo 5g\ .
Syringes
 cgfjZos / c;'/lIft ?kdf ;'O{ nufpg] sfo{ gug]{,

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 1–1
  l;of] k|of]u ul/;s]kl5 km]/L ljsf]{ gnufpg] / t'?Gt g5]l8g] efF8f]df v;fNg],
 ;s];Dd ltvf] jf l;of] hDdf efF8f] xftn] k'Ug] glhs 7fpFdf /fVg],
;'Osf] 3f]rfO{ tyf rf]6k6s kl5 z/L/af6 lg:sg] /ut tyf t/n kbfy{af6 x'g;Sg] ;+qmd0faf6
arfpg l;of] k|of]u ubf{ ;'/lIft tl/sfn] k|of]u ug{ ;'emfj lbg cfjZos 5 .

gf]6M– :jf:YosdL{x?df HIV ;+qmldt /ut ePsf] ;'O{sf] 3f]rfO{af6 !))) df # ;+qmd0f
tyf HIV ;+qmldt ePsf] /utsf l56f cf“vf, gfs / d'vdf k/]df !,))) df ! ;+qmd0f x'g]
;Defjgf x'G5 -laZj :jf:Yo ;+u7g Unf]an xft] k'l:tsf–@))!!_

kl/efiff
o; If]qdf P];]lK;;\, P]lG6;]lK;;\, b"if0f lgjf/0f, ;kmfO, pRr :t/Lo ;+qmd0f lgjf/0f /
lgd{nLs/0f h:tf ljleGg zAbx?df w]/} låljwf x'g] x'G5 . of] kl/efiffn] o;sf] pkof]udf ;3fp
k'¥ofp5 . h:t}
 hLjf0f'x? (microorganisms): hLjf0f'x? ;+qmd0f u/fpg] tTjx? x'g\ . hLjf0f'x?df JofS6]l/of
(bacteria), efO/; (virus), km+uL (fungi) / k/hLjL (parasite) kg{ cfpF5g\ .
 ls6f0f' /lxt / ls6f0f' gf; ug]{ ljlw -asepsis or aseptic technique_
ljleGg k|sf/sf] tl/sfx? ckgfP/ ;]jf lbg] qmddf ;"Id hLjf0f'x? z/L/leq k|j]z ug{ /f]s
nufp5 / ;+qmd0f ug{ ;Sg] ;Defjgfx? 36fpg ;lsG5 . h:t} xftsf] ;/;kmfO, k+hf nufpg],
zNos[of ug]{ efudf tof/L ug]{ cflb .
 ls6f0f' /lxt ug]{ k|lqmof -antisepsis_
of] Pp6f k|lqmof xf] h;n] z/L/df ls6f0f' dfg]{ antiseptic 3f]nx?sf] k|of]u u/L z/L/sf] 5fnf,
Do's; d]Da|]g cyf{t lemNnL / cGo tGt'x?df ePsf] ;"Id hLjf0f'x?nfO{ sd ug]{ u5{ .
 b'if0f lgjf/0f -decontamination_
of] Ps ljlw xf] h;n] k|of]u ul/;s]sf cf}hf/, pks/0fx?df /x]sf Pr=cfO{=eL=, x]kf6fOl6; la, ;L
/ cGo hLjf0f'x?nfO{ df/L -;g]{ k|lqmofnfO{ sd u5{_ ;fdfg ;kmf ug]{ JolQmnfO{ ;'/lIft agfpF5 .
 ;kmfO{ -cleaning_
of] b'if0flgjf/0f kl5 ul/g] Ps ljlw xf] h;n] ;/;fdfg Pj+ cf}hf/x?df k|ToIf ?kdf b]lvg] /ut,
leqL >fj, kmf]x/ jf w"nf] x6fpg'sf ;fy–;fy} k|;:t dfqfdf ;"Id hLjf0f'x?nfO{ x6fO xftn] 5'g]
jf 5fnfdf x'g] ;+qmd0fsf] vt/fnfO{ sd u5{ . o; k|lqmofdf cf}hf/x? tyf cGo pks/0fx?
;fa'g tyf ;km{ kfgLdf /fd|f];Fu wf]O kvfnL ;'sfpg' k5{ .
 pRr:t/Lo ;+qmd0f lgjf/0f -high level disinfection_
OG8f]:kf]/ -endospores_ afx]ssf ;a} k|sf/sf ;"Id hLjf0f'x?nfO{ -bacteria, fungi, parasites)
pdfn]/, akmfP/ jf /;folgs 3f]n k|of]u u/]/ k"/} dfg]{ ug]{ Ps ljlw xf] .

1–2 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
 lgd{nLs/0f -sterilization_
s'g} cf}hf/ jf pks/0fx? pRr tfkqmddf akmfP/, ;'Vvf tfkaf6, /f;folgs 3f]naf6 jf
ljls/0faf6 OG8f]:kf]/ ;lxt ;a} k|sf/sf ;"Id hLjf0f'x? -bacteria, fungi, parasites) dfg]{ ljlw
xf] .

/f]usf] ;+qmd0f rqm (Disease Transmission Cycle)

;a} jftfj/0fdf ;"Id hLjf0f'x? kfOG5 . dflg;x?n] ;fwf/0ftof 5fnfdf jf Zjf; km]g]{ gnLsf]
dflyNnf] efu, cfGb|f / of}gåf/af6 tL ;"Id hLjf0f'x? ;fg]{ u5{ . ;fy} ;"Id hLjf0f'x? hgfj/, la?jf,
df6f], xfjf / kfgLdf klg x'G5 . s'g} ;"Id hLjf0f'x? c?eGbf a9L /f]u ;fg]{ x'G5g\ . ;'xfpFbf] jftfj/0f
pknAw eof] eg] ;a} ;"Id hLjf0f'x? ;+qmd0fsf] sf/0f aGg ;S5 . h:t}M /f]u k|lt/f]wfTds zlQm x|f;
ePsf] la/fdL -Immune Suppressed Patient_ nfO{ Pr=cfO{=eL= ;g]{ k|lqmof h:t} xf] .
;a} dflg;x?df hLjf0f' tyf efO/;af6 ;+qmd0f x'g] ;Defjgf x'G5, t/ slt hLjf0f'x? z/L/df
k;]kl5 ;+qmd0f x'g;S5 eGg] s'/f jfxs -agent_ df / ;+qmd0f ePsf] 7fpFdf e/k5{ . ha hLjf0f'x?
5fnfdf dfq ;Dks{df cfpF5 eg] ;+qmd0f x'g] ;Defjgf sd x'G5 . hLjf0f' ePsf] ;fdfgx? xfdL
;a}n] lbg k|ltlbg 5f]O/fv]sf] x'G5 . t/ ha hLjf0f'x? lemNnL -mucous membrane_ / sf6]sf] jf
km'6]sf] 5fnfsf] ;Dks{df cfpF5 ta ;+qmd0fsf] ;Defjgf a9L x'G5 . slxn]sfxL s]xL hLjf0f'x? dfq}
k;]/ klg /f]u nfUg;S5 .
hLjf0f'x?, / c? ;+qmd0f u/fpg] j:t'x? ;lhn};Fu afRg / km}lng klg ljz]if jftfj/0fsf] cfjZostf
k5{ . /f]usf] ;+qmd0fdf d'Vo e"ldsf v]Ng] hLjf0f'x? Ps JolQmaf6 csf]{ JolQmdf ;g]{ k|lqmof lrq g+
!=! df lbOPsf] 5 .
lrq !=! df em} /f]u ;g{ ljz]if jftfj/0fx? x'g' cfjZos 5g\ M
 ;+qmd0f u/fpg] sf/s tTj x'g'k5{ . h:t}M hLjf0f'x? .
 sf/s tTj a:g] 7fpF x'g'k5{ . h:t}M dfgj z/L/ hxfF a;]/ /f]u a9fpF5 / c?nfO{ klg ;fg{;S5 .
s'g} b"lift vfgf / kfgLdf, lb;f lk;fadf, cyjf ;+qmldt hgfj/ jf ls/f cflbn] 6f]s]/ .
 sf/s tTjnfO{ /f]u ;g{ ;Sg] ;Defljt JolQmeGbf aflx/ a:g] ;'xfpFbf] jftfj/0f x'g'k5{ . ha
;"Id hLjf0f'x? ;Defljt JolQmaf6 aflx/ x'G5 / cGo JolQmnfO{ /f]u g;f/]sf] cjlw;Dd afFRg
;'xfpFbf] jftfj/0f x'g'k5{ . h:t}M Ifo/f]u ;fg]{ hLjf0f' Ps xKtf;Dd vsf/df afFRg;S5 t/ ;"o{sf]
tfkqmdn] s]xL 306fdf g} tL hLjf0f'x? dfg]{ sfd u5{ .
 /f]u nfUg;Sg] JolQm (susceptible host) x'g'k5{ . dflg;x? lbglbg} /f]u nfUg;Sg] j:t';Fu a:g'kg]{
jf sfd ug'{kg]{ x'G5 t/ ;Fw} /f]u nfU5 eGg] 5}g . To;}n] s'g} JolQmnfO{ ;+qmd0f x'g pm To;
/f]usf] ;DefJo JolQm x'g'k5{ . h:t}M bfb'/f, mumps cflb . dflg;x?nfO{ /f]u g;g'{sf] d'Vo sf/0f
tL dflg;x?n] klxn] g} vf]k nufO;s]sf] jf To:tf] /f]u nfu]/ To; /f]u;+u n8\g] zlQm kfO;s]sf]
x'G5 . h;n] ubf{ To; /f]usf] sf/s tTj z/L/leq k:bf klg z/L/df ePsf] /f]u;+u n8\g;Sg]
Ifdtfn] /f]u nfUgaf6 aRg;S5 .

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 1–3
 lrq !=!M /f]u ;g]{ ;+qmd0f rqm
lrq !=!M /f]u ;g]{ ;+qmd0f rqm
;+qmd0f u/fpg] sf/s
tTj
(infectious
e
agents)
hLjf0f'x?
-JofS6]/Lof ;|f]t
efO/; (reservoirs)
/f]u nfUg;Sg] ;Defljt JolQm km+ufO{
(susceptible host) dflg; / hgfj/
Kof/f;fO6_ kfgL / 3f]n
;]jfu|fxL÷la/fdL
:jf:Yo sfo{stf{ cf}hf/ / cGo ;fdfgx?
;xfos sfo{stf{ pks/0f
df6f] / xfjf

leq k:g] dfu{ lg:sg] af6f]

(place of entry) (place of exit)
km'6]sf] jf lrl/Psf] 5fnf, /ut
lemNnL jf >fj, lb;f, lk;fa, y's,
lr/]sf] 7fpF, >fj
3f]r]sf] 3fp
;g]{ dfWod
(modes of
transmission)
l;wf ;g]{
s'g} ljz]if dfWodaf6
xfjfsf] dfWofd
ls/fx?sf] 6f]sfOaf6
a:t' tyf cf}hf/af6 Adapted from APIC 1983;WPRO/WHO 1990
;kmf gul/Psf] xftaf6

 sf/s tTjnfO{ /f]u nfu]sf] Ps JolQmaf6 csf]{ /f]u nfUg;Sg] ;DefJo JolQmdf ;g]{ dfWod
rflxG5 . ;+qmd0f ;g{;Sg] tl/sfx? lgDg k|sf/sf 5g\ .
– xfjfaf6 ;g]{ h:t}M xf8] /f]u -mumps_ / 7]pnf -chicken pox_ .
– /ut jf z/L/af6 lg:s]sf] kmf]x/af6 ;g]{, h:t}M x]Kff6fOl6; aL= / Pr=cfO{=eL= ePsf] JolQmsf]
/ut jf z/L/af6 lg:sg] cGo kmf]x/af6 c? JolQmdf ;5{ . h:t}M l;of]n] 3f]r]/ .
– ;+;u{ jf ;Dks{af6 ;g]{M l;wf ;Dks{ jf b"if0f ePsf] ;/;fdfgnfO{ 5f]P/ jf o;sf] ;Dks{df
cfP/ /f]u ;g{;S5 .
– lb;f lk;faaf6 ;g]{M dflg;sf] jf hgfj/sf] lb;f lk;faaf6 b"if0f ePsf] vfg]s'/fx? vfFbf
;g{;S5 . h:t}M b"if0f ePsf] ;/;fdfg jf vfgfx? 5f]P/ xft gwf]Osg xft d'vdf /fVgfn]
jf vfgf vfgfn] klg /f]u ;5{ .
;+qmd0f–/f]syfd
hgfj/ / sL/fx?sf]
tyf :jf:Yo 6f]nsf Joj:yfkgsf
;+:yfhGo kmf]x/d} fO{af6 ;g]nflu
{M ;+;Gbe{
qmd0f ePsf hgfj/x?n] 6f]s]/, sf]kf/]/, ltgLx?sf]!–#
k'l:tsf
lb;f lk;fa jf ¥ofnaf6 klg /f]u ;g{;S5 .

1–4 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
 ;+qmd0f /f]syfd eGgfn] d'VotofM xfjf, /ut, z/L/af6 lg:s]sf] kmf]x/, lb;f lk;fa / b'lift
vfgf / kfgLaf6 /f]u ;g{af6 arfpg] pkfo xf] .

o:tf] ;+qmd0f w]/}h;f] /f]syfd ug{ ;lsG5 / w]/} vr{ gul/sg tn lbOPsf pkfox? k|of]u u/L
;+qmd0f /f]syfd ug{ ;lsG5 .
 ;+qmd0f /f]syfd ljz]if u/L xft ;kmf /fVg], k~hf nufpgsf] nflu nuftf/ ;'emfj lbg] /
cEof;sf] lglDt nflu /xg] .
 b"if0f lgjf/0f ug{, k|of]u ul/;s]sf] cf}hf/x? tyf pks/0f ;kmf ug{ / cGo ;kmfO{sf] nflu /fd|f]
Joj:yfkg ug{ / k|of]u ul/;s]sf] cf}hf/x?nfO{ pRr:t/Lo ;+qmd0f lgjf/0f / lgd{nLs/0f ug{sf]
nflu ljz]if Wofg lbO/xg] .

:jf:Yo ;+:yfhGo ;+qmd0f / o;sf] /f]syfd

(Nosocomial Infection and Its Prevention)
:jf:Yo ;+:yfhGo ;+qmd0f eg]sf] c:ktfn jf :jf:Yo ;+:yfaf6 pTkGg x'g] ;+qmd0f xf] . of] la/fdL
:jf:Yo ;+:yfdf egf{ x'Fbf;Dd pgdf ;+qmd0f eO;s]sf] x'Fb}g t/ la/fdLnfO{ pkrf/ ubf{ub}{ jf
la/fdL :jf:Yo ;+:yfdf egf{ eP/ a:bfa:b} ;g]{ x'G5 . slxn]sfxL+ o:tf] la/fdL :jf:Yo ;+:yfaf6
3/ k7fO;s]kl5 dfq ;+qmd0f ePsf] b]lvG5 jf kQf nfUb5 . h:t}M c?sf] /ut zl//df r9fpFbf
Pr=cfO=eL= ;g]{, / cGo /f]ux? x'g;S5 .
o:tf] :jf:Yo ;+:yfhGo ;+qmd0fsf] -nosocomial_ ;d:of ;+;f/el/ g} a9\bf] 5 -alvarado 2000_ .
o; ;DaGwL !((% b]lv @))* df ePsf ljleGf cg';Gwfgdf k|sflzt tYocg';f/ ljsl;t b]zdf
:jf:Yo ;+:yfhGo ;+qmd0f %=! k|ltzt b]lv !!=^ k|ltzt;Dd kfOPsf] 5 eg] o"/f]kdf dfq} &=!
k|ltzt b]lvPsf]5 . ljsf;f]Gd'v b]zdf ePsf yf]/} dfq} cg';Gwfgdf w]/}df !) b]lv !( k|ltzt;Dd
b]vfPsf] 5 .
To:t} zNols|of u/]sf] efudf ;+qmd0fsf] k|ltzt x]g]{ xf] eg] ljsf;f]Gd'v b]zdf !)) zNos[of ePsf]
dWo] !=@ b]lv @#=^ df :jf:Yo ;+:yfhGo ;+qmd0f b]lvPsf]5 eg] ljsl;t b]zdf @ b]lv # k|ltztdf
o:tf ;+qmd0f kfOPsf] 5 .
c:ktfndf hGd ePsf afnsdWo] d[To' ePsf] ;a} sf/0f x]bf{ :jf:Yo ;+:yfhGo ;+qmd0fn] ubf{ dfq
$ k|ltztb]lv %^ k|ltzt afnssf] d[To' ePsf] kfOPsf] 5 . o:sf] &% k|ltzt blIf0f k"lj{ Plzof
tyf ;a ;fxf/f clk|msf df dfq} e]l6Psf] 5 . (The Burden of Health Care-Associated Infection
Worldwide - WHO)

olb ;+qmd0f /f]syfdsf] pkfox? /fd|/L kfngf ul/Psf] v08df o:tf ;+qmd0fx?sf] /f]syfd x'g]
ePsf]n] :jf:Yo ;+:yfhGo ;+qmd0faf6 x'g] ;d:ofnfO{ sd ug{ ;lsG5 .
x]kf6fOl6; aL ;+qmd0f x'g] k|lqmof / Pr=cfO{=eL=ePsf] JolQmaf6 la/fdLnfO{ / la/fdLaf6
:jf:YosdL{x?nfO{ ;g]{ k|lqmof j0f{g ul/Psf] 5 . ha :jf:YosdL{x?n] ;+qmd0f ePsf] JolQmsf] /ut

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 1–5
jf z/L/af6 lg:sg] kmf]x/ 5'g'kg]{ x'G5, o:tf] cj:yfdf Ps JolQmaf6 csf]{ JolQmdf efO/; ;g]{
x'G5 . o;sf] ;+qmd0f rqm lrq g+ !=@ df lbOPsf] 5 .

lrq !=@M x]kf6fOl6;\ aL sf] ;+qmd0f rqm

;|f]t JolQm
x]kf6fOl6; aL
;+qmldt
JolQm
;fg]{ j:t'
;+efljt JolQm ;+qmldt JolQmsf] z/L/af6
lg:s]sf] j:t'
la/fdL÷;]jfu|fxL /ut,
:jf:YosdL{÷ ;]jf lbg] JolQm Do"s; d]Da|]g
of]gL >fj jf
jLo{

;g]{ dfWood

;'O{n] 3f]r]/
sf6]sf] tyf km'6]sf]]
5fnf
Do"s; d]Da|]gdf sf6]]/ jf
nfu]/

Pr=cfO{=eL= sf] eGbf x]kf6fOl6; aL sf] ;g]{ Ifdtf w]/} x'G5 . h:t}M ;+qmd0f ePsf] /utsf]
!)–* ld=ln= -=)))))))! ld=ln_ l56f dfq klg cfFvfdf k/]df ;Defljt JolQmdf Pr=la=eL= ;g{
;S5 -bond et al 1982_
;a}h;f] :jf:YosdL{x?nfO{ cs:dft\ x'g] x]kf6fOl6; aL jf Pr=cfO{=eL= sf] ;+qmd0faf6 arfpg
;lsG5 . h:t}M ;+qmd0f ePsf] /ut jf k|;'ltsf] qmddf lg:sg] t/n kbfy{ -amniotic fluid) :jf:YosdL{
jf 8fS6/sf] cfFvfdf l56f kg'{af6 arfpg ;lsG5 To:t} sf6]sf], km'6]sf] jf 3fp ePsf] 5fnfdf /
Do"s; d]Da|]gdf l56f kl/O x'g] ;+qmd0f /f]Sg ;lsG5 . o; k|sf/sf] ;Defljt ;+qmd0f /f]syfdsf] nflu
ljleGg cfjZos pkfox? ckgfpg' k5{ . h:t} r:df, Knfl:6s P]k|f]g, h'Qf / k~hfsf] k|of]u . o;/L
/f]syfd ug'{ w]/} cfjZos 5 lsgeg] Do"s; d]Da|]gsf] w]/} efudf ;+qmd0fo'Qm /ut jf cGo j:t' w]/}
;do;Dd /lx/x\of]] eg] ;+qmd0f x'g] ;Defjgf a9L x'G5 .
s'g JolQm x]Kff6fOl6; aL=jf Pr=cfO{=eL=af6 ;+qmldt 5 eGg] s'/f yfxf gx'g] / cf}hf/, ;/;fdfg
tyf ;'O{x? b"lift ePsf] 5 olsg gx'g] x'Fbf ;a} JolQmnfO{ ;+qmldt JolQmsf] ?kdf dfGg'k5{ / :t/Lo
;ts{tfsf pkfox? cEof; ug'{k5{ .

1–6 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
!= :t/Lo ;ts{tfsf pkfox? (Standard Precautions)

:jf:Yo ;+:yfdf ;]jf÷pkrf/sf] nflu cfpg] ;a} JolQm tyf la/fdLx?nfO{ ;+qmd0f x'gaf6 arfpg
of] :t/Lo ;ts{tfsf pkfox? agfPsf 5g\ . :t/Lo ;t{stfsf pkfox? /ut tyf z/L/af6 lg:sg]
;a} k|sf/sf kmf]x/x?, t/n kbfy{, lb;flk;fa, sf6]sf] jf km'6]sf] 5fnfdf pkrf/sf] bf}/fg jf 5'Fbf
;]jf k|bfgstf{n] ckgfpg' k5{ . o:tf] :t/Lo ;ts{tfsf pkfox? ckgfpbf s]xL a9L vr{ x'g;S5 .
h:t} k~hfsf] nflu, cGo ;/;fdfg tyf pks/0fsf] nflu sd{rf/Lx?nfO{ tfnLd lbgsf] nflu /
;"kl/j]If0fsf] nflu, t/ s'g ;do s'g la/fdL jf JolQmdf s'g k|sf/sf] hLjf0f' ePsf] x'G5 yfxf
x'Fb}g . To;}n] ;a} la/fdLsf] ;]jf sfo{ ubf{ x'g;Sg] ;+qmd0faf6 arfj6sf] nflu o:tf] :t/Lo ;ts{tfsf
pkfox? ckgfpg' clt cfjZos 5 .

@= ;+qmd0fdf cfwfl/t ;ts{tfx? (Transmission Based Precautions)

;+qmd0fdf cfwfl/t ;ts{tfx? ;+qmd0f ePsf] yfxf kfPsf] la/fdL / ;+qmd0f x'g;Sg] ;+efljt JolQmsf]
pkrf/df ckgfpg' k5{ . h:t}M
 xfjfaf6 ;g]{ /f]u — Ifo/f]u, bfb'/f
 l56f -y"s_ af6 ;g]{ /f]u — x]kf6fOl6; P, O{ / xlk{h l;DKn]S; jf cfFvf / 5fnfsf] ;Dks{af6
x'g] /f]u .
olb s'g} la/fdLnfO{ ;+qmd0f ePsf] z+sf 5 t/ /f]u lgbfg eO;s]sf] 5}g eg] /f]u lgbfg geP;Dd
la/fdLdf b]vf k/]sf] /f]usf] nIf0f / lrGxx?sf] cfwf/df ;+qmd0f cg';f/sf] ;ts{tf ckgfpg' k5{ .
;+qmd0fdf cfwfl/t ;ts{tfx?sf] nflu k|of]u ug]{ tl/sf c:ktfndf egf{ ePsf] la/fdL / :jf:YosdL{sf]
aLrdf x'g] ;+qmd0fsf] vt/fnfO{ 36fpg'sf] lglDt xf] . slxn]sfxL+ la/fdLnfO{ cnu /fVg' -isolation_
kg]{ klg cfjZos x'G5 .

#= la/fdLnfO{ cnu /fvL ckgfpg' kg]{ ;ts{tfx? (Isolation Precautions)

la/fdLnfO{ cnu /fv]/ ;+qmd0fLo /f]uaf6 arfpg] Pp6f pko'Qm tl/sf xf] . o;sf] kl/efiff cg';f/
;+qmldt JolQm jf hgfj/nfO{ c?nfO{ ;+qmd0f x'g;Sg] cjlw;Dd 5'§} 7fpF, jftfj/0fdf /fv]/ k|ToIf
jf ck|ToIf ?kdf ;DefJo JolQmnfO{ ;+qmd0f x'gaf6 arfpg' xf] .
 olb jftfj/0f ;+qmd0f x'g] vt/f 5 eg] k|ToIf jf ck|ToIf ?kdf ;+qmd0f x'gaf6 arfpg cnUu}
sf]7fdf /fVg'kg]{ x'G5 .
 olb Pp6} k|sf/sf] hLjf0f'af6 ;+qmd0f ePsf] 5 eg] Pp6} sf]7fdf b'O{ jf a9L JolQm /fVg
;lsG5 .
 sf]7fdf k|;:t xfjf / pHofnf] ePsf] x'g'k5{ .
 la/fdLsf] pkrf/ jf :ofxf/ ubf{ JolQmut ?kdf :t/Lo arfj6sf] nflu lgb]{zg u/]sf ;fdfgx?
k|of]u ug'{k5{ .

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 1–7
1–8 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
 :t/Lo ;ts{tf tyf ;'/Iffsf pkfox?
STANDARD PRECAUTIONS AND
PROTECTIVE BARRIERS @
ljifoj:t'M
:t/Lo ;ts{tfx?
 :t/Lo ;ts{tfx?
 l;kmfl/; ul/Psf ;+qmd0f /f]syfdsf] pkfo tyf cEof;x?
 ;'/Iff ;fdu||Lx?

;'/Iffsf pkfox?
 JolQmut ;'/Iff ;fdu|L -Personal Protective Equipment_
 ljleGg k|sf/sf 5f]Kg] sk8fsf] k|of]u -Drapes)

e"ldsf
!(*% df ha Pr=cfO{=eL= P8\; b]vf kg{ yfNof] :jf:YosdL{x?nfO{ /utaf6 x'g] ;+qmd0fx?af6
arfpgsf] nflu, t'?Gt} ;fjwfgLsf pkfox?sf] lgb]{lzsfsf] ljsf; ul/of] / To;}nfO{ ;a}sf nflu
pkof]uL ;fjwfgLsf pkfox? -universal precaution_ eg]/ lrlgg yflnof] . To;kl5 c:ktfn,
:jf:Yo ;+:yfx?df ;fjwfgLsf pkfox?sf] k|of]un] a9L k|fyldstf kfof] / o;}nfO{ gofF /0fgLltsf]
?kdf ckgfpg yflnof] . t/ Ps la/fdLaf6 csf]{ la/fdLnfO{ ;+qmd0f x'g] / :jf:YosdL{af6
la/fdLnfO{ x'g] ;+qmd0fnfO{ eg] s]xL xb;Dd larf/ ul/Pg lsgeg] /utaf6 x'g] ;+qmd0fsf]
nIf0fx? jf ;+qmd0f eO;s]kl5sf nIf0fx? JolQm ljz]ifnfO{ x]b}{df lrlgb}g . To;sf/0f ;a}sf
nflu pkof]uL ;fjwfgLsf pkfox?nfO{ -universal precaution), la/fdL / u|fxs ;+qmldt eP
gePsf] Vofn g/fvL :jf:Yo ;+:yfdf cfpg] ;a} JolQmnfO{ ;d]6\g] u/L km/s tl/sfn]
NofOof] . (CDC 1985)
:jf:YosdL{x?n] lbgx'F vt/gfs jftfj/0fdf sfd ug'{k5{ . cfhef]ln :jf:YosdL{x?nfO{ sfdaf6 x'g]
vt/f w]/}h;f] /ut / z/L/af6 lg:s]sf t/n kbfy{af6 x'g] ;Defjgf x'G5 . of] lbgx'F la/fdLsf] :ofxf/
ubf{ x'g;Sg] x'Fbf / w]/} vt/gfs ;+qmd0f eP/ Hofg ;d]t hfg;S5 . o:tf] sfd ubf{ub}{ x'g] ;+qmd0f
;fwf/0f pkrf/df eGbf zNolqmof ubf{ jf k|;"lt u/fpFbf ;g]{ ;Defjgf w]/} x'G5 . To;}n] o:tf] 7fpFdf
sfd ug]{ sd{rf/Lx?n] c?n] eGbf a9L ;+qmd0f /f]syfdsf nflu :t/Lo ;ts{tfsf pkfox? ckgfpg'
k5{ . :jf:YosdL{x?nfO{ ;+qmd0faf6 aRg] pkfox?sf] af/]df 1fg x'g' cfjZos 5 / c6'6 ?kdf
;+qmd0f /f]syfdsf] nflu :t/Lo ;ts{tf pkfox? k|of]u ug'{k5{ .

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 2–1
Pr=cfO=eL= / x]kf6fOl6;sf] hl6ntf / oL ;+qmd0fx? s;/L sfd ug]{ 7fpFdf ;5{ eGg] s'/f yfxf
ePklg w]/}h;f] :jf:YosdL{x?n] cfkm" Tof] vt/fdf ePsf] dx;'; ub}{gg\ / dx;'; ug]{n] ;d]t klg
:t/Lo ;ts{tfsf pkfox? k|of]u ub}{gg\ . h:t}M k~hf, xftsf] ;/;kmfO / slxn]sfxL+ eg] k|of]u ug{
rfx]/ klg kfpFb}gg\ . of] x'g'sf] d'Vo sf/0f Pr=cfO=eL= PseGbf a9L w]/} hgf;Fu of}g;Dks{ /fVg],
g;faf6 nfu"kbfy{ lng]nfO{ / ;dn}ËLs of}g ;Dks{ /fVg]x?nfO{ dfq ;5{ eGg] e|dn] ubf{ xf]] .

o:tf] x'g'sf dxTjk"0f{ sdhf]/Lx? lgDg x'g\M

 c:ktfn tyf :jf:Yo ;+:yfdf sfd ug]{ sd{rf/Lx?nfO{ ;+qmd0faf6 arfj6sf] sdL .
 la/fdLnfO{ u'0f:t/ ;]jf k'¥ofpg] / cfkm"nfO{ s;/L arfpg] eGg]af/] åGb .
 sd{rf/Lx?sf] sdL, pknAw sd{rf/Lx?df klg cfjZostf cg';f/sf] 1fg, l;k gePsf] /
sfdsf] a9L ef/ g} c:ktfndf sfd ug]{ sd{rf/Lx?nfO{ sfdaf6 x'g] vt/fsf] sf/0f xf] eg]sf]
5 . o:tf] ;d:of ;fwg / ;|f]tsf]] sdL ePsf] b]zx?df w]/}h;f] kfOPsf] 5 .

:t/Lo ;ts{tfsf d'Vo tTjx? / To;sf] k|of]u

:t/Lo ;ts{tfx? / To;sf] k|of]u tflnsf @–! Dff pNn]v ul/Psf] 5 . c:ktfndf hFrfpg cfpg]
ue{jtL dlxnf jf egf{ eO{ a;]sf la/fdL jf :jf:YosdL{ hf];'s} klg ;'Id hLjf0f'sf] ;Dks{df cfpg]
ePsf]n], ;+qmd0f x'g] ;Defjgf x'G5 . o;sf] ;'/Iffsf] nflu ;"Id hLjf0f' / JolQmsf] aLrdf ef}lts,
/f;folgs jf oflGqs 5]sjf/ nufO{ ;+qmd0faf6 arfpg' ;fjwfgL ckgfpg ;lsG5 . oL 5]sjf/x?n]
/f]usf] ;+qmd0f rqmnfO{ /f]Sg;S5 .

k|To]s JolQm -la/fdL jf :jf:YosdL{_ ;+qmd0f ePsf] jf ;+qmd0f u/fpg;Sg] Ifdtf /fV5 egL ;Demg'
kg]{ .
 xftsf] ;/;kmfO: b"lift x'gaf6 aRg] Pp6f dxTjk"0f{ pkfo ckgfpg] .

 k~hf nufpg]: /ut, z/L/af6 lg:s]sf] kmf]x/, cyjf b"lift cf}hf/x? / cGo kmf]x/x? 5'g'eGbf

cufl8, / s'g} hf]lvd sfo{ ug'{eGbf cufl8 k~hf nufpg] .

 ef}lts pkfox?sf] k|of]u ug]{M olb /ut / z/L/af6 lg:sg] kmf]x/x?sf] l56f cfpg] ;Defjgf 5

eg], o;sf] arfj6sf] nflu r:df, df:s, Pk|f]g h:tf ef}lts pkfox?sf] k|of]u ug]{ .
 P]lG6;]lK6s k|of]u ug]{M zNolqmof ug'{ cufl8 xftsf] ;/;kmfO ubf{, zNolqmof ug'{ cufl8 Do"s;

d]Da|]g / 5fnf ;kmf ubf{ k|of]u ug]{ .

 ;'/lIft ;fy sfdsf] cEof; ug]{M k|of]u ePsf] l;of]df lasf]{ gnufpg], l;of] ga+Uofpg] jf wfl/nf]

cf}hf/ lb+bf ls8\gL 6«] df /fv]/ lbg], xftdf ;f]em} glbg] .

 b"lift kmf]x/x? ;'/lIft 7fpFdf kmfNg]M b"lift kmf]x/ 5'g cufl8 k~hf nufpg], kmf]x/ 5f]O;s]kl5

;fa'g kfgLn] xftsf] ;/;kmfO ug{] .

 cf}hf/x? / cGo ;fwgx? k|of]u ul/;s]kl5M b"if0f lgjf/0f u/L /fd|/L k"/} ;kmf ug'{k5{ / ;'Vvf

kfg'{ k5{ . To;kl5 pRr:tl/o b"if0f lgjf/0f jf lgd{nLs/0f ug]{ .

2–2 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
tflnsf @–! :t/Lo ;ts{tfx?sf] d'Vo tTjx?

 ;fa'g kfgL jf P]lG6;]lK6s 3f]nn] xftsf] ;/;kmfO{

– /ut, z/L/af6 lg:s]sf] kmf]x/, lb;f lk;fa, b"lift cf}hf/ 5f]Pkl5 .
– nufO/fv]sf] k+hf vf]Ng] lalQs} .
– Ps la/fdLnfO{ hfFlr;s]/ csf]{ la/fdLnfO{ hfFRg' cufl8 .
 k+hf nufpg]
– /ut, z/L/af6 lg:s]sf] kmf]x/, lb;f lk;fa / b"lift ;/;fdfg 5'g k/]sf] v08df .
– Do"s; d]Da|]g / sf6]sf] jf km'6]sf] 5fnfdf 5'g k/]sf] v08df .
 df:s, r:df / cg'xf/ 5f]Kg],-facial shield_ df:s nufpg]
– cfFvf, gfs / d'vdf l56f kg{af6 arfpg' k/]sf] cj:yfdf .
 ufpg nufpg]
– /ut / z/L/af6 lg:s]sf] kmf]x/af6 5fnfnfO{ arfpg .
– z/L/af6 lg:s]sf] kmf]x/af6 nufPsf] sk8f kmf]x/ x'gaf6 jf leHgaf6 arfpg .
 lng]g
– b"lift sk8fx?/ lng]gx? Do"s; d]Da|]gdf / 5fnfdf 5'gaf6 arfpg .
– b"lift ePsf] sk8f la/fdLnfO{ ;]jf lbg] 7fpFdf gw'g] .
 la/fdLsf] ;]jfdf k|of]u ug]{ cf}hf/x?
– b"lift cf}hf/x? ;dfpFbf Do"s; d]Da|]g / 5fnfdf g5'jfpg] . ;fy} cGo sk8f / jftfj/0fnfO{
b'lift x'gaf6 arfpg st} g5'jfpg] .
– k'gM k|of]udf Nofpg x'g] ;fdfgx? k|of]u ug'{ cufl8 b"if0f lgjf/0f u/L ;kmf ug]{ / lgd{lns/0f jf
pRr:t/Lo ;+qmd0f lgjf/0f ug]{ .
 jftfj/0f ;kmf ul//fVg]
– la/fdLnfO{ ;]jf lbg] 7fpF, pks/0fx? / kmlg{r/x? lgoldt ?kdf b"if0f lgjf/0f u/L ;kmf ug]{ .
 wfl/nf] cf}hf/x? (sharps)
– k|of]u u/]sf] ;'O{df k'gM lasf]{ gnufpg] .
– Psk6s k|of]u u/L kmfNg] l;/L~haf6 l;of] glgsfNg] .
– k|of]u ul/;s]sf l;of]nfO{ aËofpg], efFRg] / l;l/~haf6 lgsfNg] gug]{ .
– k|of]u ul/;s]sf] l;of]nfO{ g5]l8g] -pucture resistant container_ efF8f]df t'?Gt} kmfNg] .
 la/fdLsf] l/;lz6]zg (resuscitation) ug'{kbf{
la/fdLsf] d'v hf]8]/ l/;lz6]zg gug]{ .
– l/;lz6]zg ug'{ k/]sf] v08df To;sf] Aofu jf cGo ;fwg k|of]u ug]{ .
 la/fdLnfO{ cnUu /fVg]
– h'g la/fdLaf6 jftfj/0f g} k|b"if0f x'g] x'G5 / /f]u ;g]{ ;+efjgf x'G5 eg] To:tf] la/fdLnfO{ cnUu
/fVg] .

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 2–3
 ;'/Iffsf pkfox? -Protective Barriers_
-
;'/Iffsf] nflu cfjZos _ Lx?, h:t}M k~hf, df:s, r:df, d'v 5f]Kg] ;fdfg, 6f]kL,
kg]{ JolQmut ;fdu|
ufpg, Pk|f]g / cGo ;fdfgx? x'g\ . w]/}h;f] b]zx?df 6f]kL, df:s, ufpg / 5f]Kg] ;fdu|Lx? sk8f jf
sfuhn] agfPsf] x'G5 . t/ ;a}eGbf k|efjsf/L ?kdf arfj6 ug]{ ;fdu|Lx? ljz]if k|sf/n] agfPsf]
sk8f -treated fabric_ jf l;Gy]l6saf6 agfOPsf] x'G5 lsgeg] o:tf] ;fdfgn] ag]sf] cj/f]wfTds
;fdfgdf kfgL jf cGo z/L/af6 lg:s]sf] kmf]x/ / /ut l5g{ ;Sb}g . o:tf] t/n kbf{y gl5g]{ ;fdfgx?
w]/} dx+uf] x'g] ePsf]n] ;fwf/0ftof pknAw xF'b}g . ;fwf/0ftof g/d sk8fx?af6 agfPsf ;fdfgx?
- _
w]/} kfOG5g\ t/ o:tf] sk8fn] agfPsf] ;fdfgaf6 k|efjsf/L 9+uaf6 cj/f]wsf] jf arfj6sf] sfd ug{
;Sb}g lsgeg] o:tf] sk8sf] ;fdfgaf6 ;lhn};Fu t/n kbfy{ jf /utx? leh]/ leq;Dd l5g{ ;lsG5 .
sk8fx? k|of]u ug]{ ;dodf ;]tf] jf xNsf /+usf] sk8fsf] k|of]u u/]df l56} bfu b]lvg] x'gfn] rfF8} w'g]
tyf ;kmf ug]{ ul/G5 h;n] ubf{ s]xL xb;Dd arfj6 u5{ .
/f]u ;g]{ vt/f 36fpg JolQmut arfj6sf ;fdfu|Lx? k|of]u ug{ clt cfjZos x'G5, h:t}M zNolqmof;Fu
;DalGwt :jf:YosdL{x?n] dfq geO{ zNolqmof ug]{ sf]7fdf a:g] ;a} JolQmx?n] 6f]kL, ufpg, cflb
nufpFbf w]/} ;fdfg rflxg] / vlr{nf] x'g] ePtfklg ;+qmd0f /f]syfdsf] nflu ;a} sd{rf/Lx?n] nufpg'
cfjZos x'G5 . ;fy} ;+qmd0fsf] vt/faf6 arfpgsf] nflu JolQmut arfj6sf ;fdfgx? ;xL tl/sfn]
k|of]u ug'{k5{ . h:t}M ;lh{sn 8«]K;\ / ufpg nufpFbf 3fpdf ;+qmd0f x'gaf6 arfpg ;lsG5, t/
Tof] 8«]K;\ / ufpg /fd|f];Fu ;'s]sf] 5}g / leh]sf] 5 eg] To;}n] ;"Id hLjf0f'x?nfO{ 5fnfdf jf 3fpdf
;+qmd0f x'g d2t k'¥ofpF5 .
lrq @=!M sk8f -8«]K;\_ af6 ls6f0f' ;/]sf]

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf @–4

To;}n] c:ktfnsf Joj:yfksx?, ;'kl/j]Ifsx? / :jf:YosdL{x?n] JolQmut arfj6sf ;fdfgx?sf]

kmfObf / r'gf}tLsf] af/]df yfxf kfpg'sf] ;fy} ;+qmd0f /f]syfdsf] e"ldsfsf] af/]df klg yfxf kfpg'
cfjZos 5 . h;n] ubf{ tL ;fdfgx?sf] k|efjsf/L / bIf tl/sfn] k|of]u ug{ ;lsG5 .
;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf @–4
2–4 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
 sfuhn] agfPsf] cyjf l8:kf]h]an (disposable) 6f]kL, df:s / 8«]K; slxn] klg k'gM k|of]u ug'{
x“'b}g lsgeg] o;nfO{ /fd|f];+u ;kmf ug{ ;ls+b}g .

JolQmut ;'/Iffsf ;fdu|Lx?

k~hfM k~hf nufpgfn] ;+qmd0f u/fpg] tTjjf6 :jf:YosdL{sf] xftnfO{ arfpFg'sf] ;fy} :jf:YosdL{sf]
xftaf6 la/fdLnfO{ ;"Id hLjf0f'x? ;g{af6 arfpF5 . k~hf ;+qmd0f x'gaf6 ;'/Iff ug]{ Ps k|efjsf/L
;fwg xf] t/ Ps la/fdLaf6 csf]{ la/fdLnfO{ ;+qmd0f x'gaf6 /f]syfd ug{ k|To]s la/fdLsf] nflu
5'§f–5'§} k~hfx?sf] k|of]u ug'{k5{ . h:t}M dfgj z/L/sf] /ut, leqL>fj, lb;f / lk;fa 5'Fbf, b"lift
;/;fdfg 5'Fbf / Do"s; d]Da|]g jf 5fnfsf v''Nnf jf sf6]sf efu 5'Fbf .
;Demg'xf];\ M k~hf nufpg' eg]sf] xftsf] ;/;kmfO jf P]lG6;]lK6s 3f]n nufpgsf] csf]{ ljsNk
eg] kSs} xf]Og .

tflnsf @=@ JolQmut arfj6sf ;fdfgx?n] s;/L ;"Id hLjf0f'x? km}ngaf6 /f]S5
;"Id hLjf0f' sxfF ;"Id hLjf0f'x? s;/L ;"Id hLjf0f'x? km}ngaf6 /f]Sg cj/f]wn]
kfOG5 km}nG5 cj/f]w v8f u5{ s;nfO{ arfpF5
skfn tyf 6fpsf] skfn v;]/, 6f]kL la/fdL
6fpsf]sf] km';|f]
w'nf] v;]/ (shedding)
gfs tyf d'v vf]Sbf, s'/f ubf{ df:s la/fdL

z/L/ tyf 5fnf 5fnfsf] km';|f] w'nf] ufpg, :qma;'6, -:qma ubf{ lj/fdL
v;]/, z/L/sf] /f} nufpg] n'uf_
v;]/

xft -:jf:YosdL{_ 5'Fbf k~hf, xftsf] ;/;kmfO{ jf la/fdL

kfgL ljgf PlG6;]K6Lsn] xft
df]Ng] -antiseptic hand rub_
la/fdLsf] Do"s; 5'Fbf k~hf la/fdL,
d]Da|]g tyf sf6]sf] jf sd{rf/L tyf
km'6]sf] 5fnf ;]jf k|bfos
la/fdLsf] /ut tyf l56f kg'{ k~hf, r:df, df:s, 8«]K;\, sd{rf/L
z/L/sf leqL>fj P]k|f]g
la/fdLsf] /ut tyf 5'Fbf -;Dks{df_ cf}hf/ ;kmf ug]{ la/fdL
z/L/sf leqL>fj k~hf nufpg] sd{rf/L

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 2–5
 k|of]u ePsf] wfl/nf] wfl/nf] b"lift ;'/IffTds h'Qf, b"if0f lgjf/0f, sd{rf/L
;fdfg tyf l;of] ;fdfgx? jf l;of]n] zNolqmof ubf{ cf}hf/x?
3f]r]/ ;'/lIft t/Lsf k|of]u ug]{ -safe
zone practice_
b'lift kmf]xf]/ b"lift kmf]x/ 5'+bf df]6f] k~hf, Knfl:6s Aofu, sd{rf/L tyf
;d'bfo
tof/ gu/]sf] 5'Fbf 5fnfsf] tof/L, 8«]K;\, k~hf la/fdL
la/fdLsf] 5fnf
lSnlgs tyf 5'Fbf k~hf, xft w'g], sd{rf/L /
c:ktfnsf] jftfj/0f 8«]l;Ë ug]{ pgsf] kl/jf/
tyf ;d'bfo
df:s M df:s nufpFbf gfs, lrpF8f], d'v ;a} 9fSg] u/L 7"nf] x'g'k5{ . o;n] :jf:YosdL{x? aLr s'/f
ubf{, vf]Sbf / xfR5\o"F ubf{ x'g;Sg] y's jf jfkmsf] l56f nfUgaf6 / /ut jf dfgj z/L/af6 lg:s]sf
leqL>fjx?sf] l56f :jf:YosdL{x?nfO{ nfUgaf6 arfpF5 . olb of] emf]n jf kfgL gl5g]{ ;fdfgaf6
ag]sf] 5}g eg] To:tf] df:s nufPtf klg Tolt k|efjsf/L eg] x'Fb}g .
df:s ljleGg kbfy{x?n] agfPsf] x'G5, h:t}M sk8f, sfuh / l;Gy]l6s . h;dWo] kfgL l5g]{ /
gl5g]{ vfnsf x'G5g\ . sk8fn] agfPsf df:sx? nufpg ;lhnf] ePklg ;+qmd0f /f]Sg k|efjsf/L
xF'b}g . t/ l;Gy]l6sn] ag]sf] df:s nufpg cK7\of/f] ePtfklg :jf:YosdL{n] vf]s]/ jf xfR5\o"F cfP/
:jf:YosdL{af6 glhssf la/fdLnfO{ l56f k/]/ ;+qmd0f x'g]nfO{ /f]syfd u5{ . df:s hlt g} /fd|f]
eP klg t/n kbf{y l5g]{ vfnsf] ePdf k|efjsf/L xF'b}g .
lrq @=@M df:s

r:dfM cfFvf 5f]Kg] eGgfn] r:df, d'v 5f]Kg] Knfl:6s uuN; / kfj/ ePsf] r:df klg k5{ . o;n] /ut
tyfM z/L/sf leqL>fj sf] ;fy;fy} lb;f lk;fasf l56fx? cfFvfdf hfgaf6 arfpF5 . To;}n] o:tf]
crfgs l56f kg{;Sg] x'Fbf jf sfd ubf{ ;Fw} o; lsl;dsf ;fdu|Lx?sf] k|of]u ug'{ k5{ . olb d'v 5f]Kg]
-km]; lzN8_ gePsf] v08df df:s / r:df ePklg nufpg' cfjZos x'G5 .

2–6 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
 M

lrq @=#M r:df

6f]kLM zNolqmof ubf{ skfn jf 5fnfdf x'g] km';|f] w'nf]x? lj/fdLsf] 3fpdf -zNos[of ug{ lr/f kf/]sf
7fpF_ kg'{af6 arfpg 6f]kL nufOG5 . 6f]kL 7"nf] x'g'k5{ tfls skfn ;a} 9fsf];\ . 6f]kL nufpgfn]
la/fdLnfO{ klg s]xL xb;Dd ;'/Iff u5{ t/ 6f]kL nufpg'sf] d'Vo p2]Zo /ut jf z/L/sf cGo
leqL>fjx?sf] l56f ;]jfk|bfosnfO{ nfUgaf6 arfpg' xf] .
zNolqmofdf nufpg] ufpgM o;n] :jf:YosdL{sf] z/L/sf] aflx/L efu / kfv'/fdf x'g] ;"Id hLjf0f'x?
la/fdLnfO{ ;g{af6 arfpF5 . zNolqmofdf nufpg] ufpg t/n kbfy{ l5g{ g;Sg] vfnsf] agfPsf] 5
eg]/f]szNolqmof
;+qmd0f ubf{;+:,yfhGo
yfd tyf :jf:Yo k|;"lkmf]tx/d}u/fpF bf, /ut,nfluz/L/af6
nf Joj:yfkgsf @–7
;Gbe{ k'l:tsflg:sg] leqL>fj jf lb;f lk;fa h:tf kmf]x/sf
l56f kl/O ;+qmd0f x'gaf6 arfpF5, t/ ;fwf/0ftof kfOg] xn'sf sk8fsf] ufpgx?n] w]/} sd dfq
arfj6 u5{ . o:tf] cj:yfdf ufpg nufpg'eGbf klxn] Knf:6Lssf] Pk|'g nufpg' k5{ . olb l56f k/]sf]
v08df sfd l;lwg] lalQs} g'xfpg] jf w'g] ug'{k5{ . olb ufpgsf] afx'nfdf t'gf nufPsf] 5 eg] t'gf
gfl8df afFWg'k5{ jf Onfl:6s 5 eg] l7s;Fu s;]sf] x'g'k5{ . afx'nf nfdf] eof] eg] otfptf 5'g] 8/
x'G5 / b"lift x'g] ;Defjgf a9L x'G5 . afx'nfsf] skm -5]p_ k~hfn] /fd|f];Fu 9fSg'k5{ .

zNos[of kl5 lj/fdLnfO e]6\g] lj/fdLsf] cfkmGtn] nufpg] ufpg tyf PS; /] ubf{ nufpg]
ufpg ;w} ;kmf k|of]u ug'{ kb{5 . k|To]s JolQmsf] nflu km/s km/s ufpg x'g' /fd|f] x'G5 jf
sd;]sd lbgxF' ;kmf ug'{ k5{ .

P]k|f]g M of] kfgL gl5g]{ /a/ jf Knfl:6sn] agfPsf] x'G5 / o;n] :jf:YosdL{sf] z/L/sf] cufl8sf]
efunfO{ ;+qmd0f x'gaf6 arfpF5 .

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 2–7
 lrq @–$M P]k|f]g
lrq @–$M P]k|f]g

P]k|f]g /ut jf z/L/af6 lg:sg] leqL>fjx? 5'g'kbf{ jf b"lift cf}hf/x? jf cGo ;fdfg ;kmf ug'{eGbf
cufl8 nufpg' k5{ . o;n] sfd ubf{ cs:dft l56f nfUg'af6 arfpF5 . h:t}M k|;"lt u/fpFbf, zNolqmof
ubf{ o;n] lrlsT;s / :jf:YosdL{nfO{ arfpg'sf] ;fy} lrlsT;s / :jf:YosdL{sf] zl//sf] cufl8sf]
efusf] 5fnfaf6 la/fdLnfO{ ;+qmd0f x'gaf6 klg arfpF5 .
h'QfM h'Qfn] sfd ubf{;+qumd0f
b}{ /f]s'sgyfd} wfl/nf
tyf :jf:Yojf;+:yfhGo
ux|f}+ kmf]cf}x/d}hnf/x? v;]/nflu
f Joj:yfkgsf v'§;Gbe{
fdf k'rf] 6 nfUgaf6 arfpF5 . To;}n]
l:tsf @
h'Qf nufpFbf rKkn jf sk8fsf] g/d h'Qf nufpg' x'Fb}g / /a/ jf 5fnfsf] a'6n] /fd|f] arfpF5 . t/
tL h'Qfx? /ut jf z/L/sf] leqL>fjaf6 b"lift gePsf] / ;kmf ePsf] x'g'k5{ .
zNos[of ubf{ k|of]u x'g] ;fdu|Lx? -surgical attire_ M eGgfn] zNos[of ubf{ ;'/Iffsf] nflu k|of]u ul/g]
6f]kL, r:df, df:s, k+hf, ufpg, h'Qf k5{ . o;df k|of]u ul/g] k+hf / ufpg eg] lgd{lns[t x'g'k5{ .

lrq @–%M zNos[of ubf{ k|of]u x'g] ;fdu|Lx? nufPsf]

2–8 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
8«]«K;sf] e"ldsfM
 8«]K;, sk8fnfO{ juf{sf/df sf6L rf/lt/ l;nfOPsf] ljleGg ;fOhsf] ?dfn h:tf] sk8f xf]
of]] zNolqmof ubf{ zNos[of ul/g] 7fpF lgd{lns[t :yfg agfpgsf] nflu lgd{lns/0fsf] lgldQ
cf}hf/x? kf]sf] kfg{sf] nflu / zNos[of ubf{ lj/fdLx?nfO{ Gofgf] agfpgsf] nflu klg k|of]u
ul/G5 . ;fO6 8«]K;, aLrdf Kjfn kf/]sf] x'G5 h'g pkrf/ ug]{ jf zNolqmof ug]{ 7fpFdf k5{ . of]
8«]K; k|foM ;fgf] zNolqmof jf pkrf/ ug]{ 7fpFdf k|of]u u5{ .
;Demg'xf];\M 8«]k nufPsf] 7fp“df /u8\g] jf 6f“l;g] ug{ x'+b}g lsgeg]] /u8\gfn] jf bjfj lbgfn]
hLjf0f'x? ;'Vvf 7fpFaf6 klg leq l5g{ ;S5 .
;fdfg kf]sf kfg]{ 8«]K; 7"nf] x'G5 / lgd{nLs/0f u/]sf cf}hf/x? km}nfpgsf] nflu cf]5\ofpg] ul/G5 .
of] 8«]K; w]/} cf}hf/x? kf]sf] kfg{ / lgd{lns[t cf}hf/x? 6]a'ndf km}nfpg'sf] nflu 6]a'n 9fSg k'Ug] u/L
7"nf] agfOPsf] x'g'k5{ .
 zNos[of ug{ tof/ ug{ PlG6;]lK6s nufPsf] 7fpF 7"nf] x'g'k5{ / PlG6;]lK6s k"/} ;'Vvf ePkl5 dfq
8«]K;x? nufpg' k5{{ .
 lgd{nLs/0f ePsf] 8«]K; 5'g'eGbf cufl8 lgd{nLs/0f u/]sf] k~hf nufpg' k5{ . 8«]K; /fVbf jf
km}nfpFbf k~hf nufPsf] xft la/fdLsf] z/L/df jf otfptf g5'g] u/L km}nfpg' k5{ .
;Demg'xf];\ M lgd{nLs/0f u/]sf] 8«]K; la/fdLsf] z/L/df 5f]Pkl5 To;sf] lgd{nLs[t cj:yf
IfL0f x'G5 .

sfd ug]{ 7fp“ ;'/lIft /fVg]

JolQmut arfj6sf] nflu cfjZos ;fdu|Lx? k|of]u ug]{ sfo{ 8fS6/ / g;{x?nfO{ dfq Wofg glbO{
;a} :jf:YosdL{x? / ;xof]uL sd{rf/Lx?nfO{ ;'/Iff x'g] jftfj/0f agfpg] k|of; u/]df k|efjsf/L
x'G5, lsgeg] c:ktfndf sfd ug]{ sd{rf/Lx? dWo]df zNolqmof sIfdf sfd ug]{ sd{rf/Lx?eGbf
xfp;lslkËsf sd{rf/Lx?nfO{ ;a}eGbf a9L l;of]n] 3f]Rg] u/]sf] kfOPsf] 5 .
sfd ug]{ 7fp+F ;'/lIft agfpgsf]] nflu tn lbOPsf cg';f/ lzIff lbP/ dflg;sf] Jojxf/df kl/jt{g
Nofpg k|of; ul/g' cfjZos b]lvG5 M
 c:ktfn jf :jf:Yo ;+:yfsf] Joj:yfksx?n], ;'/Iffsf] nflu lgb]{lzt arfj6sf ;fdu|L
x? k|of]u ug{ c6'6 ;xof]u ug'{k5{ . o;sf] nflu sd{rf/Lx?af6 ;'/Iffsf nflu cfjZos
sdLsdhf]/Lx? kQf nufpg] / To;sf] cfjZos ;'wf/ ug]{ tyf vt/gfs Jojxf/x? x6fpg]
cEof;x? c6'6 ?kdf k|of; ub}{ nfg] ug'{k5{ .
 ;'kl/j]Ifsx?n] ;do ;dodf sd{rf/Lx?nfO{ k[i7kf]if0f lbg] sfd ug'{k5{ / plrt Jojxf/ ug]{
sd{rf/Lx?nfO{ Ogfdsf] Joj:yf klg ug'{k5{ . -h:t}M Ps lj/fdL / csf]{ lj/fdLsf] pkrf/sf]
aLrdf xft w'g]_

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 2–9
  8fS6/ / c? jl/i7 :6fkmx?af6 ;+qmd0f /f]syfdsf pkfox? ;s[o eP/ gd"gfsf] ?kdf
cEof; u/]/ Jojxf/df ptf/L b]vfPdf c? sd{rf/Lx?nfO{ xf};nf k|bfg ub{5 / Jojxf/
kl/jt{g ug{ ;xof]u k'U5 .
;+qmd0f /f]syfdsf pkfox? l;kmfl/; ubf{ k|of]udf Nofpg ;lhnf], ;:tf], ;'/lIft / Jojxfl/s x'g'k5{,
h;n] ubf{ :jf:YosdL{x? ;'/lIft x'G5g\ lsgeg] :jf:Yo ;]jf Pp6f dxTjk"0f{ k]zf ePsf]n] la/fdL /
:jf:YosdL{x?sf] sfo{If]q ;'/lIft jftf/0f agfpg ;xof]u ug'{ o; If]qdf sfo{/t ;a}sf] bfloTj xf] .

2–10 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
 xftsf] ;/;kmfO{
HAND HYGIENE #
ljifoj:t'M
 xftsf] ;/;kmfOsf] dxTj
 xftsf] ;/;kmfO ug'{kg]{ ;do
 xftsf] ;/;kmfO ug]{ t/Lsf
 zNolqmofsf] nflu / xftsf] ;/;kmfO ug{ alcohol based antiseptic sf] k|of]u
 7Ls tl/sfaf6 xft ;/;kmfO{ ubf{ cfO{kg]{ afwfx?
 :jf:Yo ;+:yfx?df xftsf] ;/;kmfO{ ;DalGw cEof;sf] ;'wf/
7Ls tl/sfaf6 xftsf] ;/;kmfO ug{ g;Sg' :jf:Yo ;+:yfhGo ;+qmd0f (nosocomial
infection) km}ng'sf] sf/0f dflgPsf] 5, h;sf] sf/0fn] ax'k|lt/f]wL lhjf0f'x? (multi resistant
microorganism) km}lngdf d2t k'¥ofpg] / dxfdf/Lsf] ?k klg lng;Sg] s'/f kQf nfu]sf]
5 . -Boyce and Pittet 2002_

e"ldsfM
:jf:Yo ;]jf k|bfg ubf{ hLjf0f'x? ;fg]{ xft Ps k|d'v dfWod xf] . To;}n] xftsf] ;/;kmfO xflgsf/s
lhjf0f'x? ;fg{ /f]s nufpg] / :jf:Yo ;]jfhGo ;+qmd0f /f]syfd ug]{ dxTjk"{0f pkfo xf] . :jf:YosdL{
jf ;]jfk|bfos hf] lj/fdLsf] ;]jfdf k|ToIf tyf ck|ToIf ;+nUg x'G5g\ pgLx?n] ;xL t/Lsfn], ;xL
;dodf xftsf] ;/;kmfO ug{ cfjZos 5 .
xftsf] ;/;kmfO eGgfn] xftåf/f ;g]{ ;+qmd0fhGo /f]usf ;'Id lhjf0f'x?sf] j[l4 ljsf; /f]Sg',
lhjf0f'x?nfO{ dfg'{ / kmf]x/x?nfO x6fpg]] sfo{ ug]{ eGg] a'lemG5 . xftsf] ;/;kmfO ug]{ k|lqmof ;+qmd0f
/f]syfdsf] nflu Pp6f clt k|efjsf/L tl/sf xf], o;n] la/fdL / jftfj/0fsf] ;Dks{df cfPsf ;'Id
lhjf0f'x?dfq geP/ 5fnfsf] leqL ;txdf /x]sf] ;'Id lhjf0f'x?sf] j[l4 ljsf; /f]Sg] / dfg]{ sfd klg
ub{5 . h;n] xftdf ePsf b]lvg] jf gb]lvg] kmf]x/ d}nfx? ;kmf ug'{sf] ;fy} xftdf ePsf] lhjf0f'x?
klg d5{g\ . o;sf] ;fy} PlG6;]lK6sn] xft df]Ngfn] ;'Id hLjf0f'x? dfq geO 5fnfsf] leqL txdf
:yfoL ?kdf /x]sf hLjf0f'x?nfO{ klg dfg]{ sfd u5{ .

;fa'g kfgLn] jf PlG6;]lK6s k|of]u u/]/ xftsf] ;/;kmfO{ ug'{kg]{ sf/0fx? lgDg 5g\\ M
 la/fdLsf] z/L/af6 lg:s]sf] /ut, kmf]x/ d}nf jf cGo b"lift kbfy{x?sf] ;Dks{ x'g] ePsf]n]
 hLjf0f'x? ;g]{ ;Defjgf ePsf]n]

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 3–1
 la/fdLnfO{ /f]u ;g]{ ;Defjgf ePsf]n] /
 s'g} klg sfo{ -procedure_ ug'{ k/]sf]n] .
xftdf ePsf] kmf]x/ d}nf x6fpg ;fa'g / kfgLsf] k|of]u ug'{ clt cfjZos x'G5 . olb xftdf kmf]x/d}nf
gb]lvPsf] t/ ;fdfGo xftsf] ;/;kmfO ug'{kg]{ cj:yfdf kfgL / ;fa'gsf] ;'ljwf gePsf] v08df jf
jf/Djf/ xft w'g'kg]{ cj:yfdf P]lG6;]lK6s 3f]nn] xft df]Ng] ug'{k5{ h'g k|efjsf/L x'g'sf] ;fy} ;lhn}
pknAw x'g] / ;:tf] j}slNks pkfo xf] . -olb wf/fsf] kfgL b'lift ePdf kfgLnfO{ lkmN6/ u/L !) ldg]6
;Dd pdfn]/ jf )=))!% Snf]l/g kfgLdf /fvL ;kmf ug{ ;lsG5_
xftsf] ;/;kmfOdf lgDg zAbx? k|of]u x'g] ePsf]n] o;af/] yfxf kfpg' h?/L 5 M
kl/efiff
 P]lG6;]lK6s -antiseptics_ jf P]lG6dfOqmf]afon Ph]G6 (antimicrobial agent)M /f;folgs kbfy{
h'g hLjf0f' dfg{ jf lgl:qmo agfpgsf] lglDt, 5fnf ;kmf ubf{ k|of]u ug]{ / w]/} lsl;dsf]
hLjf0f'x?nfO{ dfg]{ tTj eGg] a'lemG5 .
 ;kmf kfgLM k|fs[lts jf /f;folgs tl/sfaf6 k|zf]wg u/L ;kmf u/]sf], lkmN6/ u/]sf] jf cGo s'g}
tl/sfaf6 ;kmf u/L lkpg of]Uo / c? s'g} sfo{df k|of]u ug{ pko'Qm ePsf] kfgL g} ;kmf kfgL xf] .
 Odf]n]G6 (emollient)M af/Daf/ ;fa'g kfgLn] jf PlG6;]lK6sn] xft w'Fbf xft ;'Vvf x'g],
lrlNrnfpg] h:tf ;d:ofx? x'g;Sg] ePsf]n] o;af6 arfpgsf] nflu lUn;/Lg -glycerine_,
k|f]kfOlng -propylene), UnfOsf]n -glycole_ jf ;lj{6f]n -sorbitole) h:tf kbfy{x? xftdf nufO g/d
agfpg k|of]u ul/G5 . oL j:t'x? PlG6;]lK6sdf ld;fP/ agfOG5 / o;n] xftnfO{ g/d agfO/fV5 .
 xft w'g]M ;fa'g kfgLsf] k|of]u u/L xftdf ePsf] kmf]x/ d}nf x6fpg] tl/sfnfO{ g} xft w'g] elgG5 .
 :jf:Yo;+:yf hGo ;+qmd0f -nosocomial_M la/fdL :jf:Yo ;+:yfdf cfpFbf /f]usf] s'g} nIf0f b]vf
gk/]sf] t/ :jf:Yo ;+:yfdf pkrf/ ubf{ub}{ gofF /f]usf] ;+qmd0f ePsf] nIf0f b]vf kg'{nfO{ g}
:jf:Yo;+:yf hGo ;+qmd0f elgG5 .
 ;fa'g jf l86{h]G6 -detergent_M ;kmfOsf] nflu k|of]u ul/g] j:t' xf] . of] af/, emf]n, kQf jf
kfp8/sf] ?kdf kfOG5 . o;n] ;txdf ePsf] zlQmnfO{ -surface tension_ 36fpFb5 / kmf]x/
j:t'x? / xftdf ePsf] ;lhn} x6\g ;Sg] -transient microorganism_ x6fpg d2t u5{ . ;fwf/0f
;fa'gaf6 lhjf0f'x?nfO{ x6fpg xftsf] 3if{0fsf] -friction_ cfjZos k5{ eg] PlG6;]lK6s ePsf]
;fa'gn] lhjf0f'x?nfO{ dfg]{ / logLx?sf] j[l4 ljsf; /f]Sg] sfd u5{ .
 kmf]x/ b]lvg] xftM xftdf b]lvg] u/L kmf]x/, w'nf], /ut jf cGo z/L/af6 lg:sg] t/n tyf b"lift
kbfy{nfO{ elgG5 . h:t}M lb;f, lk;fa, vsf/ jf afGtf jf cGo kmf]x/x?, cflb .
 kfgL ljgfsf] PlG6;]lK6såf/f xft df]Ng]M kfgLsf] k|of]u gu/Lsg P]lG6;]lK6s xftdf nufpFbf
;fdfGo cj:yfdf xftdf x'g] hLjf0f'x? -normal flora) / xftdf eO/x]sf] :yfoL ?kdf /x]sf
hLjf0f'x?nfO{ dfg]{ sfd u5{ . o;sf] k|of]un] 5fnfnfO{ g/fd|f] c;/ klg ub}{g . @–$ k|ltzt
glycerine, propylene, glycole ^) b]lv () k|ltzt cNsf]xndf ld;fO agfOPsf] 3f]nn] xftdf
/x]sf ;"Id hLjf0f'nfO{ dfg]{ sfd u5{ . (Larson et al 2001)

3–2 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
xftsf] ;/;kmfOsf] cEof;
xft ;kmf /fVbf xft, kfv'/fdf /x]sf ;"Id hLjf0f'x?af6 /f]u ;g{ sd ug{df d2t u5{ . xft w'g]
u/]df Ps csf]{df /f]u ;g{ jf ;+qmd0f -cross contamination_ x'gaf6 arfpF5, h:t}M :jf:YosdL{af6
la/fdLdf jf lj/fdLaf6 :jf:YosdL{df . xft slxn] w'g] eGg] s'/f ;a}nfO{ yfxf ePs} s'/f xf], t/
klg of] ;Gbe{ k'l:tsfn] pko'St t/Lsfn] slxn] / s;/L xft w'g] afgL a;fNg] k|lqmofnfO{ lgb]{lzt
u/]sf] 5 . h:t}M PlG6;]lK6s ePsf] ;fa'g, ;fwf/0f ;fa'g jf PlG6;]lK6ssf] 5gf}6 ug]{ sfo{ la/fdL
5'Fbf x'g;Sg] ;+qmd0fsf] vt/fdf e/ k5{ . -pbfx/0fsf] nflu ;fwf/0f la/fdLsf] ;]jf ubf{ / lrlsT;f
;]jf ug]{ ;dodf ;d]t o;sf] k|of]udf leGgtf x'G5_ . :jf:YosdL{x?nfO{ lbOPsf] xfn} lgb]{zgx?
lgDgfg';f/sf 5g\ M
 olb 5fnfdf rf]6 nfu]sf] 5 jf k6s k6s xft w'g cfjZos 5 eg] xftdf ePsf] kmf]x/ lgsfNg
;fwf/0f ;fa'g jf P]lG6;]lK6s gePsf] ;fa'g k|of]u ug'{k5{ .
 olb xftdf b]lvg] u/L kmf]x/ nfu]sf] 5}g eg] ;fa'gn] xft w'g'eGbf PlG6;]lK6s 3f]n k|of]u ug'{
pko'Qm x'G5 .
 Ps l;km\6df w]/} k6s xft w'g'kg]{ ePdf, 5fnfdf c;/ ug]{ -irritation) x'g;S5 . o;af6 arfpg
xftdf ;fwf/0f nf]zg jf ls|dsf] k|of]u ug'{k5{ .
xftsf] ;/;kmfO, lgoldt ?kdf xft wf]P/ jf P]lG6;]lK6s 3f]n xftdf df]n]/ / zNolqmofsf] nflu xft
:qma ubf{ kfgLljgf cNsf]xn;Fu ld;fPsf] P]lG6;]lK6s Ph]G6 k|of]u ug{ ;lsG5 . xft w'nfOsf] p2]Zo
cg';f/ k|To]s cj:yfdf s]xL km/s kg{ ;S5 .

;fwf/0f xft w'g] (hand washing) p2]ZoM

;fwf/0f xft w'g'sf] d'Vo p2]Zo xftdf ePsf] b]lvg] jf gb]lvg] kmf]x/, w'nf] x6fpg / ;g{ ;Sg] ;"Id
hLjf0f'x? sd u/fpg' xf] . ;fa'g / ;kmf kfgLn] / PlG6;]lK6s ;fa'gn] xft w'g' plts} k|efjsf/L x'G5
(Pereira, Lee and Wade 1997) . o;sf] ;fy} ;fwf/0f ;fa'gn] 5fnfnfO{ sd -skin irritation_ c;/
u5{ . (Pereira, Lee and Wade 1990)

lgDg sfo{x? ug'{ cufl8 xft w'g'k5{M

 sfof{nodf cfO{ s'g}klg sfo{ ;'? ug'{ cufl8 .
 la/fdLsf] hfFr ug'{ cufl8 .
 s'g} ;fdfGo sfo{ljlw ug{ k~hf nufpg' cufl8 .
 vfgf ksfpg] sfo{ ug{ cufl8 .
 vfgf vfg'eGbf cufl8 .
 sfdaf6 3/ kms{g'eGbf cufl8 .

lgDg sfo{ u/]k5fl8 xft w'g'k5{ M

 xft b"lift x'g ;Sg] s'g} klg cj:yfdf .
 b"lift cf}hf/x? tyf cGo ;fdfgx? xftn] 5f]P kl5 .

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 3–3
 Do"s; d]Da|]g, /ut tyf z/L/af6 lg:s]sf] cGo emf]n kbfy{ 5f]Pkl5 .
 w]/} nfdf] cjlw;Dd / w]/} ;do;Dd la/fdLsf] ;Dks{df /x]kl5 .
 k~hf km'sfln ;s]kl5 .
 s'g} klg sfo{ ljlw -procedure_ ul/;s]kl5 .
 la/fdLsf hfFr ul/;s]kl5 .
 lb;f lk;fa ul/;s]kl5 .
k~hf vf]n]kl5 xft ;kmf kfgL / ;fa'gn] w'g' jf PlG6;]lK6s k|of]u ug'{k5{ lsgeg] k~hfx?df
cf“+vfn] gb]lvg] ;–;fgf Kjfn ePsf] / kmf6]sf] x'g;S5 . k~hf nufO/x]sf] cj:yfdf xft leHg]
/ Gofgf] x'g] x“'+bf hLjf0f'x?sf] j[l4 ljsf; l5§} x'g ;S5 . (CDC 1989: Korniewicz et al 1990)

lgoldt ?kdf xft w'g] qmdx? M

!= wf/fsf] ;kmf kfgLdf -running water_ xft lehfpg] .
@= xftdf ;fa'g nufP/ b'O{ xft df]Ng] / /fd|/L kmL+h lgsfNg] ;fy} lrq g+ #=! df b]vfP h:t} u/L
r/0f @ b]lv & ;Dd ^ t/Lsfn] xftsf] ;a} efudf nufPsf] olsg ug]{ .
#= xftsf cf}+nfx? / a'9L cf}+nfsf] sfkdf, cufl8 k5fl8 / gË ;a}df /fd|f];Fu df]Ng] .
$= wf/fsf] ;kmf kfgLdf xftsf] ;fa'g guP;Dd kvfNg] .
%= ;kmf ;'s]sf] ?dfnn] xft k'5\g] jf xfjfdf ;'sfpg] -JolQmut ?dfn xft ;'Vvf ug{ dfq k|of]u
ug]{ cGo sfo{df k|of]u gug]{_ .
^= pknAw ePdf ;kmf Ps k6s dfq k|of]u ug{ ;lsg] sfuhsf] ?dfnn] xft ;'Vvf ug{ ;s]df Hofb}
/fd|f] x'G5 .
xft w'g k|f]T;fxg ug{ Joj:yfksn] ;fa'g / ;kmf kfgL c6'6 ?kdf pknAw u/fpg], olb wf/fdf kfgL
gcfP, wf/f ePsf] aflN6gdf kfgL /fVg] / JolQmut ?dfn k|of]u ug{ nufpg] Joj:yf ug'{k5{ .
xft w'g ;fa'g k|of]u ul/+bf ;w} ;fgf] ;fa'g k|of]u ug'{k5{ / ;fa'gbfgL /fd|/L kfgL r'lxg] vfnsf]
x'g'k5{, h;n] ubf{ ;fa'g ;w} ;'Vvf /xf];\ .
 xft w'Fbf af6fdf kfgL hDdf u/L w'g' xF'b}g . o:tf] kfgLdf ;'Id hLjf0f'x? afFRg] / a9\g] ;Defjgf
x'G5 . -Rutala 1996 _ olb af6fsf] kfgLdf PlG6;]K6Ls h:t}M l86f]n jf :ofenf]g k|of]u u/]sf] eP
tfklg ;"Id hLjf0f'x? lhljt /xg] / a9\g] x'G5 .
 olb emf]n ;fa'g k|of]u u/]sf] 5 eg], pSt efF8f] vfnL ePkl5 k'gM ;fa'g eg'{ cufl8 efF8f] ;kmf
ug'{k5{ . t/ zNos[of ug{sf] nflu k|of]u ePsf] eP ;f]xL ef8f] k'gM k|of]u ug{ x'Fb}g .
 olb wf/fsf] kfgL pknAw x'g ;s]g eg] aflN6gdf wf/f /fv]/ klg k|of]u ug{ ;lsG5 / xft wf]Psf]
kfgL ;'/lIft 7fpFdf kmfNg'k5{ .

3–4 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
;fa'g kfgLn] xft w'g] t/Lsf lrq #=! df b]vfP adflhd ;Dk"0f{ k|s[of k"/f ug{ $) b]lv ^) ;]s]08
;do nfU5 . o; k|s[ofdf wf/f vf]n]b]lv xft df]Ng] / ^ r/0fn] xft df]Ng] t/Lsf b]vfpg'sf] ;fy}
xft kvfn]/ ;kmf ?dfnn] k'5]kl5 ;f]xL ?dfnn] wf/f aGb ug]{ sfo{;Dd b]vfPsf] 5 . lrq g+ #=!
df b]vfP adf]lhd ;a} r/0fx? cjnDag ug{ g;s] tfklg o;nfO{ lj:tf/} k|of; ub}{ hfg'k5{ .
lrq g+ #=!

Wet hands with water; Apply enough soap to cover Rub hands palm to palm;
all hand surfaces;

Right palm over left dorsum with Palm to palm with fingers interlaced; Backs of fingers to opposing palms
interlaced fingers and vice versa; with fingers interlocked;

Rotational rubbing of left thumb Rotational rubbing, backwards and Rinse hands with water;
clasped in right palm and vice versa; forwards with clasped fingers of right
hand in left palm and vice versa;

Dry hands thoroughly Use towel to turn off faucet; Your hands are now sage.
with a single use towel;

Adapted from WHO 2009

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 3–5
PlG6;]lK6såf/f xftsf]] ;/;kmfO{
xft w'g'sf] nIo xftdf ePsf] w'nf], kmf]x/x? tyf xftdf ePsf] ;lhn} x6fpg ;lsg] -transient flora_
/ g;lsg] hLjf0f'x? -resident flora_ sd tyf gi6 ug'{ xf] . PlG6;]K6Lssf] k|of]uåf/f xft w'g] t/Lsf
ckgfpFbf ;fa'g kfgLn] ;fdfGo xft wf]Padf]lhd w'g'k5{ .
lgDg sfo{ ug'{ cufl8 PlG6;]lK6sn] xftsf] ;/;kmfO ug'{ cfjZos k5{ M
 /f]u;+u n8\g] Ifdtf sd ePsf] lj/fdL, dlxgf gk'uL hGd]sf] lzz'x?, a[4 lj/fdLx? / P8\;
nfu]sf la/fdLx?sf] ;]jf ug'{ cufl8 .
 zNolqmof;DaGwL sfo{ ug'{ cufl8 .
 x]kf6fOl6;\ P jf O{ ;+qmldtx? jf s'g} klg cf}ifwLn] k|lt/f]w ug{ g;Sg]] ;+qmd0f ePsf] lj/fdL
-methicillin resistant saureus_ hfFRg' cufl8 / sf]7faf6 aflxl/Fbf klg ;Dks{af6 ;'/Iffsf nflu
PlG6;]lK6sn] xftsf] ;/;kmfO ug'{k5{ .
;'O{ lb“bf xft w'g] cj:yf
l;ldt ;dodf w]/} u|fxsx?nfO{ ;]jf k'¥ofpFbf
;fdfGo l:ylt÷cj:yfx?df dLlgNofk, Eof;]s6f]dL,
;'O{ lb+bf
ODKnf06 / cfO=o"=;L=8L=
k|To]s u|fxsnfO{ hfFr u/]kl5 k|To]s 306f cyjf k|To]s $ k|To]s 306f cyjf k|To]s !)
hgf u|fxsnfO{ ;]jf lbPkl5 hgf u|fxsnfO{ ;]jf lbPkl5

P]lG6;]lK6såf/f xft df]Ng]

xftdf x'g] jf /x]sf] ;lhn} l;t x6fpg ;lsg] / g;lsg] hLjf0f'x? -transient/ resident flora _
nfO{ dfg{ P]lG6dfOqmf]afon Ph]G6 ePsf] ;fa'g kfgL jf ;fwf/0f ;fa'g kfgLn] ;kmf ubf{ eGbf kfgL
ljgfsf] xftdf PlG6;]lK6s nf]zgsf] -antiseptic hand lotion_ k|of]u w]/} k|efjsf/L x'G5 . o;n] l56f]
/ ;lhnf];Fu ;kmf ug{ ;lsG5 / ;'?df w]/} hLjf0f' -flora) sd u/fpF5 (Girou et al 2002) . xft w'g]
PlG6;]lK6s 3f]ndf UnLl;/Lg, k|f]kfOlng UnfOsf]n jf ;la{6n ldl:;Psf] x'G5 h;n] 5fnfnfO{ g/d
agfpg] / ;'/Iff ug]{ sfd u5{ . olb xft b]lvg] u/L kmf]x/ ePsf], /ut jf cGo kbfy{;Fu b"lift ePsf]
5 eg] klxn] ;fa'g / kfgLn] xft wf]Pkl5 dfq 3f]n k|of]u u/L xftdf 3f]n nufO{ ;kmf ug'{k5{ .

P]lG6;]lK6s emf]nåf/f xft /u8\g] r/0f

r/0f ! M PlG6;]lK6s 3f]n k|z:t dfqfdf -Ps lrof rDrf–% ld=ln= hlt_ lnP/ xftsf] ;a} efudf
/ cf}+nfx?df nufpg] .
r/0f @ M lrq g+ #=@ df b]vfP h:t} ^ r/0fdf cf}+nfsf] 6'Kkfb]lv km]b;Dd / gË;Dd tndfly u/]/
g;'s];Dd b'a} xftsf] ;a} efudf /u8\g] .
r/0f # M 3f]n hlt a9L lnof] plQ g} k|efjsfl/tf klg a9L x'G5 (Larson 1988) .
zNolqmofsf] nflu xftsf] ;/;kmfO k|To]s lj/fdL jf u|fxssf] zNolqmof cufl8 ug'{k5{ . x'gtM k|To]s
lj/fdLsf] ;]jf ubf{ k|To]s k6s ;fa'gkfgLn] xft :s|a u/]/ w'g'k5{ t/ w]/} k6s xft w'Fbf 5fnfdf
irritation x'g;Sg] ePsf] x'gfn] xftsf] ;'/Iffsf] nflu Ps lj/fdLkl5 csf]{ lj/fdLsf] zNolqmof ug{ #

3–6 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
b]lv % Pd Pn PlG6;]K6Ls 3f]nn] xft df]Ng' k5{ . t/ w]/} zNos[of ug'{ k/]sf] v08df k|To]s $ j6f
zNolqmof jf ! 306fdf -h'g klxn] cfpF5_ xftsf] :qma ug'{k5{ .

cNsf]xn ePsf] PlG6;]K6Ls 3f]ndf UnLl;/Lg (glycerine) ld;fPsf] kfOG5 eg], s'g} P]lG6;]lK6s
3f]ndf cNsf]xn jf csf]{ PlG6;]K6Ls Snf]/x]lS;l8g ld;fPsf] klg kfOG5 .
PlG6;]K6Ls 3f]nn] xft w'g] t/Lsf
of] t/Lsf ckgfp“bf @) b]lv #) ;]s]08;Dd PlG6;]K6Ls 3f]n lrq g+ #=@ df b]vfP adf]lhd ^
r/0f k|of]u ug]{
lrq g+ #=@

Apply a palmful of the product in a cupped hand, covering all surfaces; Rub hands palm to palm;

Right palm over left dorsum with Palm to palm with fingers interlaced; Backs of fingers to opposing palms
interlaced fingers and vice versa; with fingers interlocked;

Rotational rubbing of left thumb Rotational rubbing, backwards and Once dry, your hands are safe.
clasped in right palm and vice versa; forwards with clasped fingers of right
hand in left palm and vice versa;

Adapted from WHO 2009

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 3–7
cNsf]xn k|of]u u/L xft w'g] P]lG6;]lK6s 3f]n agfpg] tl/sf M
^) b]lv () k|ltztsf] OyfOn jf cfO;f]k|f]kfOn jf /]lS6kmfO8 l:kl/6 !)) ldlnln6/
lUnl;/Lg jf ;la{6n @ ldlnln6/ ld;fpg] / /fd|f];“u rnfpg] (Larson 1990;Pierce 1990)
k|To]s k6s xft w'gnfO{ em08} ! lrof rDrf -% ld=ln_ xftdf lnO{ !% b]lv #) ;]s]G8;Dd /u8\g]
{- _
jf xftdf g;'s];Dd b'a} xft df]Ng] .

zNolqmof ug'{ cufl8 xftsf] ;/;kmfO{ -surgical hand preparation_

zNolqmof ug'{ cufl8 xftsf] ;/;kmfO{sf] p2]Zo xftdf ePsf] b]lvg] jf gb]lvg] kmf]x/, ;g{;Sg]
hLjf0f'x? x6fpg / zNolqmof ug]{ cjlwdf xftd} eO/xg] residential flora nfO{ sd u/fpg' xf] .
o;sf] d'Vo nIo eg]sf] lrlsT;s jf ;xfosaf6 zNolqmof u/]sf] 3fpdf ;"Id hLjf0f'x? k|j]z /f]sL
;+qmd0f x'gaf6 arfpg' xf] .
zNolqmof cufl8 xftsf] ;/;kmfO ubf{ ^ b]lv !) ldg]6;Dd a|'; / PlG6;]lK6s ePsf] ;fa'g
(chlorhexidine or iodopher) k|of]u u/L xft w'g'k5{ eGg] lgb]{zg w]/} jif{;Dd rNof] / o:tf] cEof;n]
xftsf] 5fnfdf v/faL ug{;S5 / xftdf hLjf0f'x? w]/} /lx/xg] x'G5 (Dineen 1966:Kikuchi-
Numagami et al 1999) . w]/} cWoogåf/f xftdf hLjf0f'x? sd ug{sf] lglDt s'g} a|'; jf :k~hsf]
k|of]u ug{ cfjZos 5}g eg]sf] 5 . # b]lv % ldg]6;Dd ;fa'g / ;kmf kfgLn] xft w'g] To;kl5 @
b]lv $ k|ltztsf] Snf]/x]lShl8g jf &=% b]lv !) k|ltztsf] kf]le8g cfof]l8g jf cNsf]xn PlG6;]K6Ls
xftdf nufP/ /u8]df ;fa'g k|of]u u/]df k|efjsf/L ePsf] kfOPsf] 5 . (Deshmukh, Kramer and
Kjellberg 1996; Pereira, Lee and Wade 1997) .

h;sf] glthfcg'?k ;fwf/0f ;lh{sn :qma ug]{ tl/sf ;lhnf] x'g] / sd ;dodf cfjZos :qma ug{
;lsG5 . zNolqmof ug{ cufl8 xft lgDgfg';f/ w'g'k5{ M
r/0f !M xftdf nufPsf] cf}+7L, 38L / r'/fx? ;a} km'sfNg] / xft kfgLdf lehfpg] . gË ;kmf
ug]{M. -t'y lksn]_

lrq g+ #=# lrq g+ #=$

3–8 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
 M

r/0f @M xftnfO{ s'lxgfeGbf dfly p7fpg] / PlG6;]lK6s :qma 3f]n

jf emf]n ;fa'g kfgL xftdf lnP/ cf}+nfb]lv s'lxgf;Dd
uf]nfsf/ t/Lsfn] dNb} nufpg] -circular motion_ . of]
s[of csf]{ xftdf klg bf]xf]¥ofpg] . of] t/Lsfn] xft w'Fbf # M
b]lv % ldg]6;Dd w'g' kb{5 . ;lh{sn :qmasf (surgical
scrub) lrqdf eP h:t} ug]{ . M lrq g+ #=%
M
r/0f #M xftnfO{ s'lxgfeGbf dfly p7fP/ kfgLn] cf}+nfsf] 6'Kkf]af6
;'? u/]/ s'lxgf;Dd /fd|/L kvfNg], of] qmd b'a} xftdf
kfn};Fu ug]{ . M

lrq g+ #=^
r/0f $M xftnfO{ dfly p7fP/} hLpeGbf 6f9f /fv]sf] cj:yfdf
s'g}klg 7fpF jf j:t'nfO{ g5'g] / ;'Vvf / lgd{lns[t M
?dfnn] cf}+nfb]lv k'5\b} s'lxgflt/ nfg] / ;f]xL lgd{lns[t
?dfnsf] csf]{ 6'Kkf]n] csf]{ xftdf klg ;f]xL lgodfg';f/
xft k'5\g] . olb ?dfn 5}g eg] xfjfdf ;'sfpg] . M
lrq g+ #=&
r/0f %M Ps rDrf jf % Pd Pn @ b]lv $ k|ltztsf] chlorhexidine
jf &=% b]lv !) k|ltztsf] kf]le8g cfof]l8g xftdf
slDtdf ^) ;]s]08;Dd lrqdf b]vfP adf]lhd /u8\g] .

r/0f &M b'a} xftdf lgd{nLs[t k~hf nufpg] . lrq g+ #=*

xft w'bf P]lG6;]lK6s 3f]n nufPdf k~hfleq ;"Id hLjf0f'x? /xg sd x'G/f]5syfd/ tyf
;+qmd0f zNolqmof cjlwdf
:jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gb
xftdf x'g] hLjf0f'nfO{ lg:s[o agfO/xG5 . k~hfdf gb]lvg] Kjfnx? x'g;Sg], RoflQg] / cf}hf/n]
Roflkg ;Sg] x'Fbf of] k|lqmof ckgfpg clt cfjZos x'G5 .
k|To]s zNos[ofkl5 xft :qma -surgical hand rub_ ug{ h?/L 5 t/ w]/}hgfsf] zNolqmof ug'{kg]{ ePdf
;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gb
k|To]s k6s xft w'g' cfjZos 5}g, o:tf] cj:yfdf PlG6;]K6Ls 3f]nn] xftdf dNg] -alcohol hand
rub_ ug{ ;lsG5 . t/ $ hgfsf] zNolqmofkl5 jf k|To]s ! 306f -h'g klxnf cfpF5_, To;a]nf xft
:qma ug]{ k|s[of bf]xf]¥ofpg' k5{ .

xftsf] ;/;kmfO{sf] sfo{ ;'wf/ ug{ s] s] ug{ ;lsG5 <

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;G
of] cEof; ;'wfg{ uf¥xf] ePtfklg lgDg lnlvt t/Lsf ckgfPdf xft w'g] sfo{df ;'wf/ ug{ d2t
k'¥ofpF5 .
;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gb
;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 3–9
  xftsf] ;/;kmfOsf] afgL a;fNg] lgb]{zgx? ;a} 7fpFdf afF8\g] / :jf:YosdL{x?n] pSt lgb]{zgx?
kfngf ug'{kg]{ cfjZostf klg pNn]v ug]{ .
 :jf:Yo ;+:yfsf Joj:yfksx?nfO{ xft w'g] / cGo xftsf] ;/;kmfOnfO{ a9fjf lbg o;af6 x'g]
kmfObf a'emfpFb} pSt lgb]{zgx? k|efjsf/L t/Lsfn] k|of]udf Nofpg ;xefuL u/fpg] .
 ;'k/efOh/x?n] xft w'gsf] nflu cfkm' gd"gf ag]/ b]vfpg] / Jojxf/df ptfg]{ . :jf:YosdL{x?n]
xft wf]P gwf]Psf] af/]df /]vb]v ug]{, k[i7kf]if0f / lgb]{zg lbg] h:tf ;kmn lzIffsf] tl/sfx?
ckgfpg] .
 8fS6/ / g;{x? cfkm\gf] sfdnfO{ dfq Wofgdf g/fvL ;a} :jf:YosdL{x?sf] nflu xft w'g] sfo{
;Dkfbg ;'wf/ ug]{ tl/sfx? ckgfpg ;xof]u ug]{ .
 sd{rf/Lx?nfO{ xftsf] ;/;kmfO ;lhnf];Fu x'g] u/L pgLx?sf] cfjZostfnfO{ Wofg lbO{ Joj:yf
ldnfOlbg] .

zNolqmof cufl8 cNsf]xnn] xftsf] ;/;/kmfO ug]{ t/Lsf

3–10 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf #–11
 gf]6M olb s'g} JolQmnfO{ P]lG6;]lK6ssf] PnhL{ 5 eg] PnhL{n] ubf{ 5fnfnfO{ g/fd|f] c;/ u5{ h;df
;"Id hLjf0f'x? a:g] / a9\g] u5{ To;}n] o:tf] PnhL{af6 arfpg' k5{ . o:tf] JolQmn] ;fwf/0f
;fa'g kfgLaf6 dfq xft w'g] / dfly eg]h:tf] kfgL gePsf] cNsf]xndf lUnl;l/g jf cNsf]xndf
Snf]/x]lS;l8g ld;fPsf] emf]n k|of]u u/L xft df8\g] . of] emf]nn] k|;:t dfqfdf xftdf x'g] ;"Id
hLjf0f'x? sd u/fpF5 / 5fnfnfO{ :j:Yo /fVg] / ;do klg sd dfq nfUg] x'G5 .

xftsf] ;/;kmfO{ /fVg] ;DaGwdf Wofg lbg'kg]{ c? s'/fx?

;+5fnf
qmd0f /f]km'
syfd6\g' tyf
/ 3fp
:jf:Yo x';+g:' yfhGo
(lesions and
kmf]x/d}n M xft
k'l:tsf/
gfl8x?df 3fp x'g'x'Fb}g / 5fnf km'6]sf], #–12
skin breaks)
f Joj:yfkgsf nflu ;Gbe{
lklN;Psf] tyf km'6]sf] x'g'xFb}g . 5fnf lklN;Pdf / sf6]sf] ePdf kfgL gkg]{ u/L 9fSg'k5{ . olb o;/L

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 3–11
kfgL gk:g] u/L 9fSg] ;Dej 5}g eg] To:tf] :6fkmn] 3fp lgsf] geP;Dd s'g}klg zNolqmof ug]{ jf
zNolqmofdf ;xof]u ug'{ x'Fb}g .
g·x?M xftdf ;a}eGbf a9L ;"Id hLjf0f'x? gËsf] d'lg jf leqL efudf x'G5 eg]/ w]/} cWoogx?n]
b]vfPsf] 5 -McGinley Larson and leydon 1988) . o;df klg yk cWoogn] s] b]vfPsf] 5 eg]
nfdf] gË u|fd g]u]l6e a]l;nfO -gram negative bacilli), loi6 -yeast_ / cGo Kofyf]lhg\x? a:g]
;|f]th:t} xf] . -Hedderwick et al 2000) . ;fy} nfdf] gË cfˆg} jf gSsnL h'g;'s} ePklg k~hfnfO{
;lhnf];Fu Kjfn kf5{ (Olsen et al 1993) . To;}n] gË 5f]6f] sf6\g' k5{ h'g cf}+nfeGbf # ldlnld6/ -jf
!÷* O~r_ aflx/ cfpg' x'Fb}g .
g·kfln;M gËdf nufpg gx'g] egL lgoGq0f u/]sf] gePtfklg zNolqmof ug]{ 6f]nL ;b:ox? /
jl/kl/sf] jftfj/0fdf sfd ug]{ cGo sd{rf/Lx?n] gË kfln; nufpg x'Fb}g, nufpg} k/]sf] v08df ev{/}
nufPsf] gËkfln;nfO{ :jLsfg{ ;lsG5, gpKs]sf] kfln;df eGbf pKs]sf] gË kfln;df lhjf0f'x?sf]
j[l4 ljsf;df ;xof]u k'U5 . To;df klg cFWof/f] /+usf] gË kfln; k|of]u u/]df gËdf kmf]x/ ePsf]
klg b]lvGb}g / ;kmf ug]{ r]i6f klg ul/+b}g .
uxgfM cf}+7L gnufPsf] cf}+nfdfeGbf nufPsf] cf}+nfdf kmf]x/ / lhjf0f'x? cTolws dfqfdf hDdf eP/
j;]sf] x'G5 . t/ xfn;Dd cf}+7L nufPsf] sf/0fn] ls6f0f'x? sltsf] ;g{ d2t k'¥ofO/x]sf] x'G5 eGg]
olsg ePsf] 5}g . t/ klg cf}+7L nufP/ k~hf nufpFbf k~hf nufpg sl7gfO x'g] / Rofltg] ePsf]n]
zNolqmof ug]{ 6f]nL ;b:ox?n] cf}+7L gnufpg ;Nnfx lbOPsf] 5 . o;sf] ;fy} 38L / r'/fx? klg
gnufpg ;Nnfx lbOPsf] 5 .
;f/f+zdf, xftsf] ;/;kmfO ug]{ lgb]{zg cg';f/ kfngf ug{ w]/} cK7\of/f] 5, t/ klg s]xL ;+3 ;+:yfx?n]
o;sf] ;kmntfk"j{s kfngf u/]sf] 5 . of] ;kmntfsf] d'Vo sf/0fx? Jojxf/df kl/jt{g Nofpg]
dgf]j[ltdf w]/} ;DaGw /fVb5 . h:t}M gofF gofF hfgsf/L, cg'udg / k[i7kf]if0f ug]{, ;'k/efOh/ cfkm}
/f]n df]8]n eP/ b]vfpg] / Joj:yfkgn] ;xof]u ug]{ cflb .

3–12 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
 k~hfx?
GLOVES $
ljifoj:t'M
 k~hf nufpg] ;do
 k~hfsf] k|sf/
 k~hf k|of]u ug'{kg]{ jf gkg]{ cj:yfx?
 k~hf nufpg] tyf km'sfNg] t/Lsf .

e"ldsf
/f]u km}ng sd ug{ tyf ;+qmd0f /lxt jftfj/0f agfpg] ljleGg pkfox?dWo] k~hf nufpg', klg Ps
k|d'v pkfo xf] . k~hfsf] k|sf/ / k|of]u s'g s'g cj:yfdf ug{ ;lsG5 eGg] af/] hfGg' clt cfjZos
5 . h;n] ubf{ la/fdL / sd{rf/Lx?nfO{ x'g;Sg] vt/faf6 ;'/lIft /fVg ;lsG5 . k~hf k|of]u gubf{
x'g;Sg] ;d:of / ;dfwfgdf nfUg] vr{nfO{ ;dod} /f]syfd ug{ ;lsG5 .

w]/} jif{ cufl8 :jf:YosdL{x?n] tLgj6f sf/0fn] k~hf nufpg] uy]{ . tL x'g\M
!= la/fdLaf6 sd{rf/Lx?nfO{ ;+qmd0f x'g] vt/f sd ug{ .
@= sd{rf/Lx?sf] 5fnfdf ePsf] lhjf0f' la/fdLnfO{ ;g{af6 arfpg .
#= sd{rf/Lx?n] la/fdLsf] ;]jf ubf{ pSt lj/fdLsf] lhjf0f'x?, Ps la/fdLaf6 csf]{ lj/fdLdf
sd{rf/Lx?sf] xftaf6 ;g{] sfo{ 36fpg -cross contamination) .
sd{rf/Lx?n] ;+qmldt la/fdLx?sf] :ofxf/ ug]{ qmddf jf x]kf6fOl6; aL sf] ;+qmd0fsf] pRr hf]lvd
ePsf lj/fdLx?sf] :ofxf/ ubf{ dfq w]/}h;f] k~hf nufpg] u/]sf] kfOGYof] .
!(*& b]lv Pr=cfO=eL=sf] dxfdf/L ;'? ePkl5 Pr=cfO{=eL=tyf c? /ut hGo ;+qmd0fx?af6 ;a}
txsf sd{rf/Lx?nfO{ arfpg ljleGg k|of; x'g yfNof] To;dWo] k~hf Ps dxTjk"0f{ k|of; x'g
uof] . h;n] ubf{ cfhsn, :jf:YosdL{x?n] cfˆgf] JolQmut arfj6sf] lglDt, lgd{lns[t / Psk6s
dfq k|of]u x'g] tyf 3/fo;L k~hf w]/} g} k|of]udf NofP/ cfk'mnfO{ ;'/lIft ug]{ pkfo ckgfOPsf]
kfOPsf] 5 .

;Demg'xf];\M k~hf nufpg'cl3 / km'sfnL;s]kl5 t'?Gt} xftsf] ;/;kmfO ug'{k5{ .

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 4–1
k~hf lgDg sfo{ ubf{ k|of]u ug'{ k5{M
 /ut>fj, Do"s; d]Da|]g / RofltPsf] 5fnf 5'g] s'g} klg sfo{x? ubf{
 s'g} klg 7"nf jf ulx/f] pkrf/sf] sfo{ ubf{
 kmf]x/ jf b'lift j:t'x? 5'Fbf
Ps JolQmaf6 csf]{nfO{ /f]u ;g{af6 arfpg, k|To]s la/fdLsf] nflu leGbfleGb} k~hfsf] k|of]u ug'{k5{ .
lsgsL Pp6} k~hf nufP/ w]/}hgf la/fdLnfO{ hfFr ubf{ / z/L/sf] leqL efu hfFr ubf{ Ps lj/fdLsf]
;+qmd0f csf]{ lj/fdLnfO{ ;g]{ vt/f x'G5 .

k~hfsf] k|sf/
:jf:Yo ;+:yfx?df tLg k|sf/sf k~hfx?sf] k|of]u ul/G5 . h:t}M lgd{lns[t k~hf, hfFr ug]{ k~hf /
df]6f] jf 3/df sfd ubf{ k|of]u ug]{ k~hf .
!= lgd{lns[t k~hf -sterile gloves_M zNolqmof ubf{ jf dfgj z/L/sf] /ut, >fj / z/L/sf] leqL
efudf 5'g] s'g}klg sfo{x? -invasive surgical procedure) ug{sf] nflu lgd{lns[t k~hf k|of]u ug'{
k5{ . of] w]/}h;f] n]6]S; /a/n] ag]sf] x'G5 . o:tf k~hfx? Ps k6s dfq k|of]u ug{ ;lsG5, k'gM
k|of]u ug{ ;lsFb}g .
gf]6M lgd{lns[t / hfFr ug]{ k~hfx? k'gM k|of]u ug{ x“'b}g . df]6f] k~hf k|of]u ul/;s]kl5 b"if0f
lgjf/0f ug]{, ;kmf ug]{ / ;'sfpg] ug'{k5{ . k~hf 5fofdf dfq ;'sfpg' k5{ .
@= la/fdLnfO{ hf+r ubf{ k|of]u ug]{ k~hfM -single use exam gloves)
o:tf k~hfx? ;kmf x'G5g\ t/ lgd{lns[t x'b}gg\ / lolgx? gRofltPsf] Do's; d]Dj|]gsf] ;Dks{df
cfpFbf k|of]u ug'{k5{ . o:tf k~hfx? Ps k6s dfq k|of]u ug{ ;lsG5 .

#= df]6f] jf 3/df sfd ubf{ k|of]u ug]{ k~hfM -utility gloves)

b"lift cf}hf/ tyf pks/0fx?, b"lift kmf]x/ j:t'x?, xflgsf/s /f;folgs j:t'x? 5'Fbf / ;/;kmfO
ubf{ o:tf] k|of]u ug'{k5{ .

olb k~hfsf] cfk"lt{ sd eof] eg] s] ug]{ <

k~hfsf] k|of]un] ljleGg k|sf/sf ;+qmd0fsf] /f]syfd x'g] ePsf] xF'bf o;sf] cfjZostfeGbf a9L k|of]u
x'g;S5 . h;sf] kmn:j?k o;sf] cfk"lt{df sdL cfpg ;S5 . To;}n] :jf:Yo ;+:yfsf Joj:yfksx?
/ ;'kl/j]Ifsx?n] k~hfsf] k|of]u cgfjZos / unt 9+un] -h:t}M /Qmrfk gfKbf, jf s'g} ;kmf sfd
ubf{ jf kmf]x/d}nf 5'+bf jf ;/;kmfO{ ubf{ cgfjZos lgd{lns[t k~hf k|of]u ug]{ u/]sf]_ k|of]u ul//x]sf]
5 jf 5}g eGg] af/]df hfgsf/L /fVg ;'kl/j]If0f ug'{k5{ / ;f]xL cg';f/ ;xL 9+un] k|of]u ug{ ;'emfj
lbg'k5{, o;f] u/]df s]xL xb;Dd o;sf] sdLdf ;['wf/ cfpg ;S5 . Ps k6s k|of]u ePsf] k~hf k'gM
k|of]u ug{ l;kmfl/; ul/Psf] 5|}g .

4–2 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
df]6f] k~hf gkfPsf] cj:yfdf Ps k6s dfq nufpg] k~hf b'O{j6f -double gloving_ nufpFg ;lsG5 .
o;f] u/]df k|of]u ul/;s]sf] cf}hf/x? jf b"lift cf}hf/x? ;kmf ug]{ sd{rf/Lx? tyf b"lift kmf]x/ 5'g'kg]{
jf kmfNg'kg]{ sd{rf/Lx?nfO{ ;'/Iff u5{ .
;Demg'xf];\ M n]]6]S; /a/sf] k~hf k|of]u ubf{ ldg/n k]6«f]lnod h]nL Nofgf]lng jf Eof;lng
ePsf] lqmd xftdf k|of]u ug'{ x'+b}g lsgeg] o;n] s]xL ldg]6leq g} k~hf RoflQg jf Kjfn kfg{
;S5 . n]]6]S;\ k~hfsf] PnhL{ x'g;Sg] s'/fnfO{ klg Wofg lbg'k5{ .

tflnsf $–! laleGg k|sf/sf k~hfx?sf] kmfObf / a]kmfObfx?

k~hfsf] k|sf/ kmfObf a]kmfObf
lgd{lns[t k~hfM of] ;a} k|sf/sf – k~hf xftdf ldNg] -fit_ x'G5 dx+uf] x'g ;S5
pkrf/ ;]jf ubf{ h:t}M 5fnfleq – zNolqmof ubf{ xft rnfpg
-tGt'_ 5'g'kbf{ jf zNolqmof ubf{ ;lhnf] x'G5 .
nufOG5 .
hf“r ubf{ k|of]u ug]{ k~hfM – lgd{lns[t k~hfeGbf ;:tf] g} of] ;fgf], dWod / 7"nf]
of] Do"s; d]Da|]g / 5fnfsf] x'G5 . ;fOhsf] x'G5 .
;Dks{df cfpbf k|of]u ul/G5 – ;lhn} pknAw x'G5 .
h:t}M of]gLåf/ hfFr, /ut tfGbf
k|of]u ul/G5 .
df]6f] jf 3/df sfd ubf{ k|of]u – ;:tf] x'G5 . o:tf] k~hf gkfOPsf]
ug]{ k~hfM b"lift cf}hf/, pks/0f – k'gM ;kmf u/L k|of]u ug{ v08df la/fdL hfFr ubf{
/ kmf]x/ 5'g' kbf{ jf ;kmf ubf{ ;lsG5 . nufpg] k~hf b'O{j6f
nufpg' k5{ . – o;sf] /a/ afSnf] x'g] x'gfn] nufpg' k5{ .
;fdfg ;kmf ug]{, kmf]x/ kmfNg]
jf 5'g] sd{rf/Lx?nfO{ ;'/lIft
/fV5 .

lrq $=!M lgd{lns/0f ePsf]] zNolqmof ubf{ k|of]u ug]{ k~hf nufpg] qmlds k|lqmofx?
!= lgd{lns/0f ul/Psf] k~hfsf] kf]sf vf]Ng cufl8 ;kmf, ;'Vvf, v'Nnf / ;dtn ;txsf] 5gf}6 ug]{
-;kmf lgd{lns/0f ul/Psf] 7fpFdf /fVg] . s_ olb ;xof]uL sf]xL 5}g eg] k~hf kf]sfsf] aflx/L
se/ vf]Ng] / xft :qma ug{ hfg] / xft ;'sfpg] . v_ olb ;xof]uL 5 eg] klxnf xft :qma ug{
hfg] / xft ;'sfpg] To;kl5 ;xof]uLnfO{ k~hfsf] kf]sf vf]Ng cfu|x ug]{ .

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 4–3
 @= k~hfsf] kf]sfsf] leqL efu vf]Ng] . of]
vf]Nbf k~hfsf] cf}+nfsf] efu dflylt/ kfg]{
/ gfl8sf] efu cfkm'lt/ kfg]{ . Pp6f xftsf]
xTs]nfdfly kmsf{O csf]{ xftn] k~hfsf]
skmsf] leqL efudf dfq 5'g] u/L l6Kg] .

#= klxnf] k~hf nufpFbf k~hfsf] skmsf] leqL

efudf dfq 5'g]u/L l6Kg] h'g efudf cfˆgf]
xft leq k5{ .

$= klxnf] k~hfsf] skmsf] leqL efu ;dft]/

l6k]kl5 +k~hfnfO{ tnlt/ kmsf{P/
xTs]nfnfO{ dflylt/ kmsf{O xft la:tf/}
k~hfleq 3';fpg] . of] ;dodf cfˆgf]
cf}+nfx? k~hfsf] s'g cf}+nfdf 3';fpg] xf]
larf/ u/L cf}+nfx? la:tf/} l5/fpFb} hfg] .
k~hfn] st}klg 5'g x'Fb}g / k~hf nufpFbf
xftnfO{ sDd/eGbf dfly prfn]/ nufpg'
k5{ . -;Demg';\ M olb klxnf nufPsf] k~hf
;+qmd0f/fd|
/f]sfyfd
];Futyf
ldn]:jf:Yo
g eg];+:bf] >f] kmf]
yfhGo k~hf
x/d}nnufpg l9nfnflu ;Gbe{ k'l:tsf
f Joj:yfkgsf $–4
;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
ePklg la:tf/} ldnfpg] / kl5 bf]>f] k~hf $–4
nufpg] / lgd{lns/0f ePsf] k~hf bf]>f]
xftdf nufO;s]kl5 dfq cf}+nfx? /fd|f];Fu
ldnfpg] t/ o;/L ldnfpFbf lgd{lns/0f
ePsf] k~hfn] st} 5'g eg] x'Fb}g .

4–4 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
 %= bf]>f] xftdf k~hf nufpFbf klxnf k~hf
nufO;s]sf] xftsf] cf}+nfn] csf]{ k~hfsf]
bf]af/]sf] sksf] leqL efudf ;dfpg] /
p7fpg] .

^= bf]>f] xft bf]>f] k~hfleq k;fpg] / klxnf]

k~hf nufP h:t} cf}+nfx? nufO{ l7s
7fpFdf cg'dfg ub}{ leq k7fpg] / k~hf
nufpg] . ofb ug'{xf];\ k~hf nufPsf] xftn]
k~hf gnufPsf] v'Nnf xft jf 7fpFdf
st}klg 5'g x'Fb}g .

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf $–5

&= k~hfsf cf}+nfx? /fd|f];Fu xftdf gldn];Dd

/fd|f];Fu k~hf ldnfpg] ug{'k5{ .

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 4–5
 lrq $=@M k~hf nufPsf] / km'sfn]sf]
!_ b"if0f lgjf/0f 3f]n ePsf] af6fdf xft
8'afpg] / k~hfdf nfu]sf] /ut tyf cGo
leqL>fjx? x6fpg] .

!_ b"if0f lgjf/0f 3f]n ePsf] af6fdf xft

8'afpg] / k~hfdf nfu]sf] /ut tyf cGo
leqL>fjx? x6fpg] .

@_ Pp6f xftn] csf]{ xftsf] k~hfsf] skmsf]

aflx/L efu ;dftL la:tf/} s]lx efu dfq
km'sfNg] . o;/L km'sfNbf k~hfsf] leqL
efu aflx/ eP/ lg:sG5 . k~hf ePsf]
xftn] xftsf] v'Nnf efu jf 5fnf 5'gaf6
arfpg] . bf]>f] k~hf km'sfNg' cufl8
klxnf] xftsf] k~hf cfwf dfq} km'sfNg'
cfjZos x'G5 .

;+;+qqmd0f
md0f /f]
/f]s
syfd
yfd tyf
tyf :jf:Yo
:jf:Yo ;+;+::yfhGo
yfhGo kmf]
kmf]xx/d}
/d}nnff Joj:yfkgsf
Joj:yfkgsf nflu
nflu ;Gbe{
;Gbe{ k'k'll:tsf
:tsf $$––77

4–6 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
 #_ klxnf] k6s km'sfn]sf] k~hf cfwf xft;Dd
lg:s]kl5 To; cfwf k~hf km'sfn]sf]
xftsf] cf}+nfn] -k~hf ePs} x'g'k5{_ csf]{
xftsf] k~hfsf] skmsf] aflx/L efu dfq
;dft]/ la:tf/} cfwf efu -klxnf] xftsf]
h:t}_ km'sfNg] . o;k6s klg k~hfsf]
leqL efu aflx/ k/]/ lg:sG5 .

$_ o;/L cfwf cfwf k~hf km'sfn]kl5 b'O{j6f

xftaf6 la:tf/} k~hfdfq 5f]P/ lgsfNg] .
k~hf ePsf] cf}+nfn] k~hf gePsf] xftsf]
s'g} efu jf 5fnf 5'g x'Fb}g / k~hf
gePsf] cf}+nfn] k~hfsf] leqL efu dfq
5f]P/ k~hf km'sfNg'k5{ .

%_ k|of]u ePsf] k~hf b'if0f lgjf/0f u/]/ dfq]

7Ls 7fpFdf kmfNg] .
;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf $–8
;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf $–8

{
;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 4–7
;]jfsfo{ (clinical procedure) ubf{ k~hfsf] cfjZostf
la/fdLsf] ;fdfGo pkrf/ sfo{ ubf{ jf zNolqmof ubf{ ;'/Iffsf] nflu k|of]u ug{ cfjZostf cg';f/sf]
k~hf tflnsf $=@ df lbOPsf] 5 . Ps k6s k|of]u ul/;s]sf] k~hf k'gM k|of]u ug{ xF'b}g . t/ o;f]
ubf{ cfk'lt{sf] nflu w]/} vr{ nfUg] ePsf] xF'bf clt cfjZos sfo{sf] nflu dfq k|of]u ug'{k5{ .

tflnsf $=@ ;fdfGo pkrf/ / zNolqmof sfo{sf] nflu cfjZos k~hf

k~hfsf] cfjZostf l:jsfo{
ug'{kg]{ sfo{x? k~hf u|fx\otf
5 jf 5}g < k~hf
/Qmrfk hfFRg 5}g
tfkqmd gfKg 5}g
;'O{ nufpg 5}g
/ut tfGg 5 hfFr ug]{ k~hf
/St gnLdf ;'O lb+bf 5 hfFr ug]{ k~hf
of]gLdfu{sf] hfFr ug{ 5 hfFr ug]{ k~hf
cfO=o"=l;=l8= /fVg jf lgsfNg 5 hfFr ug]{ k~hf
ue{ktgkl5 ug]{ pkrf/ -st} 5 hfFr ug]{ k~hf
g5f]O_ sfo{ ubf{
ODKnfG6 /fVg jf lgsfNg 5 lgd{lns/0f u/]sf] k~hf
;fdfGo k|;"lt u/fpFbf 5 lgd{lns/0f u/]sf] k~hf
l;hl/og ;]S;g jf Nofk|f]6f]dL 5 lgd{lns/0f u/]sf] k~hf
zNolqmof ubf{
Eof;]S6f]dL, ldlgNofk jf 5 lgd{lns/0f u/]sf] k~hf
Nofk|f]:sf]kL ubf{
k|b"lift cf}hf/x? ;kmf ubf{ jf 5 afSnf] jf 3/;kmf ubf{ hfFr ug]{
rnfpFbf nufpg] k~hf
b"lift kmf]x/x? 5'g 5 afSnf] jf 3/;kmf ubf{ hfFr ug]{]
nufpg] k~hf
/ut jf z/L/af6 lg:s]sf] 5 afSnf] jf 3/;kmf ubf{ hfFr ug]{
leqL>fj ;kmf ubf{ jf 5'+bf nufpg] k~hf

lgd{lns/0f u/]sf zNolqmofsf] nflu k|of]u ug]{ k~hfx? b'3{6\gfjz k|b"if0f x'g]
lgd{lns/0f u/]sf] k~hf w]/} tl/sfaf6 b"lift x'g;S5 h:t}M
– k~hf Kjfn k/]/ jf RoflQP/ .
– k~hf nufPsf] xftn] cGo lgd{lns/0f gePsf] ;fdfg jf pRr:t/Lo ;+qmd0f lgjf/0f gu/]sf]
;fdfg 5f]P/ .
– lgd{lns/0f u/]sf] k~hf nufPsf] xftdf k~hf gnufPsf] xftn] 5f]P/ .

4–8 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
zNolqmof ubf{ ub}{ nufO/fv]sf] lgd{lns/0f ePsf] k~hf b"lift eof] eg] k'gM k~hf nufpg]
tl/sf
– k~hfsf] skm ;dft]/ l;kmfl/; ul/Psf] tl/sf cg';f/ k~hf km'sfNg] .
– ;xof]uL :jf:YosdL{ -circulating nurse_ n] lgd{lns/0f ePsf] k~hfsf] kf]sf vf]lnlbg] / kf]sf
;kmf ;dtn 6]a'ndf /flvlbg] .
– k~hf nufPsf] csf]{ xftn] k~hfsf] skm ;dflt p7fpg] / 7Ls tl/sf ckgfP/ k'gM k~hf
nufpg] .

j}slNks pkfo
– ;xof]uL :jf:YosdL{n] lgd{lns/0f u/]sf] k~hfsf] kf]sf vf]lnlbg] . k~hf nufP/ zNolqmofdf
efu lnO/x]sf :jf:YosdL{ -:qma g;{_ n] k~hf nufO/x]s} xftaf6 lgd{lns/0f ePsf] k~hf
lemSg] / b'O{ xftaf6 k~hfsf] skm ;dftL v'Nnf ul/lbg] / nufpg'kg]{ lrlsT;s jf :jf:YosdL{n]
aflx/ st} g5f]O{ la:tf/} k~hfdf xft k;fpg] jf nufpg] .
– k~hf nufO;s]kl5 csf]{ k~hf nufPsf] xftn] cfkm} ldnfpg] -Sorensen and Luckman
1979_ -dfly pNn]v ePsf] t/Lsf cg';f/ k~hf nufpg] _

;Demg'xf];\ M zNolqmof ug]{ :jf:YosdL{x?n] lgd{lns/0f ePsf] k~hf nufPkl5 lgd{lns/0f

gu/]sf] cf}hf/ tyf 7fp“x? st} 5'g x'+b}g .

k~hf k|of]u ubf{ Wofg lbg'kg]{ s'/fx?

 ;xL ;fOhsf] k~hf nufpg] ug'{k5{M ;xL ;fOhsf] k~hf gnufPsf] v08df s'g} klg sfo{ ubf{ o;n]
cj/f]w ;[hgf ug]{ u5{ h;n] ubf{ /fd|f] / ;lhnf];Fu sfo{ ug{ ;ls+b}g . ;fy} k~hf klg ;lhn}
RoflQg] jf kmfl6g] x'G5 .
 w]/} ;do nfUg] zNolqmof ubf{ aLr aLrdf k~hf km]g]{ ug'{k5{M lsgeg] Nof6]S; jf /a/sf] k~hfn]
;+qmd0f arfpg] cjlw 5f]6f] x'G5 / cgfjZos tl/sfn] kmf6\g ;S5 / ;+qmd0f x'g;S5 .
 cf}+nfsf] g· 7Ls dfqfdf sf6\g] ug'{k5{M k~hf Rofltg'af6 arfpg gªnfO{ 5f]6f] u/L sf6\g' k5{ .
 olb ufpg nufpg' kg]{ ePdf k~hfsf] skm ufpgsf] afx'nf dfly;Dd nufpg] ug'{k5{ .
 /a/sf] k~hf nufpg] cj:yfdf Eofl;lng, xftdf nufpg] nf];g jf lqmdx? k~hf nufp“bf k|of]u
ug'{ x“'b}g lsgsL oL kbf{yx?n] k~hf sdhf]/ x'g], Rofltg] Kjfn kg]{ x'G5 .
 tfkqmd a9L ePsf] 7fp“df k~hfx? g/fVg] . h:t}M 3fd ePsf] 7fpFdf, lx6/ cufl8, PS;–/] d]lzg
ePsf] 7fpFdf, cN6«fEjfOn]6 nfO{6 ePsf] 7fpFdf . o:tf] 7fpFdf /fVbf k~hf lalu|g ;S5 / k~hfn]
ug]{ arfj6sf] k|efjsfl/tf 36\5 .
;Demg'xf];\M k~hf km'sfn]/ xft wf]O;s]kl5 5fnf km'6\gaf6 arfpgsf] nflu s'g} lrNnf] kbfy{
jf lqmd nufpg ;lsG5 .

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 4–9
4–10 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
 P]lG6;]lK6s, P]lG6;]lK;;\ tyf ls6f0f'
/lxt t/Lsf
ANTISEPTICS, ANTISEPSIS AND ASEPTIC
TECHNIQUE
%
ljifoj:t' M
 k|efjsf/L P]lG6;]lK6sx?
 P]lG6;]lK6s / ;lh{sn P]lG6;]lK;;\ ug{] t/Lsf
 P]lG6;]lK6s b"lift x'gaf6 arfpg]
 ls6f0f' /lxt t/Lsf ckgfpg]

e"ldsf
zNolqmof u/]sf] 7fpFdf ;+qmd0f x'g;Sg] d'Vo sf/0fdf w]/}h;f] :jf:Yo ;+:yfhGo ;+qmd0f -nosocomial)
g} x'g\ . of] w]/}h;f] ;fwg / ;|f]tsf] sdL ePsf] ljz]if u/L ljsf;f]Gd'v b]zx?df w]/} x'g] u/]sf]
kfOPsf] 5 . zNolqmofkl5 3fpdf ;+qmd0f x'g'sf] d'Vo sf/0f la/fdLsf] 5fnfdf ePsf] ;"Id hLjf0f'x?
zNolqmof u/]sf] 3fpdf ;/]/ x'g] u5{ . :jf:Yo ;+:yfhGo ;+qmd0fdf gfs, d'v / Zjf;k|Zjf; gnLaf6
x'g] ;+qmd0f eg] sd kfOPsf] 5 . ;fy} zNolqmof ug]{ lrlsT;s / ;xof]uLsf] xftdf ePsf] ;"Id
hLjf0f'x? zNolqmof u/]sf] 3fpdf ;/]/ klg ;+qmd0f x'g]u5{ .

zNolqmofeGbf cufl8 P]lG6;]lK;;\ ug]{ # j6f tl/sf 5g\ . tL x'g\M

 xft :qma ug]{ / ;kmf ug]{ .
 zNolqmof ug]{ ;d"xn] k~hf nufpg] .
 zNolqmof ug]{ 7fpFdf P]lG6;]lK6s nufpg] .
o:sf] d'Vo p2]Zo zNolqmof u/]sf] 3fpdf ;+qmd0f /f]syfd ug'{ xf] .
xftsf] ;/;kmfO u/]/ PlG6;]lK6s nf]zg jf cNsf]xn ePsf] xftdf nufpg] nf]zgn] AofS6]l/of /
km+ufO{ h:tf lhjf0f'x? sd ePsf] s]xL cWoogx?n] b]vfPsf] 5 -Larson et al 2001 _ .

zNolqmof u/]kl5 3fpdf ;+qmd0f x'g] cGo sf/0fx? lgDg klg x'g ;S5g\M
 ;"Id hLjf0f'x? 3fpdf k:gfn],
 hLjf0f'x?sf] lsl;d / /f]u ;fg]{ Ifdtf cg';f/
 la/fdLsf] /f]u;Fu n8\g] zlQm Ifdtf cg';f/,
 zNolqmof ubf{sf] cjlw -$ 306f eGbf a9L_ jf zNolqmof ug'{eGbf cufl8, c:ktfndf w]/}
nfdf] ;do egf{ eP/ a:bfsf] cj:yf

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 5–1
  ;+qmd0f x'gaf6 arfpg] ;fwgx?sf] /fd|f] k|of]u gul/+bf zNolqmof kl5 3fpdf ;+qmd0f x'G5 .
PlG6;]K6Lsn] 5fnfdf ePsf] lhjf0f'x?nfO{ dfg]{, lgZs[o ug]{ sfd u5{, To;}n] zNos[ofeGbf
klxn] ul/g] PlG6;]K;L;\n] -surgical antisepsis_ zNolqmof ul/Psf] ;dodf ;"Id hLjf0f'x?
;g{af6 arfpF5 . t/ o;n] zNolqmof kl5 x'g] ;+qmd0fnfO{ Tolt arfpFb}g .
kl/efiff
PlG6;]lK6s jf PlG6dfO{qmf]afon P]h]06M of] /f;folgs tTj xf] h'g 5fnfdf jf tGt'x?df k|of]u u/L ;"Id
hLjf0f'x?sf] a[l4 ljsf; /f]Sg], lgZs[o ug]{ jf dfg]{ sfd u5{ . h;n] ubf{ hLjf0f'x?sf] s"n ;+VofnfO{
36fpF5 . h:t}M cNsf]xn, -ethyl or isopropyle_ 8fONo"6 cfof]l8g ;f]n'zg, cfO8f]kmf]/, Snf]/f]x]S;fl8g
/ 6«fOSnf]hf]g x'g\ . :jf:YosdL{x?n] o;sf] k|of]u, k|efjsf/Ltf, kmfObf / a]kmfObfx?af/] k"/f hfgsf/L
/fVg cfjZos x'G5 .
PlG6;]lK;;\M 5fnfdf, Do"s; d]Da|]gdf / z/L/sf] c? tGt'x?df ePsf] ;"Id hLjf0f'x?sf] ;+VofnfO{
PlG6;]lK6s k|of]u u/L 36fpg] k|lqmof xf] .

PlG6;]lK6ssf] 5gf}6
;fwf ;fa'g / ;kmf kfgLn] xft w'+Fbf 5fnfdf ePsf] kmf]x/, w'nf] / ;"Id hLjf0f'x? x6fpF5 / PlG6;]lK6s
3f]nn] ;"Id hLjf0f'x?sf] j[l4 ljsf; /f]Sg] jf dfg]{ u5{ . o;n] efO{/; / AofS6]l/ofnfO{ ;d]t dfg{
;S5 . o;sf] ;fy} s'g} P]lG6;]lK6s 3f]n 5fnfdf nufPkl5, w]/} ;do kl5;Dd klg ;"Id hLjf0f'x?nfO{
dfg{;Sg] Ifdtf ;d]t /fV5 residual effect_ .
w]/}h;f] PlG6;]K6Ls /f;folgs tTjx? ;'/lIft tyf u'0f:t/Lo x'G5g\ . tflnsf %=! df PlG6;]lK6s
3f]nsf] k|sf/, k|efjsfl/tf, sfd / To;sf] k|of]usf] nflu ;'emfj lbOPsf] 5 . w]/}h;f] k|of]u
ug]{ P]lG6;]lK6sdf Snf]/f]x]S;fl8g Un'sf]g]6 k5{, h'g lxaL6]g, lxaL:qma / cfO8f]kmf]/ -la6fl8g_ tyf
a]:sf]8fOg cflbdf kfOG5 .
slxn]sflx+ P]lG6;]lK6s -;fenf]g tyf l86f]n_, cf}hf/ pks/0fx?sf] b"if0f lgjf/0fsf] nflu
k|of]u u/]tfklg Tof] To; sfdsf] nflu agfOPsf] xf]Og . P]lG6;]lK6sdf, /f;folgs l8;OGkm]S6]G6
-Un'6/nl8xfO8\;, xfOkf]Snf]/fO6, tyf k]/f]S;fO8_ df em}+ ;"Id hLjf0fx? dfg{ ;Sg] Ifdtf x“'b}g
/ o;sf] nflu k|of]u ug{ x“'b}g .(Rutala 1996)

P]lG6;]lK6ssf] k|of]u
xftsf] ;/;kmfO{
;+qmd0f x'g] vt/f sd ug{sf] nflu lgoldt xftsf] ;/;kmfO ul/G5 . ;fa'g kfgLn] xft wF'bf xftdf
b]lvg] u/L ePsf kmf]x/x?nfO{ x6fpg] sfd u5{ . PlG6;]K6lsn] xftsf] ;/;kmfO ubf{ xftdf ePsf]
hLjf0f'x?nfO dfg]{ sfd u5{ . kfgL sd ePsf] 7f+pFdf of] Ps j}slNks pkfo xf] / w]/} dxTjk"0f{
x'G5 . ;fy} w]/} la/fdLsf] ;]jf ubf{ w]/} k6s xft w'Fbf xftsf] 5fnfdf ;fa'gsf] c;/ kg]{ x'gfn] klg
PlG6;]K6Lssf] dxTj a9]sf] 5 . xftsf] ;/;kmfOsf] nflu olb xftdf /ut jf s'g} b]lvg] u/L kmf]x/
ePsf] cj:yfdf PlG6;]K6Lsn] xftsf] ;/;kmfO ug{ xF'b}g . o:tf] cj:yfdf ;fa'g kfgLn] g} xftsf]
;/;kmfO ug'{k5{ / PlG6;]K6Ls 3f]nn] xftsf] ;/;kmfO u/]df k|efjsf/L x'G5 . PlG6;]K6Ls 3f]nn]
5fnfdf ePsf] hLjf0f'x?nfO{, ;fa'g kfgLn] ;kmfO{ ubf{ x6fpg g;lsg] lhjf0f'x?nfO{ klg dfg]{ sfd
u5{ .

5–2 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
 tflnsf %=! PlG6;]lK6ssf] sfd / k|of]u
;d"x AofS6]l/of lj?4sf] lqmofsnfk d'Vo k|of]u
u|fd u|fd lqmofzLntfsf] oflGqs ;lh{sn 5fnfsf]
l6=aL efO{/; km+ufO{ OG8f]:kf]/ l6Kk0fL
kf]lhl6e g]u]l6e k|efjsfl/tf k|efj :qmj :qmj
cNsf]xn w]/} /fd|f] w]/} /fd|f] w]/} /fd|f] w]/} /fd|f] w]]/} /fd|f] k|efj l56f] 7Lssf] x'G5 x'Fb}g Do"s; d]Da|]gdff
-^)–()Ü OyfO{n kb}{g ;kmf ug{ k|of]u gug]{
5fnfsf] ;kmfOdf
jf cfO;f]k|f]kfOn_
k|of]u ug{ Tolt /fd|f]
x'b}g
Snf]/f]x]S;fl8g w]/} /fd|f] /fd|f] 7Ls} w]/} /fd|f] 7Ls} k|efj aLrsf] clnslt x'G5 x'G5 o;df /fd|f] / w]/}
-@–$Ü_ -lxaL6]g, kb}g k|efjsf/L 5 t/
cfFvf / sfgsf] nflu
lxaL:qmj_
v/fa u5{ .
cfof]l8gaf6 w]/} /fd|f] w]/} /fd|f] w]/} /fd|f] w]/} /fd|f] /fd|f] 7Ls} aLrsf] b]lvg]u/L x'Fb}g x'G5 Do"s; d]Da|]gdf
agfPsf] -#Ü_ k|of]u ug{nfO{ x'Fb}g
o;n] 5fnf kf]N5
cfO8f]kmf]/ w]/} /fd|f] w]/} /fd|f] 7Ls} /fd|f] /fd|f] k|efj aLrsf] 7Ls}sf] x'G5 x'G5 Do's; d]Da|]gdf
-&=%–!)Ü_ kb}{g k|of]u ug{ ;lsG5 .
-la6fl8g_

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
kf/f–Snf/f] – /fd|f] w]/} /fd|f] 7Ls} /fd|f] l7s} yfxf 5}g l9nf yf]/} x'Fb}g x'G5 5fnfleq hfG5 /
d]6flS;gf]n gjhft lzz'df
k|of]u ug'{ x'Fb}g
-lk=l;=Pd=PS;_
-)=%–$Ü_
6«fOSnf];f]g w]/} /fd|f] /fd|f] 7Ls} w]/} /fd|f] x'Fb}g yfxf 5}g aLrsf] yf]/} x'G5 x'Fb}g xftdf k|of]u ug{
-)=@–@Ü_ ;lsG5 t/ laleGg
tl/sfn] k|of]u
ul/Psf] kfO{G5
Adopted from : Boyce and Pittet 2002; Olmsted 1996

5–3
zNolqmof ug'{ cufl8 5fnfsf] tof/L
5fnfnfO{ lgd{lns/0f ug{ g;lsg] ePklg P]lG6;]lK6s ;f]n'zg nufP/ zNolqmof ug]{ efudf /lx/x]sf]
;"Id hLjf0f'x? h;n] kl5 3fpdf ;+qmd0f km}nfpF5, To:tf] hLjf0f'x?nfO{ dfg{ / sd ug{ ;lsG5 .

lgb]{zg
r/0f !M zNolqmof ug]{ efux?sf] /f}+ vf}l/g' x“'+b}g lsgeg] vf}l/gfn] 5fnfdf ePsf dl;gf Kjfnx?df
;"Id hLjf0f'x? a:g] / a9\g] jftfj/0f agfp5 . To;}n] olb /f}+ vf}l/of] eg] hLjf0f'x? km}lng]
jftfj/0f aG5 / %—!) u'0ff ;+qmd0f x'g] vt/f a9\5 . olb /f}+ sf6\g} k5{ eg] zNolqmof ug{
t'?Gt} cufl8 dfq} s+}rLsf] k|of]u u/L /f}+nfO{ 5f]6f] kfg'{k5{ .

r/0f @M PlG6;]lK6s 3f]n 5fGg' / nufpg' cufl8 PnhL{ l/ofS;g 5 jf 5}g ;f]Wg]
-cfof]l8g_
r/0f #M olb 5fnf jf aflx/L of}gf· kmf]x/ b]lvG5 eg] klxn] ;fa'g kfgLn] ;kmf ug]{ / PlG6;]lK6s
nufpg' cufl8 ;'Vvf ug]{ . tn lbPsf] P]lG6;]lK6sdWo] s'g}klg k|of]u u/] x'G5 t/ l7s
k|ltztsf] x'g'k5{ .
 cfO8f]kmf]/ la6fl8g &=% – !) Ü
 cNsf]xndf agfPsf] cfof]l8g jf Snf]/f]x]S;fl8g
 ^)–()Ü /]lS6kmfO8 l:kl/6
 Snf]/f]x]S;fl8g Un"sf]g]6 @–$Ü
 Snf]/f]x]S;fl8g Un"sf]g]6 / ;]6«Ldfo8 slDtdf @Ü s8f h:t}M -;]enf]g_
r/0f $M pRr:t/Lo ;+qmd0f lgjf/0f jf lgd{lns/0f u/]sf cf}hf/ k|of]u u/L ;'Vvf skf; jf uh
PlG6;]lK6sdf 8'afP/ 5fnfnfO{ ;kmf ug]{ . o;/L ;kmf ubf{ zNolqmof ug]{ efudf klxnf ;'?
u/]kl5 la:tf/} 3'dfpFb} aflx/L efu;Dd ;kmf ug]{ (inner to outward with circular motion) .
h;n] ubf{ aflx/L kmf]x/ leqL efu jf zNolqmof ug]{ efudf ;g{af6 arfpF5 .
r/0f %M zNolqmof ug'{ cufl8 cfjZos dfqfdf PlG6;]lK6s nufpg] s]xL ;do;Dd s]xL gu/L
5f]8\g] -kv{g]_ . h:t} M olb la6fl8g k|of]u u/]sf] 5 eg] @ ldg]6;Dd jf 5fnfdf PlG6;]lK6s
g;'s];Dd To;} 5f]8\g' k5{ . -lsgeg] o:tf] cfof]l8gn] la:tf/} sfd u5{ / k|efjsf/L x'G5
-cfof]l8g lg:sg slDtdf @ ldg]6 nfU5_ . -cfof]l8g nufPkl5 uh jf s6gn] k'5]/ ;'Vvf
gug]{_
gf]6M PlG6;]lK6s la/fdLsf] z/L/d'lg au]sf] 5 eg] Tolts} g5f]8\g';\ lsgeg] o;n] la/fdLnfO{
kf]Ng] jf 5fnfdf Ol/6]zg u/fp“+5 .
kf7]3/sf] d'v tof/ ug]{ lgb]{zg
OG8f]d]l6«Pn afof]K;L ubf{ jf s'g} klg zNolqmof ubf{ klxn] g} PlG6;]lK6s s'g k|of]u ug]{ eGg] lgwf]
ug'{k5{ . o;/L PlG6;]lK6s 5fGbf To;sf] k|efjsfl/tf a'em]/ / kfgLdf 3f]n]sf]nfO{ 5fGg'k5{ h:t}M

5–4 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
cfO8f]kmf]/ -la6fl8g_ jf @–$Ü Snf]/f]x]S;fl8g Un"sf]g]6 jf /fd|f];Fu k|ltzt ldnfPsf] 5 eg] ;]enf]g
klg x'G5 t/ cNsf]xn;Fu 3f]n]sf] P]lG6;]lK6s, h:t}M 8]6f]n k|of]u ug'{ x'Fb}g lsgeg] o;n] 5fnf jf
Do's; d]Da|]gnfO{ c;/ kf5{ / emg a9L ;"Id hLjf0f'x?nfO{ ;zQm x'g / a9fpg d2t k'¥ofpF5 .
o;sf] ;fy} x]S;fSnf]/f]km]g Go"/f]6lS;s ePsf] sf/0fn] of] Do's; d]Da|]gdf -h:t}M e]hfOgn Do'sf];f_
df k|of]u ubf{ t'?Gt ;f];]/ lnG5 . -Larson 1995)
r/0f !M PlG6;]lK6s ;f]n'zg 5fGg'eGbf klxn] la/fdLnfO{ cfof]l8gn] agfPsf] cf}ifwLsf] l/ofSzg
-allergy_ 5 jf 5}g eGg]af/] ;f]Wg] .
r/0f @M olb zNolqmof ug]{ 7fpF h:t} 5fnf jf aflx/L of}gfË kmf]x/ b]lvG5 eg] ;fa'g / ;kmf kfgLn]
w'g ;Nnfx lbg] / PlG6;]lK6s nufpg'eGbf cufl8 ;'Vvf ug]{ .
r/0f #M olb of}gåf/df s'g} pkrf/ jf zNolqmof ug{ nfu]sf] eP klxn] kf7]3/sf] d'vdf PlG6;]lK6s
nufpg] / kl5 of}gfËdf nufpFb} aflx/ Nofpg] t/ aflx/L efu ;kmf 5 eg] pSt efudf
PlG6;]lK6s nufpg' kb}{g .
r/0f $M olb cfO8f]kmf]/ h:t}M la6fl8g k|of]u u/]sf] 5 eg] nufP/ @ ldg]6;Dd ;'Sg lbg] / kl5 dfq
lrlsT;f sfo{ ;'? ug]{ .

;"O{ lbgsf] nflu 5fnfsf] tof/L

;]jfu|fxLnfO{ ;''O{ nufpg'eGbf k"j{ ;'O{ lbg] 7fpFsf] 5fnf kmf]xf]/ eP ;kmf ug'{k5{, olb ;kmf ug'{ k/]df
kfgL / ;fa'gn] w'g] / ;kmf ?dfnn] k'5\g'k5{ . /St gnLdf -IV_ / Therapeutic df;'df -IM_ ;'O{
nufpFbf PlG6;]lK6s k|of]u ug'{k5{ . -WHO best practice for injections and related procedures
toolkit_ PlG6;]lK6s k|of]u ubf{ ;'O{ nufpg] efudf klxnf ;'? u/]kl5 la:tf/} 3'dfpFb} aflx/L efu;Dd
;kmf ug]{ (inner to outward with circular motion) / PlG6;]K6Lssf] sfd ug{ s]xL ;do kv{g] .

PlG6;]lK6s af“8\g] tyf e08f/0f ug]{

P]lG6;]lK6s 3f]ndf b"lift ePsf] ;"Id hLjf0f'x?dWo] :6fkmfOnf]sf]s;, u|fd g]u]l6e Aofl;nfO / s]xL
OG8f]:kf]/ ePsf] x'G5 . b"lift P]lG6;]lK6sn] xft wF'bf jf zNolqmof cufl8 5fnfsf] tof/L ubf{ k6s
k6s ;+qmd0f x'G5 . tn lbOPsf ;fjwfgL ckgfPdf P]lG6;]lK6s b"lift x'gaf6 arfpg ;lsG5 .
 Jofkfl/s b[li6sf]0faf6 geOsg lbgx'F k|of]usf] nflu yf]/} dfqfdf P]lG6;]lK6s emf]n ;fgf]
efF8f]df vgfP/ rnfpg' k5{ . o;n] afkm eP/ p8\g / b"lift x'gaf6 arfpF5 . k|To]s k6s
;fgf] efF8f]df vGofpFbf P]lG6;]lK6s emf]nsf] gfd 7Ls;Fu n]v]sf] kSsf ug'{k5{ . P]lG6;]lK6s
ePsf] efF+8f]df uh jf skf; sf]Rg' xF'+b}g o;n] b"lift agfpg d2t k'¥ofpF5 .
 gofF 3f]n agfpg / P]lG6;]lK6s 3f]n vgfpg] efF8f] ;kmf ug]{ sfo{sf] ;dotflnsf agfpg'
k5{ . P]lG6;]lK6s 3f]n /fv]sf] efF+8f]sf] lasf]{ vf]n]/ g/fVg] . -agfPsf] 3f]n e08f/ u/]sf] Ps
xKtfkl5 b"lift x'Fb} cfpF5 ._
 P]lG6;]lK6s k'gM eg'{eGbf cufl8 efF8f], ;fa'g / ;kmf kfgLn] w'g], pdfn]sf] kfgLn] kvfNg] /
/fd|f];+u ;'Vvf ug]{ .
;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 5–5
  P]lG6;]lK6s k'gM eg]{ efF8f] ;kmf u/]sf], ;'Vvf u/]sf] / k'gM slxn] P]lG6;]lK6s /fv]sf] xf] ldlt
:ki6;Fu n]v]/ 6fF:g] .
 z'4, s8f P]lG6;]lK6s 3f]n lr;f] / cFWof/f] 7fpFdf e08f/0f ug'{k5{ . l;wf 3fd ePsf] 7fpF+
jf a9L tfkqmd ePsf] 7fp+Fdf slxn] klg e08f/0f gug]{, h:t}M l6gsf] 5fgf ePsf] sf]7fdf .

lrq %=!M P]lG6;]lK6ssf] k|of]udf ug]{÷gug]{

b"lift x'gaf6 arfpg

P]lG6;]lK6s ;+e08f/0f
qmd0f /f]syfdu/]
tyfs:jf:Yo
f] ef“+8;+:f]yfhGo
b"liftkmf]xx'/d}gnaf6 arfpgnflu
f Joj:yfkgsf] ;]j;+fGbe{k|bk'fg
l:tsfug]{ ;do P]lG6;]lK6s 3f]n
;fgf] efF8f]df vGofpg' k5{, lsgeg] of] efF8f] slxn] vf]Ng], slxn] aGb ug]{ / af/Daf/ k|of]u ug'{kg]{
x'G5, h;n] ubf{ b"lift x'g] vt/f a9\5 . Ps xKtfkl5 csf]{ k6s efF8f]df P]lG6;]lK6s k'gM eg'{eGbf %–6
cufl8 ;f] efF8f] k"/f pRr :t/Lo ;+qmd0f lgjf/0f ePsf] olsg u/]/ dfq k'gM cf}ifwL eg]{ .

k|To]s k6s ;kmf ubf{, ;'sfpFbf /

k'gM eg]{ sfo{ ubf{ ldlt / ;do
n]v]/ 6fF:g' k5{ .

s'g} pkrf/sfo{ ug'{eGbf cufl8 ;fgf] efF8f]df cfjZos dfqfdf P]lG6;]lK6s 3f]n vGofpg] /
pkrf/ sfo{kl5 afFsL ePsf] 3f]n kmflnlbg] .

5–6 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
 3f]n vGofpFbf k'gM eg]{ efF8f]sf] d'vdf l;;Lsf] d'v jf lasf]{df 5'gaf6 arfpg'
5'g' x'Fb}g / 3f]nn] cfˆgf] xftdf k5{ . lasf]{ vf]Ng] ;dodf Tof] lasf]{ sxfF
skf;df jf uhsf] 6'qmfdf 5'g x'Fb}g . /fVg] eGg] ljrf/ ug'{k5{ . olb lasf]{
o;n] efF8f]df ePsf] ;a} P]lG6;]lK6s b"lift ePsf] 5 / k'gM ;f]xL lasf]{ l;;Ldf
3f]nnfO{ g} b"lift kf5{ . nufOof] eg] ;a} P]lG6;]lK6s 3f]n b"lift
x'G5 .

uh, skf;, skf;sf] 8Nnf], P]lG6;]lK6s 3f]neGbf leGg} /fVg'k5{ . uh, skf;, P]lG6;]lK6s 3f]ndf
/fVbf 3f]n b"lift x'G5 / x'g] ;Defjgf a9L x'G5 . o:tf] uh / skf;df ;"Id hLjf0f'x? a9\g] 7fpF x'G5 .
ha ;"Id hLjf0f'x? :jf:YosdL{sf] xftaf6 jf b"lift cf}hf/x?af6 uh, skf; / P]lG6;]lK6s 3f]ndf
5'G5 ta PlG6;]lK6s 3f]n b"lift x'G5 .

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf] nflu ;+Gbe{ k'l:tsf

%–8

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf] nflu ;+Gbe{ k'l:tsf

%–8

PlG6;]lK6s / l8;OGkm]S6]G6x? lr;f] / cFWof/f] 7fpFdf e08f/0f ug'{k5{ . ;fy} l;wf ;"o{sf] ls/0fdf jf w]/}
tfkqmd ePsf] 7fpFdf g/fVg] lsgeg] o;n] 3f]ndf ePsf] k|efjsf/Ltf 36fpF5 .

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 5–7
ls6f0f' /lxt t/Lsf -aseptic technique)
ls6f0f'/lxt t/Lsf eGgfn] lSnlgsn jf ;lh{sn sfo{ljlw -procedure_ ug'{eGbf 7Ls klxn] jf
sfo{ljlw eO/x]sf] ;dodf ;+qmd0f x'g] hf]lvd sd ug{ ckgfOg] sfo{ xf] . of] sfo{ ckgfpFbf z/L/sf]
ljleGg efudf ;+qmd0f u/fpg ;Sg] lhjf0f'x? k|j]z ug{nfO{ /f]Sg ;lsG5 .

ls6f0f'/lxt t/Lsf eGgfn]M

 zNos[of ul/Fbf ;'/Iffsf 3]/fx? -surgical attire_ k|of]u ug]{
 zNos[ofsf] nflu xftsf] ;kmfO / k~hfsf] k|of]u ug]{
 ;]jfu|fxLsf] tof/L ug]{ -preparation of client or patient)
 zNos[of ubf{ lgd{lns[t 7f+pFsf] :yfkgf ug]{ / o;nfO{ sfod ug]{
 zNos[of ubf{ pko'St t/Lsf ckgfpg]
 zNos[of ug]{ sf]7f ;'/lIft agfpg]

zNos[of ul/“bf ;'/Iffsf pkfox? -surgical attire_ k|of]u ug]{

;'/Iffsf 3]/fx? h:t}M k+hf, df:s, cf+vfsf] ;'/Iffsf] nflu km]; l;N8, ufpg, 6f]kL aGb h'Qfsf] k|of]u
ul/g' zNos[of k"j{ xftsf] ;/;kmfO, lgd{lns[t k+hfsf] ;'/lIft t/Lsfn] k|of]u, PlG6;]K6Lssf] k|of]u
o;sf] u'0fx?, zNos[ofsf] nflu 5fnfsf] tof/Lsf] af/]df of] ;Gbe{ k'l:tsfsf] ljleGg v08df j0f{g
ul/;lsPsf] 5 . of] v08df zNos[of ubf{ lgd{lns[t 7f+pFsf] -sterile field_ :yfkgf ug]{ / o;nfO{
sfod ug]{, zNos[of ubf{ pko'St t/Lsf ckgfpg] / zNos[of ug]{ sf]7f ;'/lIft jgfpg] j0f{g
ul/g]5 .

zNos[of ubf{ lgd{lns[t 7fp“sf] -sterile field_ :yfkgf ug]{ / o;nfO sfod ug]{
zNos[of ug]{ 7fpsf] jl/kl/ lgd{lns[t 8«]K; /fv]/ lgd{lns[t 7fpFsf] :yfkgf ul/G5 . 8«]K; ePsf] 7fpF
eGbf aflx/sf] efudf ;fdfgx? k/]df lgd{lns[t cj:yfdf xF'b}g . lrqdf b]vfP cg';f/sf] 7fpF dfq
lgd{lns[t :yfg x'G5 . lgd{lns[t ufpg / k~hf nufPsf] If]q 5ftLb]lv lgd{lns[t :yfg;Dd x'G5 .
xftsf] afx'nfsf] lgd{lns[t efu s'lxgfeGbf % ;]= ld=b]lv gf/Lsf] skm;Dd x'G5 .

5–8 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
lgd{lns[t If]q sfod ug{ M
 lgd{lns[t If]qdf lgd{lns[t ;fdfg dfq k|of]u ug]{ / lgd{lns[t pks/0f k|of]u u/]sf] JolQmn]
dfq 5'g] ug'{k5{ .
 lgd{lns[t ;fdfgx? vf]Nbf, k|of]u ubf{ / cf];f/ k;f/ ubf{ b'lift x'gjf6 arfpg' k5{ .
 lgd{lns[t ;fdfg cf}hf/x?sf] KofsnfO{ s'g} sf/0fjz 3f]Rof], sfl6of] jf Rofltof] eg] tL
;fdfgx? lgd{lns[t cj:yfdf xF'b}g .
 lgd{lns[t If]q v'Nnf em\ofn, jf 9f]sfsf] glhs} ;]6 ug'{ xF'b}g . ;fdfgx? lgd{lns[t z+sf:kb
ePsf] v08df tL ;fdfgx? b'lift ePsf] dfGg'k5{ .

zNos[of ubf{ pko'St t/Lsf ckgfpg]

zNos[of ubf{ jf lSnlgsn sfo{ljlw ubf{ /ut aUg] / tGt'x?nfO{ rnfpFbf Hofb} g} Wofg k'¥ofPdf
;+qmd0f /f]syfddf ;xof]u k'U5 . zNos[ofsf] qmddf tGt'x?nfO{ w]/} jf clgolGqt t/Lsfn] rnfPdf
jf /St>fj a9L ePdf lhjf0f'x?sf] k|a]z a9L x'G5 / zNos[ofkl5 ;+qmd0f x'g] ;Defjgf a9L x'G5 .

zNos[of sf]7f ;'/lIft agfpg]

 zNos[ofsf] nflu ljz]if k|sf/sf] sf]7fsf] Joj:yf ug'{k5{ .
 zNos[of sf]7fdf ;+qmd0f sd ug{sf] nflu To; If]qdf w]/} dflg;x?sf] k|j]z /f]Sg'k5{ / o;
If]qdf s'g} lsl;dsf] s[ofsnfk klg x'g' xF'b}g o:tf s[ofsnfkn] lhjf0f'x?sf] ;+Vofdf j[l4
x'g;S5 .

;'/lIft jftfj/0f ;[hgf ug{ lgDg sfo{x? ug'{k5{M

 zNos[of ug]{ sf]7fdf cgfjZos dflg;x?sf] eL8 /f]Sg'k5{ . zNos[ofdf ;+nUg JolQmx?eGbf
a9L dflg;x? pSt sf]7fdf k:g lbg' xF'b}g .
 tf]lsPsf] JolQmx? zNosf]7f hfg] cg'dlt lbg'k5{ .
 zNos[of eO/x]sf] ;dodf 9f]sfx? aGb ug'{k5{ .
 zNols|of ubf{ k|of]u ul/g] ;'/IffTds ;fdfu|Lx? h:t}M 6f]kL, df:s, ufpg cflbn] u|fxsnfO{
zNols|of u/]kl5 ;+qmd0fsf] ;DefjgfnfO{ sd u5{g\ .
 cfhsn ;]nkmf]gsf] k|of]u a9L ePsf]n] zNos[of sf]7fdf ;+qmd0f x'g] ;Defjgf x'g] ePsf]n]
;s];Dd o;nfO{ zNos[of sf]7fdf lgif]w ul/g'k5{ . cTofjZos k|of]usf] nflu eg] ljz]if
;fjwfgL ckgfpg' k5{ .
 zNos[of ug]{ qmddf wfl/nf] cf}hf/x? Ps JolQmaf6 csf]{ JolQmnfO{ lbFbf ;f]em} xftdf lbg'
xF'b}g o;sf] nflu Ps leGb} ljz]if ;'/lIft 7fpF tf]Sg'k5{ h:t}M s'g} Ps ls8\gL l8; jf ljz]if
7fpF . o;sf] nflu zNos[of ;xof]uLn] ljif]z 7fpFaf/] ;]jf k|bfos jf ;h{gnfO{ atfOPsf]
x'g'k5{ . h;n] ubf{ ;]jf k|bfosn] pSt ;fdfgx? ljz]if 7fpFaf6 lng] / k|of]ukl5 ;f]xL 7fpFdf
/fVg] ug'{k5{ .

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 5–9
  zNolqmof ug]{ sf]7f aGb /fVg], w'nf] l5g{ / lemËf / cGo ls/fx? k:g lbg' xF'b}g . olb
ls/fx?sf] ;d:of 5 eg] slDtdf xKtfsf] Ps lbg -sfd gug]{ lbgdf_ ls/f dfg]{ cf}iflwx?
5ls{g' k5{ . ;fy} sf]7f k|z:t k|sfz ePsf] x'g'k5{ . sfd gePsf] a]nfdf sf]7fsf] tfnf aGb
/fVg'k5{ .
 zNos[of ug]{ sf]7fdf ;Dej eP;Dd Pc/ slG8;g/sf] -Air conditioner_ Joj:yf ug'{k5{,
olb k+vf /fVg' k/]df :6f08 km\ofg -stand fan_ /fVg'k5{ .
 zNolqmof ug]{ sf]7fsf] eF'OnfO{ ;kmf ug{, ;lhnf] agfpgsf nflu 6fOn jf l;d]G6 Knfi6/
u/]sf] x'g'k5{ .
 zNolqmof sf]7fleq cgfjZos cf}iflwx?, cf}hf/x? / ;fdfgx? e08f/ ug'{ xF'b}g .
 em\ofnx? e'FO{af6 !=* dL6/ -^ lkm6_ dfly x'g'k5{ .
 x/]s k6s jf k|To]s lj/fdLsf] ;]jf lbg] sfd ;lsgf;fy, zNolqmofsf] 6]jn )=% k|ltzt
Snf]l/g 3f]nn] k'5\g'k5{ .
 lj/fdLsf] ;]jf lbg] sfd ;lsPkl5 x/]s lbgsf] cGtdf 6]jn j/k/sf] e"O{ / b'lift x'g] cGo
;+efljt If]qx?, h:t}M aQLsf] Xof08n tyf sfpG6/sf] dflyNnf] efux?nfO{ )=% k|ltzt
Snf]l/g 3f]nn] k'5\g'k5{ .
 k|To]s lbgsf] ljxfg s'g} sfo{ ug'{eGbf klxn] zNolqmof sf]7fsf] eF"OnfO{ kfgLn] lehfPsf] dkn]
-eF"O ;kmf ug]{ sk8fsf] dk_ / 6]a'nnfO{ kfgLn] lehfPsf] sk8fn] k'5g'k5{ .
 zNolqmof sIfnfO{ sDtLdf xKtfsf] Ps rf]6L /fd|/L ;kmf ug'{k5{ . -thorough scrubbing_

PseGbf a9L dfqf ePsf] efOnsf] -multidose vial) k|of]udf Wofg lbg'kg]{ s'/fx?M
efOn r'lxPsf], efOnsf] cf}iflw wldnf] jf s'g} lsl;dsf] kbfy{ gePsf] Plsg ug'{k5{ . -;fdfGotof
o:tf efOndf cf}iflw ;kmf x'G5_ efOnaf6 cf}iflw lemSg'eGbf klxn] efO{nsf] 6fpsf]nfO{ ^) b]lv
() k|ltzt cNsf]xndf -xfn} agfPsf] l:kl/6 :jfa_ skf;n] ;kmf ug{'k5{ / ;'Vvf ug'{k5{ . o:tf]
efOnaf6 cf}iflw lgsfNbf k|To]s k6s gofF+ l;of]sf] k|of]u ug'{k5{ . w]/} k6s k|of]u ug{ Pp6} l;of]
efOndf 3';fO /fVg] sfd slxNo} ug'{xF'b}g . of] ;'/lIft t/Lsf xf]Og o;f] u/]df k|To]s k6ssf] k|of]udf
lhjf0f'x?nfO{ k|j]z ug{ ;f]em} af6f] aG5 .
-;|f]tMOGh]08/ x]Ny OGkm]S;g lk|e]G;g XofG8a's . k|hgg\ :jf:Yosf] nflu lrlsT;f dfkb08 @)!)_

l;of] / cGo wfl/nf cf}hf/x?af6 x'g] rf]6k6ssf] Joj:yfkgM

olb k|of]u ul/;s]sf l;of] jf cGo wfl/nf] cf}hf/x?af6 rf]6k6s nfu]df jf /ut jf z/L/sf] leqL
>fjx?sf] l56f cf+vf, d'v jf 3fp tyf rf]6k6s nfu]sf] 7fpF+ k/]df lgDg pkfox? ckgfpg'k5{ .
x]kf6fO6L;\ aL sf] ;+qmd0f /f]syfdsf] nflu ;Dk"0f{ :jf:YosdL{ tyf ;xfos sd{rf/Lx?n]
x]kf6fO6L; lj?4sf] vf]k nufPdf /fd|f] x'G5 .

5–10 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
l;of]n] 3f]r]df, 3fp nfu]df jf 5fnf v's]{df -5fnfleq l56f k;]df_ M
 ;fa'g / kfgLn] /fd|f];+u ;kmf ug]{
 3fp nfu]sf] 7fpF+df kfgL l5g{ g;Sg] lgd{nLs/0f u/]sf] Aof08]h nufpg]
 olb z+sf nfu]df tLg dlxgfkl5 /ut k/LIf0f ug]{ .
 c+fvf of d'vleq l56f k/]df
 au]sf] k|z:t kfgLn] /fd|f];+u kvfNg]
 w]/}h;f] lj1x?sf] cg';f/ hlt w]/} kl/df0fdf /ut b'lift x'G5, ;+qmd0f x'g] ;+efjgf klg Tolt
g} a9L x'G5 . To;}n] hlQ ;Sof] rf+8} k|fylds pkrf/ ;'? ug'{k5{ / ;s];Dd z/L/leq k/]sf]
/ut jf z/L/sf] >fj /fd|/L kfgLn] kvfn]/ x6fpg' k5{ .
5fnf 5]8]/ x'g] ;Dk"0f{ b'3{6gfx?sf] nfluM
lj/fdL jf u|fxsnfO{ /utaf6 ;g]{ ;+qmd0f ePsf] kSsf ePsf] v08df ;+qmd0f x'g] ;+efjgfnfO{
sd ug{ post exposure prophylaxis measures ckgfpg ;lsG5 . oL arfj6sf pkfox?
af/] yk hfgsf/L kfpgsf] nflu lhNnf :jf:Yo clws[t jf post exposure prophylaxis af/]
hfgsf/L ePsf]] ljz]if1;+u t'?Gt} ;/;Nnfx lng'k5{ .

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 5–11
5–12 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
 k|of]u ePsf cf}hf/x? tyf cGo
;fdfgx? k|zf]wg ug]{ ?k/]vf
OVERVIEW OF REPROCESSING USED
INSTRUMENTS AND OTHER ITEMS
^
ljifoj:t'M
 b"lift cf}hf/x?, k~hf tyf cGo k'gM k|of]u x'g;Sg] ;fdfgx? k|zf]wg ug]{ t/Lsf
 b"lift ;fdfgnfO{ 5'Fbf cfkm' ;'/lIft x'g To;nfO{ )=%Ü Snf]l/g 3f]naf6 b"if0f lgjf/0f ug]{ ljlw
 k|zf]wgsf ug]{ ljlw k|of]u
sfo{If]qdf ;+qmd0f/lxt jftfj/0f ;[hgf ug{, c:ktfnsf sd{rf/Lx? h:t} :jf:Yo sfo{stf{x?,
;kmf ug]{ tyf Joj:yfkg ug]{ ;a} txsf sd{rf/Lx?n] l;kmfl/; ul/Psf k|To]s ;+qmd0f /f]syfd
ljlwx? ckgfpgsf] sf/0f a'‰g' dxTjk"0f{ x'G5 .

e"ldsf
b"lift cf}hf/x? tyf k'gM k|of]u x'g;Sg] cGo ;fdfgx?af6 ;?jf /f]u ;g{ ;Sg] s'/fnfO{ sd ug{
b"if0f lgjf/0f ug]{, ;kmf ug]{ tyf lgd{nLs/0f jf pRr:t/Lo ;+qmd0f lgjf/0f h:tf cfwf/e"t ;+qmd0f
/f]syfd ljlwx? l;kmfl/; ul/Psf] 5 . zNolqmofTds pks/0fx? tyf cGo ;fdfgx?sf] k|zf]wg ug]{
lqmofTds ljlw tyf r/0fx?sf] ;DaGwdf lrq ^=! df pNn]v ul/Psf] 5 . zNolqmof cyjf invasive
medical procedure ul/;s]kl5 / k~hf nufO/fv]sf] a]nfdf g} lrlsT;s cyjf ;xfosn] b"lift
j:t'x? -uh jf sk8f jf cGo kmf]x/ j:t'x?_ nfO{ gr'lxg] lasf]{ ePsf] efF8f]df /fVg'k5{ . csf]{ s'/f,
kmfNg'kg]{ wfl/nf tyf ltvf j:t'x? -h:t}M :sfNk]n An]8, tyf ;'r/ gL8n_ nfO{ wfl/nf] j:t' /fVg]
efF8f]df /fVg'k5{ . cGtdf ;a} cf}hf/ tyf k'gM k|of]u ePsf ;fdfgx? h:t}M zNolqmofdf k|of]u ePsf
cf}hf/x? tyf ;fdfgx?nfO{ !) ldg]6;Dd )=%Ü Snf]l/g 3f]ndf lehfP/ b"if0f lgjf/0f ug'{k5{ . xftn]
;kmf ul/g'kg]{ ;fdfgx?sf] nflu b"if0f lgjf/0f k|lqmofsf] ljz]if dxTj /xG5 -Nystrom 1981_ .
b"if0f lgjf/0f ul/;s]kl5 pks/0fx? tyf k'gM k|of]u x'g] ;fdfgx?nfO{ qmdzM ;fag' tyf kfgLn]
;kmf ug]{, k"0f{ ?kdf w'g] tyf ;'sfpg] ug'{k5{ . zNolqmofdf k|of]u ul/g] cf}hf/x? tyf /ut cyjf
tGt'x?;Fu ;Dks{df /xg] -hl6n ;fdfgx?_ j:t'x?nfO{ To;df ePsf ;a} lsl;dsf lhjf0f'x?nfO{
-bacterial endospores_ dfg{ lgd{nLs/0f ug'{k5{ .
-ha lgd{nLs/0f ug]{ pko'Qm cj:yf 5}g jf pks/0f pknAw 5}g eg] pRr :t/Lo ;+qmd0f lgjf/0f
-high level disinfection_ t/Lsfaf6 pdfn]/, jfliks/0f u/]/ jf /f;folgs ;+qmd0f lgjf/s 3f]ndf
8'afP/ pRr :t/Lo ;+qmd0f lgjf/0f ug'{ dfq j}slNks l:jsf/ of]Uo tl/sf xf] . pks/0fx? tyf
cGo ;fdfgx?n] Zn}l:ds lemNnL -mucous membrane_ jf RoflQPsf] 5fnfnfO{ 5f]Psf] dfq ePklg
To;nfO{ pRr:t/sf] ;+qmd0f lgjf/0f ug'{ cfjZos 5 .

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 6–1
 ;Demg'xf];\ M nfdf] ;do;Dd afliks/0f jf pdfn]/ jf pRr:t/sf] ;+qmd0f lgjf/s 3f]ndf @)
ldg]6;Dd 8'afP/ klg OG8f]:kf]/ ls6f0f' k"0f{?kdf gfz ePsf] x“'+b}g . sd{rf/Lx?n] pRr :t/Lo
;+qmd0f lgjf/0fsf] l;ldttfnfO{ ;ts{tfsf ;fy lng'kb{5 .

;fdfgx? k|zf]wg ug{sf] nflu lgb]{zg

b"lift wft'sf cf}hf/x? jf zNolqmofdf k|of]u ul/Psf cGo ;fdfgx?nfO{ ljz]if ?kdf ;Dxfn]/ /fVg'
k5{ . o;nfO{ k|zf]wg ugf{n]M
 ;/;kmfO{ ug]{ sd{rf/LnfO{ /ut tyf z/L/af6 lg:sg] t/n kbfy{ ;kmf ubf{ x'g;Sg] cfsl:ds
b'3{6gfsf]] vt/f sd x'G5 .
 pRr u'0f:t/sf] ;fdfg pknAw x'G5 -h:t}M lgd{nLs/0f jf pRr:t/Lo ;+qmd0f lgjf/0f ePsf
pks/0fx? tyf cGo ;fdfgx?_ .
:jf:Yo pkrf/ ;]jf s]Gb|x?df k|of]u x'g] cf}hf/x?, pks/0f tyf cGo ;fdfgx?nfO{ k|zf]wg ug{sf
nflu tf]lsPsf lgb]{zgx? tflnsf ^=$ df 5f]6s/Ldf lbOPsf] 5 . o; tflnsfdf klxnf] sf]nddf
k|zf]wg ug'{kg]{ ;fdfgx?sf] ;"lr 5 eg] csf]{ b'O{ sf]ndx?df k|To]s ;fdfgnfO{ b"if0f lgjf/0f /
;kmfO{ ug]{ eGg] af/] j0f{g ul/Psf 5g\ . clGtd b'O{ sf]ndx?df cfjZos k/]sf] v08df ;fdfgx?nfO{
lgd{nLs/0f jf pRr:t/Lo ;+qmd0f lgjf/0f ug]{ cj:yfx? b]vfPsf] 5 .
Tff]lsPsf] lgb]{zgx? 7Ls t/Lsfn] kfngf u/]sf] v08df la/fdLx? tyf :jf:Yo pkrf/ s]Gb|sf
JolQmx?nfO{ zNolqmofsf cf}hf/x?, pks/0fx? tyf cGo ;fdfgx?af6 ;+qmd0f km}ng] ;DefjgfnfO{
/f]Sg /fd|f] 6]jf k|bfg ub{5 .

b"if0f lgjf/0f k|lqmof

b"if0f lgjf/0f k|lqmofn] zNolqmof cf}hf/x?df /xg] ;"Id ls6f0f'o'Qm b"if0fsf] dfqf 36fPsf] ljleGg
cWoogn] b]vfPsf] 5 . To;}n] xftn] ;kmf ug'{kg]{ cf}hf/x? tyf cGo ;fdfgx? ;kmf ug]{ sd{rf/LnfO{
cfsl:ds ?kdf x'g;Sg] ;+qmd0fsf] vt/f sd ug{ b"if0f lgjf/0f k|s[of ckgfpg l;kmfl/; ul/Psf]
5.
lrq ^=! df b]vfP cg';f/ b"lift cf}hf/ tyf cGo ;fdfgx?nfO{ k|zf]wg ug]{ klxnf] r/0f g} b"if0f
lgjf/0f k|lqmof xf] . ;fdfgx?nfO{ ;kmf ug'{cl3 tL ;fdfgx?nfO{ )=%Ü Snf]l/g 3f]ndf !) ldg]6;Dd
8'afP/ b"if0f lgjf/0f ug'{ dxTjk"0f{ 5 . of] r/0f Pr=aL=eL=, Pr=;L=eL= / Pr=cfO{=eL= nfO{ dfg]{ sfo{
ub{5 / tL ;fdfgx? ;kmf ug]{ JolQmnfO{ ;g{af6 ;'/lIft ub{5 .

6–2 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
 lrq ^=!Mcf}hf/x?, zNolqmofsf k~hfx? tyf cGo ;fdfgx?sf] k|zf]wg k|lqmof
lrq ^=!Mcf}hf/x?, zNolqmofsf k~hfx? tyf cGo ;fdfgx?sf] k|zf]wg k|lqmof
b"if0f lgjf/0f ug{
)=%Ü k|ltzt 3f]ndf !) ldg]6 8'afpg]

;fdfgx? k"0f{?kn] w'g] tyf ;kmf ug]{

;'/IffTds ;fwfgx?sf] k|of]u ug]{

/fd|f] tl/sf l:jsf/of]Uo tl/sf

lgd{nLs/0f k|lqmof pRr:t/sf] ;+qmd0f lgjf/0f tl/sf

/f;folgs c6f]Sn]e ;'Vvf tfk pdfn]/ jf /f;fogaf6

lgd{nLs/0f !)^ s]=kL=P= rfk -!% !&) l8= ;]= jfliks/0f
kfp08sf] k|];/ k|lt O{~r_ tl/sfaf6 ;fO8]S; @Ü
;fO8]S; ^) ldg]6 df@) ldg]6
@Ü(gluterald !@! l8=;] - @%) ljsf]{ nufPsf] 8'afpg]
ehyde) df !) l8=km=_ga]l/Psf] efF8f]df @)
306f ;Dd ;fdfgnfO{ @) ldg]6 / ldg]6;Dd @) ldg]6;Dd
pDn]sf] kfgLn]
lgd{nLs[t kfgLn] a]l/Psf] ;fdfgnfO{ #)
;kmf ug]{
dfq ;kmf ug]{ ldg]6

lr;f] kfg]{
t'?Gt k|of]u ug]{ jf e08f/ ug]{

b"if0f lgjf/0f ul/g] tTjx?

;f]l8od xfOkf]Snf]/fO8af6 ag]sf Snf]l/g 3f]n b"if0f lgjf/0fsf] nflu w]/} lqmoflzn / k|efjsf/L tTj
xf] ;fy} kfp8/ / rSsLsf] ?kdf klg Snf]l/g pknAw x'g] ub{5, . )=%% Snf]l/g agfpg] t/Lsf lgDg
5g\M

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf ^–3
;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 6–3
tflnsf ^=! Snf]l/g sG;G6«]6]8 ;f]n'zgaf6 8FONo"6 ;f]n'zg agfpg] ;"qM

 Snf]l/g 3f]n agfpFbf Snf]l/gsf] dfq -Ü df_ slt k|of]u ePsf] 5 egL hfFRg] .
 k"/f cfjZos kfgLsf] efu slt eg]/ tnsf] ;"q k|of]u u/L lgsfNg] .

s"n kfgLsf] dfqf  kfgLdf ld;fpg k|of]u ul/g] Snf]l/g 3f]nsf] Ü – !

rfxgf cg';f/sf] Snf]l/g 3f]nsf] Ü

 cfjZos kfgLsf] dfqfdf Ps efu Snf]l/g 3f]n ld;fpg]

pbfx/0f %Ü Snf]l/g 3f]naf6 -)=%Ü_ Snf]l/g 3f]n agfpg

%=)Ü
r/0f ! M cfjZos kfgLsf] dfqf lgsfNg] )=%Ü – !  !) – !  (

r/0f @ M ( efu kfgLdf ! efu Snf]l/g ld;fpg] .

ahf/df kfOg] ljleGg k|ltztsf] Snf]l/g -;'Vvf kfp8/_af6 )=!Ü / )=%Ü Snf]l/g 3f]nx? agfpg
nueu slt dfqf -u|fddf_ rflxG5 eGg] s'/f tflnsf ^=! df ;"lrs[t ul/Psf 5g\ . s'g} klg Snf]l/g
kfp8/sf] dfqfaf6 Snf]l/g 3f]n agfpg] ;"q tflnsf ^=@ df b]vfOPsf] 5 .
gf]6 : ljZj :jf:Yo ;+u7g -!(*(_ n] pks/0fx? tyf To;sf ;txx?df ;kmf ug'{ cl3 )=%Ü Snf]l/g
3f]n ld;fP/ tL ;fdfgx?nfO{ b"if0f lgjf/0f ug{ l;kmfl/; u/]sf] 5 lsgeg] 3f]n agfpg ;kmf kfgL pknAw
gePsf] x'g;S5 . o;sf] ;fy} b"lift ;fdfgx?df s8f /f]u lgDTofpg] ;"Id ls6f0f'x? cyjf cGo z/L/sf
tTjx? -/ut jf z/L/af6 lg:sg] t/n kbfy{x?_ sf] ;Defjgfn] ubf{ b"if0f lgjf/0fsf] nflu )=%Ü Snf]l/g
3f]nn] To:tf ;+qmd0f x'gaf6 w]/} ;'/Iff k|bfg u5{ -tietjen and macIntosh 1989_ . Pr= Pn=8L= (HLD)
sf] nflu pdfn]sf] / lkmN6/ u/]sf] -pknAw ePdf_ kfgLdf )=!Ü Snf]l/g 3f]n /fv]/ 3f]n tof/ ug{ ;lsG5 .
tflnsf ^=@ ;'Vvf Snf]l/g kfp8/af6 Snf]l/g 3f]n agfpg] ;"q
 k|of]u ul/g] Snf]l/g kfp8/sf] efu -Üdf_ hfFr ug]{ .
 tnsf] ;"q k|of]u u/L cfjZos lAnr kfp8/ -u|fddf_ lgsfNg] .
u|fd÷ln6/  Snf]l/g 3f]nsf] k|ltzt – !))
Snf]l/g kfp8/sf] k|ltzt
 ! ln6/ kfgLdf gflkPsf] lAnr kfp8/sf] efu ld;fpg] .
pbfx/0f M snf]l/g kfp8/ -#%Ü_ af6 Snf]l/g 3f]n -)=%Ü_ agfpg

)=%Ü
r/0f !M u|fd÷ln6/ lx;fa lgsfNg] M #%Ü – !))  !$=@ u|fd÷ln6/

r/0f @ M ! ln6/ kfgLdf !$=@ u|fd - !$ u|fd_ ld;fpg] .

6–4 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
 ]
lrq ^=@ Snf]l/g 3f]n agfp“+b} u/]sf]

)=%%
Snf]l/g 3f]n

Snf]l/g 3f]n agfpg k~hf ;lxt c? klx/g nufO{ tof/ ePsf] .

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf ^–5

!^) u|fdsf] Snf]l/gsf] a§f lng]

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 6–5
 kfgL ePsf] ef+8f]df Snf]l/g kfp8/ vGofO ldnfp+b} u/]sf] .

Snf]/Lg 3f]n agfPkl5 @$ 3G6f;Dd dfq k|of]u ug{ ;lsG5 . olb @$ 306fleq g} k|of]u
ul//x]sf] Snf]/Lg 3f]nsf] /ª kl/jt{g ePdf csf]{ 3f]n agfpg' kb{5 .

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf ^–6

)=% k|ltzt Snf]l/g 3f]n tof/ ePsf] .

Snf]l/g rSsLx? (Sodium dichloroiscyanurate) df Snf]l/gsf] dfqf !=% u|fd k|lt rSsL
ePdf Ps ln6/ kfgLdf ^ rSsL /fVbf )=%% Snf]l/g 3f]n aG5 .

b"if0f lgjf/0fsf l6K;\x?

b"if0f lgjf/0fsf] ug{sf] nflu Knfli6s efF8f] k|of]u ugf{n] lgDg s'/fx? /f]syfd ug{ d2t u5{g\ .
wft'sf] efF8f];Fu ;Dks{ x'Fbf tLvf, wfl/nf j:t'x?sf]] -h:t}M s}+rLx?_ wf/ sd x'g] .
olb wft'sf] ef8f]df b"if0f lgjf/0f u/]df b'O{j6f km/s wft'x?sf] aLr /f;folgs k|lts[ofn]
ubf{ pks/0fx?df lvof nfU5 .

6–6 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf

;Demg'xf];M
 ;Demg'xf];\M b"if0f lgjf/0f k|lqmofsf] p2]Zo /f;folgs k|ltlqmofjf6 (On]S6«f]nfOl;;\_ zNolqmofdf
k|of]u x'g] pks/0fx? tyf cGo ;fdfgx? 5'g] JolQmx?nfO{ ;+qmd0faf6 arfpg' xf] . o:tf
;+qmd0fx? s8f /f]ux?af6 /ut tyf z/L/af6 lg:sg] t/n kbfy{x?sf] ;Dks{af6 nfU5 .
b"if0f lgjf/0f k|lqmofkl5 pks/0fx?nfO{ ;kmf ug'{cl3 To;df /x]sf b]lvg] vfnsf h}ljs tTjx?
x6fpg t'?Gt lr;f] kfgLn] w'g'kb{5 . h;sf] nflu :jf:Yo ;+:yfx?n] k|zf]wg If]qdf cyjf zNolqmof
sf]7fx?df @ j6f efF8f]x? /fVg'kb{5, h;dWo] Pp6fdf )=%Ü Snf]l/g 3f]n / csf]{df kfgL x'G5 lsgeg]
pks/0fx?nfO{ Snf]l/g 3f]ndf !) ldg]6;Dd 8'afPkl5 k'gM kfgLdf /fVg ;lsof];\ . o;n] ubf{ lvof
nfUgaf6 arfpg s]xL xb;Dd d4t k'Ub5 t/ klg pks/0fx?nfO{ kfgLdf ! 306feGbf a9L To;}
/fv]df lvof nfUg;S5 .
/ut tyf z/L/sf t/n kbfy{sf] ;Dks{df cfPsf, k]lNes hfFr cyjf zNolqmofdf k|of]u x'g] 7"nf]
;tx ePsf 6]a'nx?nfO{ b"if0f lgjf/0f ug'{k5{ / ;fdfgx?nfO{ k'gM k|of]u ug'{eGbf cufl8 klg b'if0f
lgjf/0f ug{'kb{5 o;sf] nflu pko'Qm b'if0f lgjf/s )=%Ü Snf]l/g 3f]n k|of]u ug'{kb{5 . o;/L
;txx?nfO{ / ;fdfgx?nfO{ b"if0f lgjf/0f ug]{ t/Lsf ;lhnf] tyf sd vlr{nf] pkfo xf] .
pks/0f tyf ;fdfgx?nfO{ b"if0f lgjf/0f u/]kl5 tL ;fdfgx?nfO{ ;'/lIft ?kdf k|zf]wg ug{ ;kmf
ul/G5 / cGtdf lgd{nLs/0f jf pRr:t/sf] ;+qmd0f lgjf/0f k|lqmof ckgfpg' kb{5 .
gf]6M w]/}h;f] ;kmf ul/g] ;fdfgx?df Pdf]lgof /xG5 h;n] AnLr;“u k|ltlqmof ug{;S5 . o;sf]
sf/0fn] ljiffn' w'“jf (toxic fumes) pTkfbg u5{ . To;}n] s'g}klg ;kmf ul/g] ;fdfgx?df
P]df]lgof ePsf] 5 ls eg]/ hf“r ug]{ . -slxn]sfxL+ efF8f] vf]n]/ Pdf]lgof ;“+'3]/ klg yfxf kfpg
;lsG5 ._

;fdfgx? ;kmf ug]{

;fdfgx?nfO{ ;kmf ug'{ dxTjk"0f{ 5 lsgeg],
 pko'Qm tl/sfn] ;kmf gubf{ ;fdfgx? g t k|efjsf/L ?kdf lgd{nLs/0f x'G5 g t pRr:t/sf]
;+qmd0f lgjf/0f g} ePsf] x'G5 -kf]6{/ !(*&_ .
 ;fa'g tyf ;kmf kfgLn] k"/f wF'+bf h}ljs tTjx? h:tf] /ut tyf z/L/sf t/n kbfy{x?nfO{1 x6fpg
;lsG5 . ;'Vvf h}jLs j:t'x?df OG8f]:kf]/;\ ;lxt ;"Id hLjf0f'x? /xg] ePsf]n] of] ;kmfO{ k|s[of
dxTjk"0f{ 5 . olb ;fdfgx?sf] h}ljs j:t'x? /fd|/L ;kmf ePg eg] lgd{nLs/0f jf pRr:t/Lo
;+qmd0f lgjf/0f k|lqmofdf afwf k'¥ofpg' ;fy} sd k|efjsf/L agfpF5 -AORN 1992, Rutallaetal
1998_ .

k|efjsf/L ?kdf ;kmf ug{sf] nflu ;fa'g k|of]u ug'{ dxTjk"0f{ x'G5 lsgeg] kfgLn] dfq k|f]l6g, t]nLo
kbfy{ tyf u|LhnfO{ x6fpg ;ls+b}g . pknAw ePdf emf]n ;fa'g k|of]u ug'{ /fd|f] x'G5 lsgeg] c?
!
olb wf/fsf] kfgL b"lift 5 eg] !) ldg]6;Dd pdfn]sf] kfgL k|of]u ug]{ / s]xL j:t'x? x6fpg lkmN6/ ug]{ -pknAw
ePdf_ cyjf )=))!Ü sf] clGtd 3f]n agfpg 8fONo"6 AnLr ;f]n'zg -;f]l8od xfOkf]Snf]/fO6_ af6 pkrf/ ul/Psf]
Snf]l/g]6]8 kfgL k|of]u ug]{ .

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 6–7
;fa'g tyf kfp8/eGbf of] emf]n ;fa'g kfgLdf ;lhn} 3'N5 . o;sf] ;fy} emf]n ;fa'gn] u|Lh, t]n /
cGo j:t'sf] ;ld>0fnfO{ 5'6\ofpF5 / kufN5 jf kG5fpF5 . o;n] ubf{ tL ;fdfgx? ;kmf ubf{ To:tf
j:t'x? ;lhn} x6fpg ;lsG5 .
;fdfgx? ;kmf ug{ s8f vfnsf] ;kmf ug]{ kfp8/ h:t}M eLd kfp8/ jf sf]d]6_ jf l:6n hfnLsf]
k|of]u ug'{ x“'b}g lsgeg] o;n] ;fdfgx?nfO{ sf]g{ ;S5 jf wft'nfO{ lvofpg] sfo{ ug{;S5 . olb
;fdfgx? sf]l/Pdf To:tf sf]l/Psf 7f“pdf ;"Id hLjf0f' /xg] 7fp“ kfp“5 h;n] ubf{ ;kmf ug{
w]/} ufx|f] x'g'sf ;fy} lvof nfUg] ;Defjgf a9\b5 .
tflnsf ^–# df b]vfP h:t} /ut tyf cGo h}jLs j:t'x?df /xg] w]/}h;f] ;"Id hLjf0f'x? -*)Ü ;Dd_
;kmf ubf{ x6]/ hfG5 . o;af6 of] s'/f lglZrt x'G5 ls ;fdfgx?nfO{ k"0f{?kdf ;kmf ug'{ cfjZos
x'G5 / zNolqmof sfo{sf] nflu ;'/lIft ;fdfgx? k|fKt x'G5 .

tflnsf ^=# ;fdfgx? k|zf]wg ug{sf] nflu k|efjsf/L t/Lsfx?

k|efjsf/L
t/Lsf cGtdf
-;"Id ls6f0f''nfO{ dfg'{ jf x6fpg'_
b"if0f lgjf/0f Pr=aL=eL=, Pr=cfO{=eL= / w]/}h;f] !) ldg]6 8'afpg] .
;"Id ls6f0f'nfO{ df5{ .
;kmf ug]{ -kfgLn]_ %)Ü ;Dd ;kmf gb]lvP;Dd .
;kmf ug]{ -;fa'g *) Ü ;Dd ;kmf gb]lvP;Dd .
tyf kfgLn] w'g]_
pRr:t/sf] ;+qmd0f (%Ü -Og8f]:kf];{ dfg]{ sfd @) ldg]6;Dd pdfn]/, jfliks/0f u/]/
lgjf/0f ub{}g_ jf /;folgs tl/sfaf6 .
lgd{nLs/0f !)) Ü pRr rfksf] jfkm, ;'Vvf tfk jf
/f;folgs tl/sfsf] nflu l;kmfl/;
ul/Psf] ;do .
;fdfgnfO{ wf]O -wash_, kvfnL -rinse_ ;'Vvf ug'{k5{ . k"0f{ ?kdf kfgLn] ;kmf ubf{ ;fa'gsf cjz]if
x6\g'sf ;fy} lgd{nLs/0f jf pRr:t/Lo ;+qmd0f lgjf/0f k|s[ofnfO{ k|efjsf/L agfpF5 . vf;u/L olb
tL ;fdfgx?nfO{ /f;folgs ;+qmd0f lgjf/s k|of]u u/]/ lgd{nLs/0f jf pRr:t/sf] ;+qmd0f lgjf/0f
ug'{ 5 eg] tL ;fdfgx? wf]O;s]kl5 ;'sfpg' jf k'5\g'k5{ . kfgLsf] c+z afFsL /x]sf ;fdfgx? -h:t}M
zNolqmofdf k|of]u x'g] cf}hf/x?_ 3f]ndf ldl;+bf k|zf]wg sfo{ ljkmn x'G5 .
gf]6M df]6f] k~hf nufP klg, wfl/nf ;fdfgx? w'“bf xftdf sf6\g] jf ;'Ox?n] 3f]Rgaf6 aRg
;ts{ x'g'k5{ .
;kmfO{sf l6K;\x?
 ;fdfgx? tyf pks/0f ;kmf ubf{ k~hfx? nufpg] . -df]6f] cyjf 3/df sfd ubf{ nufpg] k~hf
/fd|f] x'G5 ._ olb Tof] RofltPsf] jf Kjfn k/]sf] jf lau|]sf] eP To;nfO{ kmfNg'k5{ .

6–8 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
 cfFvf tyf z/L/df b"lift t/n kbfy{x?sf] l56f kg]{ vt/fnfO{ sd ug{ ;fdfgx? tyf pks/0fx?
;kmf ubf{ cfFvfnfO{ ;'/lIft ug]{ -cg'xf/ 5f]Kg] kf/bzL{ df:s, rZdf cyjf lzzfx?_ tyf
Knfli6ssf] Pk|f]g nufpg'k5{ .
l56f kg]{ ;Defjgfaf6 aRg ;fdfgx? ;kmf ubf{ kfgLsf] ;txd'lg /fv]/ ;kmf ug{'kb{5 .
 ;fdfgx?nfO{ ;fa'g kfgLdf g/d a|'zn] w'g'k5{ .
 ;fdfgx? ;kmf ubf{ To;sf] bfFtL, hf]gL{ cyjf k]rx?df ljz]if Wofg lbg'k5{ hxfF h}jLs j:t'x?
hDdf ePsf] x'g;S5 . ;kmf ul/;s]kl5 ;fa'gsf cjz]if x6fpg ;fdfgx?nfO{ k"0f{?kdf ;kmf
kfgLn] w'g'k5{ . o;f] gu/]df pRr:t/Lo ;+qmd0f lgjf/0f jf lgd{nLs/0f k|lqmof k|efjsf/L x'Fb}g .
 /a/ / Knfl:6s 6\o"a h:t} lzz'x?sf] nflu k|of]u ul/g] gf;f]Uofl:6s ;Szg 6\o"laËnfO{ k'gM k|of]u
ug{nfO{ klxnf b"if0f lgjf/0f u/L k"0f{ ?kdf ;kmf ug]{, w'g] tyf ;'sfpg] ug'{k5{ .
 cf]/n jf /]S6/ ydf]{dL6/ ;kmf ul/;s]kl5 slxNo} klg ld;fpg' x'Fb}g . ltgLx?nfO{ 5'§f5'§} efF8f]df
/fVg'k5{ .
Nofkf/f]:sf]K;\nfO{ clGtd k|zf]wg ug]{ sfo{df :ofEnf]g k|of]u gug]{ lsgeg] of] pRr:t/sf]
;+qmd0f lgjf/s xf]Og / To;sf n]G; wldnf] klg x'g;S5 .
;fdfgx?nfO{ s;/L b"if0f lgjf/0f ug]{ / ;kmf ug]{af/] tn lbOPsf ;fdfgx?sf] nflu yk r/0fj4
lgb]{zgx? lbOPsf] 5 .
 n'uf tyf cGo ;fdfgx?
 zNolqmofsf cf}hf/x?
 ;'O{x? h:t} 9f8sf] kfgL lemSg] l;of] -lumber pucture needle)
 Nofk|f]:sf]K;\
cf}hf/x?nfO{ lgd{nLs/0f ug{'sf] nflu ;kmf ul/;s]kl5 Kofs ug]{ jf 5'§f5'§} kf]sfdf a]g'{ kb{5 .

;kmf ug]{ r/0fx?

 cf}hf/ tyf cGo ;fdfgx? ;kmf ubf{ 3/df k|of]u ug]{ k~hf, Knf:6Lssf] Pk|f]g df:s / cfFvfnfO{
;'/lIft ug]{ j:t' nufpg] .
 g/d a|'z jf 6'ya|z, l86h]{G6 tyf kfgL k|of]u u/L cf}hf/ tyf cGo ;fdfgnfO{ /fd|/L 3f]6\g]
tfls ;a} /ut, z/L/sf t/n kbfy{, tGt' tyf cGo j:t'x? k"0f{?kdf x6]sf] x'g'k5{ . cf}hf/ tyf
cGo ;fdfgnfO{ 3f]6\bf jf ;kmf ubf{ l56f kg]{ ;Defjgfaf6 aRg To;nfO{ kfgLsf] ;txd'lgaf6
;dfTg'k5{ . 5'l§Psf cf}hf/x? tyf cGo w]/} v08x? ePsf ;fdfgx?sf] s'gfsfKrf, bfFtL tyf
hf]gL{x?df a|'zn] ;kmf ug'{k5{ . hxfF h}jLs j:t'x? hDdf ePsf] / 6fF;]sf] x'g;S5 .
 ;a} k|sf/sf] l86h]{G6nfO{ x6fpg cf}hf/ tyf cGo ;fdfgx?nfO{ k"0f{?kdf ;kmf kfgLn] w'g] .
 cf}hf/ tyf cGo ;fdfgx?nfO{ xfjfdf ;'sfpg] jf ;kmf ?dfnn] k'5/] ;'sfpg] . -/f;folgs
pRr:t/sf] ;+qmd0f lgjf/0f ug'{cl3 cf}hf/ tyf cGo ;fdfgnfO{ ;'sfpg'k5{ . kfgLsf] c+z
/f;folgs 3f]ndf ldl;+bf To;sf] k|efjsf/Ltf sd x'G5 ._

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 6–9
gf]6gf]
M 6M pRr:t/sf] ;+qmd0f lgjf/0f ug'{kg]{ cf}hf/ tyf cGo ;fdfgx?nfO{ pdfn]/ jf jfliks/0f ubf{ klxnf
;'sfpg' cfjZos 5}g .

lrq
lrq^=%M
^=%M;kmf
;kmfug]ug]
{ ljlw
{ ljlw

s= g/d a|'zn] l86h]{G6 kfgLsf] ;txd'lg cf}hf/ 3f]6\b} ;kmf ul//x]sf] .

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf ^–11

v= l86h]{G6 x6fpg ;kmf kfgLn] cf}hf/ w'+b} u/]sf] .

u= ;'Vvf ?dfnn] cf}hf/ k'5]/ xfjfdf ;'sfp+b} u/]sf] .

6–10 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
 tflnsf ^=$ cf}hf/x?, zNolqmofsf k~hf tyf cGo ;fdfgx?nfO{ k|zf]wg ug{sf] nflu yk lgb]{zgx?
ljlw ÷k|lqmof k|of]u ePsf ;fdfgnfO{ 5+'bf ;a} k|sf/sf] b]lvg] /ut, lgd{nLs/0fn] ;a} k|sf/sf] pRr:t/sf] ;+qmd0f lgjf/0f
b"if0f lgjf/0f ug'{ klxnf] r/0f z/L/sf t/n kbfy{ tyf OG8f]:kf];{ /x]sf ;a} ;"Id tl/sfn] ;a} efO/;,
xf] . o;n] Pr=aL=eL=,Pr=;L=eL= kmf]x/ j:t' ;kmf u/]/ hLjf0f'x? gi6 u5{ . AofS6]l/of, Kof/f;fO6;,
/ Pr=cfO=eL= efO/; hLjf0f'sf] x6fpg] . km+ufO{ df5{ .
vt/f 36\5 .
cf}hf/ jf cGo ;fdfgx? b"if0f lgjf/0f k|lqmof ;kmfO{ lgd{nLs/0f pRr:t/sf] ;+qmd0f lgjf/0fv
Pc/j]h\ -Knfl:6s_ ;kmf ug{sf] nflu )=% Ü Snf]l/g ;fa'g kfgLn] ;kmf ug]{ . cfjZos 5}g . cfjZos 5}g .
3f]ndf !) ldg]6;Dd 8'afpg] . ;kmf kfgLn] wf]O xfjf jf
;kmf ?dfndf ;'sfpg] .
PDa' Aofu / l;=lk=cf/= ;txx?df ^)–()Ü cNsf]xn jf ;fa'g kfgLn] ;kmf ug]{ . cfjZos 5}g . cfjZos 5}g .
km]; df:s )=%Ü Snf]l/g 3f]nx?df 8'afPsf] ;kmf kfgLn] wf]O xfjf jf
uh Kof8n] ;kmf ug]{ / t'?Gt} ;kmf ?dfndf ;'sfpg] .
w'g] .
Pk|f]g -afSnf] Knfli6s jf )=%Ü 3f]nn] ;kmf ug]{ . ;kmf emf]n ;fa'g kfgLn] ;kmf cfjZos 5}g . cfjZos 5}g .
/a/sf]_ kfgLn] w'g] . k|To]s ljlw jf k|To]s ug]{ . kmf]xf]/ b]lvPdf To;

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
k6ssf] aLrdf ug'{k5{ . sfo{lbgsf] cGtdf ;kmf
kfgLn] ;kmf u/L xfjf jf
?dfndf ;'sfpg] .
a]8 Kofg, o"l/gn jf cfjZos 5}g a|'z k|of]u u/L ;+qmd0f cfjZos 5}g . cfjZos 5}g .
Od]l;;\ a]l;g lgjf/s 3f]n - ;fa'g /
)=%Ü Snf]l/g_ n] ;kmf ug]{
/ ;kmf kfgLn] w'g] .

6–11
6–12
cf}hf/ jf cGo ;fdfgx? b"if0f lgjf/0f k|lqmof ;kmfO{ lgd{nLs/0f pRr:t/sf] ;+qmd0f lgjf/0fv
An8 k|];/ skm olb /ut jf z/L/sf t/n kmf]x/ b]lvPdf ;fa'g cfjZos 5}g . cfjZos 5}g .
kbfy{af6 b"lift ePdf )=%Ü kfgLn] ;kmf ug]{ . ;kmf
Snf]l/g 3f]ndf 8'afPsf] uh Kof8 kfgLn] wf]O{ xfjf jf
jf sk8fn] k'5\g] . ?dfndf ;'sfpg] .
kl/If0f tyf zNolqmof )=%Ü Snf]l/g 3f]nn] k'5\g] . b"if0f lgjf/0f u/]kl5 cfjZos 5}g . cfjZos 5}g .
sf]7fsf] 6]a'n jf cGo 7"nf h}jLs j:t'x? afFls /x]df
;tx ePsf ;fdfgx? ;fa'g kfgLn] w'g] .
-sf6{;\ / :6«]r/_
v'§fdf nufpg] -/a/sf] )=%Ü Snf]l/g 3f]nn] w'g] . ;kmf emf]n ;fa'g kfgLn] w'g] . cfjZos 5}g . cfjZos 5}g .
h'Qf jf a'6_ kfgLn] kvfNg] . kmf]x/ b]lvPdf kmf]x/ b]lvPdf lbgsf]
lbgsf] cGtdf of] sfo{ ug]{ . cGtdf ;kmf kfgLn] kvfNg]
tyf xfjf jf ?dfndf
;'sfpg] .
IUCD / inserters pko'Qm 5}g . pko'Qm 5}g . l;kmfl/; ul/Psf] l;kmfl/; ul/Psf] 5}g .
-slxNo}klg k'gM k|of]u 5}g . w]/}h;f] cfO=o"=l8= /
gug]{_ Og;6{/x? lgd{nLs/0f u/]sf]
Kofs]hdf cfpF5 . Kofs]6
lauf/]kl5 To;nfO{ kmflnG5 .
Nofkf/f]:sf]k ^)–()Ü cNsf]xndf lehfPsf] ;fdfgsf] v08x? 5'6\ofP/ /f;folgs lgd{nLs/0faf6 @) ldg]6;Dd lehfpg] M
uh Kof8n] ;txx?df k'5\g] / a|'z k|of]u u/L ;fa'g ;fdfgnfO{ b}lgs lgd{nLs/0f  Un"6/lN8xfO8 -@–Ü_
t'?Gt kvfNg] . kfgLn] ;kmf ug]{ . ;kmf ug]{ . lehfpgsf] nflu – jf
kfgLn] kvfNg] / ?dfndf Un"6/lN8xfO8 ;fO8]S;  )=!Ü Snf]l/g 3f]n,
;'sfpg] . pdfn]/ lkmN6/ u/]sf]
kfgLdf

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
 cf}hf/ jf cGo ;fdfgx? b"if0f lgjf/0f k|lqmof ;kmfO{{ lgd{nLs/0f pRr:t/sf] ;+qmd0f lgjf/0f
-@Ü_ df !) 306f;Dd agfPsf] -pknAw ePdf_ @)
ldg]6;Dd pdfn]sf] kfgLn] #
k6s kvfNg] .
lk=lk=O= -Sofk, df:s, cfjZos 5}g . ;fa'g tyf tftf] kfgLn] w'g] cfjZos 5}g . cfjZos 5}g .
se/ufpg_ ;kmf kfgLn] kvfnL xfjf
jf d]lzgaf6 ;'sfpg] . k'gM
k|of]usf] :qL u/]/ k6\ofP/
e08f/ ug]{ .
:6]y]:sf]k ^)–()Ü cNsf]xndf lehfPsf] kmf]x/ b]lvPdf ;fa'g kfgLn] cfjZos 5}g cfjZos 5}g
uh Kof8n] k'5\g] . w'g] . ;kmf kfgLn] kvfnL xfjf
jf ?dfndf ;'sfpg
cf}hf/x? -wft' jf Knfl:6s_ ;kmf ug{nfO{ !) ldg]6;Dd )=%Ü ;fa'g kfgLn] w'g] . ;kmf  !&)l8=;]=-#$)l8=;]_ :jLsf/ of]UoM
e08f/ ul/Psf efF8f]x?sf] Snf]l/g 3f]ndf lehfpg] . t'?Gt} kfgLn] kvfNg] / xfjf jf tfkqmd k'u]kl5 ! efF8f] tyf 9sgLnfO{ @)
nflu w'g] / kvfNg] . ?dfndf ;'sfpg] . 306f;Dd ;'Vvf tfkdf ldg]6;Dd pdfNg] . olb efF8f]
jf w]/} 7"nf] ePdf–

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
 !@!l8=;] -@%)l8=km_  efF8f]df )=%Ü Snf]l/g
/ !)^ Kpa -!%lbs/in2_ 3f]n eg]{ / @) ldg]6;Dd
df ga]l/Psf] ;fdfgnfO{ 8'afpg] .
@) ldg]6;Dd c6f]Sn]e  @) ldg]6 pdfn]sf] kfgLn]
ug]{ . -a]l/Psf] ;fdfgsf] ;kmf ug]{ / k|of]u ug{'eGbf
nflu #) ldg]6;Dd_ klxn] xfjfdf ;'sfpg] .
;Szg aNj -/a/sf]_ ;kmf ug{nfO{ )=%Ü Snf]l/g ;fag' kfgLn] w'g] . ;kmf cfjZos 5}g . cfjZos 5}g .
3f]ndf !) ldg]6;Dd lehfpg] . kfgLn] kvfn]/ xfjf jf
To;nfO{ t'?Gt w'g] tyf kvfNg] . ?dfndf ;'sfpg] .

6–13
6–14
cf}hf/ jf cGo ;fdfgx? b"if0f lgjf/0f k|lqmof ;kmfO{ ug'{ lgd{nLs/0f pRr:t/sf] ;+qmd0f lgjf/0f
Dofg'Pn Eofs'd Pl:k/]zg ;kmf ug{nfO{ )=%Ü Snf]l/g 3f]ndf ;a} j:t'x? x6\g] u/L # l;kmfl/; ul/Psf] 5}g . @) ldg]6;Dd jfliks/0f jf
-Pd=eL=P_sf] nflu ;Szg !) ldg]6;Dd lehfpg] . To;nfO{ k6s;Dd Sofg'nfdf ;fa'g -c6f]Sn]leË jf ;'Vvf tfk pdfn]/ .
Sofg'nf t'?Gt w'g] tyf kvfNg] . kfgL k7fpg] . cf]egaf6 tfk lb+bf Sofg'nf
-Knfl:6ssf]_ v/fa x'g;S5 ._
;lh{sn ufpg, sk8f cfjZos 5}g . -kmf]x/ sk8f ;fa'g tyf tftf] kfgLn] w'g] !@)l8=;]= -@%)l8=km_ / Jojxfl/s 5}g .
;dfTbf n08«Lsf sd{rf/Lx?nfO{ . ;kmf kfgLn] kvfnL xfjf !)^ Kpa - !% lbs/in2_
;'/lIft ug]{ vfnsf] Knfli6s jf d]lzgdf ;'sfpg] . df #) ldg]6;Dd c6f]Sn]e
Pk|f]g, k~hf tyf v'§f / ug]{ .
cfFvfnfO{ ;'/lIft ug]{ ;fwg
nufpg] .
;lh{sn cf}hf/x? -wft'sf]_ ;kmf ug{nfO{ !) ldg]6;Dd a|'z k|of]u u/L ;fa'g k|fyldstfof]Uo :jLsf/of]UoM
= )=%Ü Snf]l/g 3f]ndf 8'afpg] kfgLn] w'g] . ;kmf kfgLn]  !&)l8=;]-#$)l8=km_  @) ldg]6;Dd jfliks/0f
t'?Gt} kvfNg] jf w'g] . kvfNg] . lgd{nLs0f ug'{ tfkqmd k'u]kl5 ! jf pdfn]/
5 eg] xfjf jf ?dfndf 306f;Dd ;'Vvf  @) ldg]6;Dd /;folgs
;'sfpg] / Kofsdf jf tfkdf jf pRr:t/sf] ;+qmd0f
5'§f5'§} lt ;fdfgnfO{ a]g]{ .  !@!l8=;]-@%) lgjf/sdf lehfpg] .
pdfn]sf] kfgLdf /fd|f]l;t
l8=km_ tfkqmddf
kvfNg] tyf k|of]u ug'{
c6f]Sn]e ug]{ . !)^
cl3 jf e08f/ ug'{ cl3
Kpa -!%lbs/in2_ df @)
xfjfdf ;'sfpg] .
ldg]6c6f]Sn]e ug]{ .

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
 cf}hf/ jf cGo ;fdfgx? b"if0f lgjf/0f k|lqmof ;kmfO{ lgd{nLs/0f pRr:t/sf] ;+qmd0f lgjf/0f
==qmdz -a]l/Psf] ;fdfgsf] nflu
;lh{sn cf}hf/x? -wft'sf]_ #) ldg]6;Dd_ wfl/nf
cf}hf/x?nsf] nflu M !^)
l8=;]-#@)l8=km_ tfkqmddf
k'u]kl5 @ 306f;Dd ;'Vvf
tfklbg]
ydf]{dL6/ l8lh6n dfq cfjZos 5}g . ;+qmd0f lgjf/s 3f]nn] cfjZos 5}g . cfjZos 5}g .
k'5\g] . -;fa'g / )=%Ü
Snf]l/g_ ;kmf kfgLn] w'g] /
xfjf jf ?dfndf ;'sfpg] .
kmf];]{K; (chittle) / efF8f] ;kmf ug{nfO{ )=%Ü Snf]l/g a|'z k|of]u u/L ;fa'g k|fyldstfof]Uo -wft'dfq_ :jLsf/of]UoM -/a/ / wft'_
-wft'_ 3f]ndf !) ldg]6;Dd 8'afpg] kfgLn] ;kmf ug]{ . ;kmf  !&)l8=;]-#$)l8=km_  @) ldg]6;Dd jfliks/0f
/ t'?Gt kvfNg] jf w'g] . kfgLn] kvfNg] lgd{nLs/0f tfkqmd k'u]kl5 ! jf pdfn]/
-k|To]s k6ssf] k|of]u kl5 jf ug'{ 5 eg] xfjf jf 306f;Dd ;'Vvf @) ldg]6;Dd /;folgs
kmf]x/ b]lvPkl5 of] k|lqmof k'gM ?dfndf ;'sfpg] . tfkdf jf pRr:t/sf] ;+qmd0f lgjf/sdf

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
bf]xf]¥ofpg] ._  !@!l8=;]-@%)l8=km_ lehfpg] . pdfn]sf] kfgLdf
tfkqmddf c6f]Sn]e ug]{ /fd|f]l;t kvfNg] tyf k|of]u
. jf ug'{ cl3 jf e08f/ ug'{ cl3
 !)^ Kpa -!%lbs/in2_ xfjfdf ;'sfpg] .
df c6f]Sn]e ug]{ .
-a]l/Psf] ;fdfgsf] nflu
#) ldg]6;Dd / gj]l/Psf]
;fdfgnfO{ @) ldg];Dd
c6f]Sn]e ug]{_

6–15
6–16
cf}hf/ jf cGo ;fdfgx? b"if0f lgjf/0f k|lqmof ;kmfO{{ lgd{nLs/0f pRr:t/sf] ;+qmd0f lgjf/0f
Sofy]6/ -/a/ jf l;;f ;kmf ug{nfO{ )=%Ü a|'z k|of]u u/L ;fa'g k|fyldstfof]Uo :jLsf/of]Uo -/a/ jf wft'_
wft'sf]_ Snf]l/g 3f]ndf !) kfgLn] ;kmf ug]{ . leq  !^)l8=;]-#@)l8=km_ tfkqmd @) ldg]6;Dd jfliks/0f jf
ldg]6;Dd 8'afpg] / aflx/ b'a}tkm{ ;kmf k'u]kl5 @ 306f;Dd ;'Vvf tfkdf pdfn]/ .
t'?Gt kvfNg] jf w'g] . kfgLn] # k6s kvfNg] -/a/ Sofy]6/nfO ;'Vvf tfkdf
. /fVbf uNg ;S5_jf
 !@!l8=;]-@%)l8=km_ tfkqmddf
c6f]Sn]e ug]{ jf
 !)^ Kpa -!%lbs/in2_ df c6f]Sn]e
utg]{ .
 -a]l/Psf] ;fdfgsf] nflu #)
ldg]6;Dd / gj]l/Psf] ;fdfgnfO{
@) ldg];Dd c6f]Sn]e ug]{_
e]lG6n]6/ 6\o"ljË jf ;ls6 cfjZos 5}g . a|'z k|of]u u/L ;fa'g c6f]Sn]e jf ;'Vvf tfk cf]eg k|of]u :jLsf/of]UoM
kfgLn] ;kmf ug]{ . ug{ ;Dej 5}g . @) ldg]6;Dd jfliko jf
;kmf kfgLn] kvfNg] / /;folgs lgd{nLs/0f . pdfn]/ .
xfjfdf ;'sfpg] . k|of]u ug'{ cl3 xfjfdf
;'sfpg] .
s_ ga]l/Psf] ;fdfg t'?Gt k|of]u ug]{, a]l/Psf] ;fdfgx?df olb Kofs u/]sf] lalu|Pdf jf b"lift ePdf k'gM k|zf]wg ug]{ .
v_ olb lgd{nLs/0f -;'Vvf tfk jf c6f]Sn]e_ pknAw 5}g eg] lt ;fdfgx?nfO{ pdfn]/ jf jfliks/0f tl/sfaf6 jf /f;folgs
;+qmd0f lgjf/sdf lehfP/ pRr:t/sf] ;+qmd0f lgjf/0f ug{ ;lsG5 .
u_ cf}hf/x?df lvof nfUg] / /a/ jf sk8fsf ;fdfgx? lau|gaf6 arfpg )=%Ü eGbf a9L Snf]l/g 3f]ndf @) ldg]6eGbf a9L nfdf]
;do P]S;kf]h gug]{ . -g8'jfpg]_
3_ sfuh jf Knfl:6s ufpg, 6f]kL jf df:snfO{ kmfNgsf] nflu Knfl:6ssf] emf]nf jf gr'lxg] lasf]{ ePsf] kmf]x/ kmfNg] efF8f]df /fVg] .

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
ª_ wfl/nf] cf}hf/x? cyjf ;'O{x? !^) l8=;]= eGbf a9L tfkqmddf lgd{nLs/0f ug'{ x'Fb}g o;f] u/]df o:sf] wf/ sdhf]/ x'G5 .
 lgd{nLs/0f
STERILIZATION &
ljifoj:t'M
 lgd{nLs/0f ug]{ ;fwf/0f tl/sfx?
 lgd{nLs[t ;fdfgx?sf] e08f/

lgd{nLs/0f k|lqmofn] JofS6]l/on OG8f]:kf];{ ;lxt cGo ;Dk"0f{ ;"Id hLjf0f'x?nfO{ df5{ .

e"ldsf
zNolqmofdf k|of]u x'g] pks/0fx? tyf /ut jf z/L/leqsf tGt'x?;+u k|ToIf ;Dks{df cfpg] cGo
cf}hf/x? lgd{nLs/0f k|s[of u/]/ dfq k|of]u ug'{k5{ . -spaulding 1939_ of] k|s[of pRr rfksf
jfliks/0f, -steam sterilization jf autoclave_ ;'Vvf tfk / -dry heat sterilization_ /f;folgs
lgd{nLs/0f -chemical sterilization_ af6 ug{ ;lsG5 . lgd{nLs/0fsf] -sterilization_ nflu ul/g]
k|s[ofx? ckgfpFbf o;sf ;a} cj:yfx? ;xL 9+un] k"/f ePs} x'g'k5{ .

k|efjsf/Ltf
lgd{lns/0f k|s[of k|efjsf/L x'g ;xL ;do cjlw, ;Dks{, tfkqmd x'g cfjZos x'G5 eg], jfliko
lgd{nLs/0fsf] nflu dfly pNn]v ePsf s'/fx?sf] ;fy} pRr rfksf] klg cfjZostf k5{ .

s'g}klg lgd{nLs/0f k|lqmof k|efjsf/L x'gsf] nflu cGo rf/ cj:yfx?df klg e/ kb{5
 ;"Id hLjf0f'sf] k|sf/M s]xL ;"Id hLjf0f'x?nfO{ dfg{ w]/} ufx|f] x'G5 eg] cGonfO{ ;lhn}] dfg{
;lsG5 .
 ;"Id hLjf0f'x?sf] ;+VofM w]/} ;'Id hLjf0f'x?nfO{ dfg{ eGbf Pp6fnfO{ dfg{ w]/} ;lhnf] x'G5 .
 cf}hf/x?df ePsf ;"Id hLjf0f'sf] dfqfM 7Ls tl/sfn] ;kmf gePsf pks/0fx?df /ut /
tGt'x? 6f+l:;P/ a;]sf] 5 eg] To;n] ;"Id hLjf0f'x?sf] nflu /Ifssf] ?kdf sfd u5{ .
 rls{Psf] tyf s'gfsfKrf ePsf pks/0fdf ;"Id hLjf0f'x? n's]/ a;]sf] x'G5 M ;fdfgx?sf]
leqL efu tyf ;fdfg rls{Psf], sf]/]sf] tyf bfFt ePsf] cf/L h:tf] vf]+rleq ;"Id hLjf0f'x?
/x]sf x'g;S5g\ .
gf]6M /fd|f];Fu ;kmf gu/]sf] b"lift j:t'x? /x]sf pks/0fx? nfdf] ;do;Dd lgd{nLs/0f k|s[of
u/]klg ;"Id hLjf0f'x? lhljt} /x]sf] x'g;S5 .

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 7–1
tfkåf/f lgd{nLs/0f ug]{ tl/sfx?
 pRr rfk ljlw -c6f]Sn]e_ k|of]u u/]/ lgd{lns/0f ul/G5 . of] ljlw cf}hf/ tyf pks/0fx?sf]
lgd{nLs/0f ug]{ Ps k|efjsf/L / pQd ljlw xf] . ljB'tsf] ;d:of ePsf] 7fpFdf cGo OGwgsf]
;xfotfn] tfksf] >f]t lgsfnL pks/0fx?nfO{ ljgf ljB'lto tl/sfaf6 klg lgd{nLs/0f ug{
;lsG5 .
;Demg'xf];\M ha cf}hf/ tyf pks/0fx? pRr rfksf] jfkm c6f]Sn]eåf/f lgd{lns/0f ul/G5,
To;a]nf ;a} efudf jfkm k'Ug' cTofjZos 5 .

lrqlrq
&=! &=!
lrq &=!
 ;'Vvf tfkåf/f lgd{nLs/0f ug]{ tl/sf cf];o'Qm df};ddf /fd|f] x'G5 t/ ljB'tsf] cfk"lt{ lg/Gt/
x'g cfjZos ePsf]n] ljB'tsf] cfk"[lt lg/Gt/ gx'g] 7fFpx?df Jojxfl/s gx'g ;S5 . ;'Vvf
tfk lgd{nLs/0fdf pRr tfkqmdsf] cfjZostf ePsf] x'gfn] Unf; jf wft'sf j:t'x? dfq
k|of]u ug{ ;lsG5 . c? j:t'x? kufNg ;S5 .
lgd{nLs[t pks/0f tyf cGo ;f.dfgx? k|of]u ubf{ Wofg lbg'kg]{ s'/fx? :
 lgd{nLs/0fsf] nflu ;'tL sk8fsf] bf]xf]/f] kqn] a]l/Psf] -double layer_ x'g'k5{ .
 lgd{nLs[t ;fdfgx? 9sgL /fd|f];Fu sl:;Psf] efF8f]df e08f/ ul/g'k5{ / oL ;fdfgx? t'?Gt} k|of]u
ug{ jf ! xKtf;Dd k|of]u ug{ ;lsG5 . kf]sf] gkf/]sf] v'Nnf ;fdfg ePdf t'?Gt k|of]u ug'{k5{ .
a]l/Psf pks/0f tyf cGo ;fdfgx?df jfkm k|zf/0fsf] nflu k|of]u ul/g] j:t'df k|z:t l5b|x? x'g'k5{
t/ w"nf]sf s0fx? tyf ;"Id hLjf0f'af6 arfpg sl:;P/ a'lgPsf] sk8f g} kof{Kt x'G5 . a]l/Psf]
lgd{nLs[t kf]sfx?sf] ;fdfg a]l/Psf] efu RoflQPdf, kf]sfx? leh]df jf cGo sf/0fn] efF8f]df ;"Id
ls6f0f'x? k|j]z ug{ ;S5g\ . olb ;fdfgx? b'lift gePsf] v08df & lbg;Dd lgd{lns[t cj:yfdf
/x]sf] olsg x'G5 .
;+qmd0f /f]
;+qs yfd
md0f /f]styf :jf:Yo
yfd tyf :jf:Yo ;+;+::yfhGo
yfhGo kmf]kmf]
x/d}xn/d} nf Joj:yfkgsf
f Joj:yfkgsf nflu ;Gbe{nflu
k'l:tsf;Gbe{ k'l:tsf &–2

7–2 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
 tfkåf/f lgd{nLs/0fsf] nflu lglZrt cj:yfx?
lgd{nLs/0f eO;s]sf] pks/0fx? d]l;gaf6 lemSg' cufl8 ;'Vvf x'g' h?/L 5 .
gf]6M rfk ldnfg -lgd{nLs/0f ug]{ ;fwgsf] k|of]ucg';f/ kpa jf lbs/in2 df s]lx km/s x'g;S5 . ;Dej
ePdf pTkfbssf] l;kmfl/;nfO{ cg'z/0f ug'{xf];\ _
jfliko lgd{nLs/0f M tfkqmd !@!l8=;]= -@%)l8=km_, rfk !)^l8=;]=-!% l8=km_ df v'Nnf ;fdfgsf]
nflu @) ldg]6, kf]sf] kfl/Psf] ;fdfgsf] nflu #) ldg]6 cfjZos k5{ .
;'Vvf tfk
 !&)l8=;] #$) l8=km df ! 306f -cf]egdf /fv]sf] hDdf ;dodf ! 306fsf] nflu !&) l8=;] /
To;kl5 @ b]lv @=% 306faf6 lr:ofpg] cyjf
 !^)l8=;] -#@)l8=km_ @ 306f -hDdf ;do # b]lv #=% 306f_
;Demg'xf];\
 sterilizer lglZrt tfkqmdf k'u]kl5 dfq PS;kf]h/ ;do ;'? x'G5 .
 lgd{nLs/0f ug]{ ;fwgdf cf]e/nf]8 ug'{ x'Fb}g . ;fdfgx? tyf :6/LnfOh/sf] leQfsf] aLrdf
slDtdf &=% ;]=dL= -# O{~r_ vfnL 5f]8\g'k5{ . cf]e/nf]8n] tfk kl/jt{g ug]{ x'gfn] lgd{nLs/0f
ug{ a9L ;do nfU5 .
>f]t M kls{G;\ 1983

jfliko lgd{nLs/0f
;fdfGo l;4fGtx?
jfkmåf/f lgd{nLs/0f ug'{ b'O{ tl/sfaf6 k|efjsf/L x'G5 . tflko zlQmdf ;'Vvf tfkeGbf jfkmåf/f
ul/g] tl/sf w]/} u'0ff a9L k|efjsf/L 5 . vfgf ksfpg] k|];/ s's/df cfn' s]xL ldg]6df g} ksfpg
;lsG5 hasL pRr tfkqmddf ;'Vvf tfksf] cf]eg k|of]u ubf{ klg ! 306feGbf a9L ;do nfU5 .
vf;u/L jfik k|lqmofdf rfksf] sf/0fn] cfn'nfO{ w]/} l56f] tflko pmhf{ -thermal energy_ k|fKt x'G5 .
hasL tftf] xfjfn] w]/} l9nf] pmhf{ lbG5 . bf]>f], jfkm k|s[of w]/} k|efjsf/L 5 lsgeg] jfkmn] ;"Id
hLjf0f'sf] s8f aflx/L vf]nnfO{ g/d kf/L pQm hLjf0f'sf] leqL ;+j]bgzLn efunfO{ c;/ u5{ . -c08f
ksfP h:t} ._
sltko b"lift kbf{y vf;u/L t]no'Qm kbfy{df jfkmn] c;/ -dfg{_ ug{ ;Sb}g / ;"Id hLjf0f' aR5 .
o;sf/0f lgd{nLs/0f k|s[ofnfO{ jfwf k'¥ofpF5 / k|efjsf/L xF'b}g . o;sf] nflu lgd{nLs/0f ug'{eGbf
cufl8 ;fdfgx? /fd|/L ;kmf ug'{ clt cfjZos 5 .

cfjZostfx?
jfliks/0fåf/f ul/g] lgd{nLs/0fdf rf/ cj:yfx? cfjZos k5{ . ltgLx?M kof{Kt ;Dks{, kof{Kt pRr
tfkqmd, 7Ls ;do / kof{Kt jfkm (Moisture) x'g\ . lgd{nLs/0f ul/Fbf ;a} cj:yfx?df Wofg k'¥ofpg'

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 7–3
clt cfjZos x'G5 . cS;/ lSnlgs / c:ktfnx?df w]/}h;f] lgd{lns/0f ubf{ ;fdfgx?df plrt jfkm
;Dks{sf] cefj jf kof{Kt tfkqmd gkfP/ lgd{nLs/0f c;kmn x'g]u5{ .

kmfObfx?
 of] ljlw w]/}h;f] k|of]u x'g] / k|efjsf/L lgd{nLs/0f ljlw xf] .
 of] ;'Vvf tfk jf /f;folgs lgd{nLs/0feGbf sd ;dodf x'g] ljlw xf] .

lgb]{zgx? -jfliko lgd{nLs/0f ug]{ r/0f_

r/0f ! M ;a} pks/0f tyf cGo lgd{nLs/0f ug'{kg]{ ;fdfgx?af6 b"if0f lgjf/0f ug]{], ;kmf ug]{ /
;'Vvf /fVg] .
r/0f @ M olb ;fdfgx?sf ljleGg efux? hf]l8Psf 5g\ eg] tL hf]l8Psf ;a} k|sf/sf efux?
vf]Ng] jf v'Nnf cj:yfdf /fVg] cyjf lemSg x'g] efux? 5'6\ofpg] .
r/0f # M pks/0fx?df /a/sf rSsfx?n] jf cGo j:t'n] sl:;Psf] x'g' x'Fb}g . o;n] ;a} ;txx?df
jfkm ;Dks{ x'Fgdf afwf k'¥ofpF5 .
r/0f $ M ;fdfgsf kf]sfx?nfO{ ;a} ;txdf :jtGq ?kdf jfkm 3'Dg] / k'Ug] u/L r]Da/df ldnfP/
/fVg] .
gf]6 M lgd{nLs/0f k|lqmof yfNg'eGbf cufl8 ;fdfgx?sf] ltvf] efux? tyf wfl/nf] lsgf/fnfO{
uhn] a]g'{k5{ .
r/0f % M jfliko lgd{nLs/0f k|of]u ul/bf ;kmf ul/Psf cf}hf/ cyjf cGo ;fdfgx?nfO{ bf]xf]/f]
(double) afSnf] sk8fn] a]g'{ /fd|f] x'G5 . ga]l/Psf cf}hf/x? -sterilizer_ pks/0faf6
lemSg] lalQs} k|of]u ug'{k5{ jf lasf]{ aGb ug{ ldNg], lgd{nLs[t efF8f]df e08f/ ug'{k5{ .
olb k|];/ s's/ jf :6f]e -cljB'lto_, u|fo\lel6 l8:Kn];d]G6 l:6d :6/LnfOh/ k|of]u eO/x]sf]
5 eg] k|];/ eNeaf6 l;7L gcfpGh]n kfgL pdfln/xg'k5{ . To;kl5 tfknfO{ sd ug]{ .
r/0f ^ M a]l/Psf] ;fdfgnfO{ !@! l8=;]=-@%) l8=km_ df #) ldg]6 ;do;Dd lgd{nLs/0f
-sterilization_ ug'{k5{ . ga]l/Psf] ;fdfgx?nfO{ @) ldg]6;Dd dfq lgd{lns/0f ug'{k5{ .
r/0f & M :6/LnfOh/ k"/f lr;f] x'g @) b]lv #) ldg]6 kv{g'k5{ . -cyjf k|];/ uh z"Go cÍdf
gcfP;Dd_ To;kl5 jfkm lg:sg lasf]{ jf 9Ssg vf]Ng'k5{ . To;kl5 pks/0fsf
kf]sfx?nfO{ rnfpg'eGbf cufl8 k"/f ;'Vvf ug'{k5{ . o;n] #) ldg]6;Dd lng;S5 . olb
kf]sfx? leh]sf] cj:yf ePdf ls6f0f' tyf km+u;x?nfO{ j[l4 ljsf; ug{ /fd|f] jftfj/0f
x'G5 . jfliko lgd{nLs/0f ug]{ RofDa/af6 lems]sf] Kofs]hsf] aflx/L efudf kfgLsf]
yf]kfx? jf lr;f]kgf b]lvPdf a]l/Psf pks/0fsf kf]sfx? cl:jsfo{ dflgG5 . olb s8f
vfnsf] efF8f] -h:tf] 8«d_ eP afkm lg:sg] Kjfnx? ug'{k5{ .

gf]6M c6f]Sn]e ;'? ug'{eGbf cufl8 kfgLsf] ;tx hfFr ug'{xf];\ .

7–4 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
r/0f * M lgd{lns[t ls:tL / Kofsx? RofDa/af6 lems]kl5 lr;f]kgfaf6 arfpg sk8f jf sfuh
la5\ofPsf] ;txdf /fVg'k5{ .
r/0f ( M sk8fdf a]l/Psf] lgd{nLs[t ;fdfgx? Kofs gvf]n];Dd Ps xKtf;Dd lgd{lns[t cj:yfdf
/lx/xG5 . ga]l/Psf ;fdfgx? tTsfn k|of]u ug'{k5{ jf lgd{nLs[t efF8f]x?df lasf]{ aGb
u/]/ e08f/ ug'{k5{ .

jfliko lgd{nLs/0fsf] lgDg /]s8{ /fVg'k5{ M

 ;'? u/]sf] ;do .
 7Ls tfkqmd / rfk k|fKt ePsf] ;do .
 tfk sd u/]sf] ;do /
 cfuf]]af6 lgsfn]sf] .
/]s8{ /fVgfn] gofF, k'/fgf cyjf xtf/ ug]{ JolQmx?sf] nflu klg lgd{nLs/0f ubf{ nfUg] cfjZos
;dosf] lgZro ug{ d2t k'U5 .

;'Vvf tfkåf/f lgd{nLs/0f

;'Vvf tfkåf/f lgd{nLs/0f k|lqmof pRr pks/0f ePsf] c:ktfndf k|of]u ug{ ;lsG5 . of] ljlwdf
cf]egsf] k|of]u ul/G5 / o;sf] nflu nuftf/ ljB't cfk"lt{ x'g h?/L 5 . of] ljlw k|of]u ul/Fbf lgDg
tfk / ;dodf Wofg k'¥ofpg'k5{ . ;'Vvf tfk ljlw l;;f / l:6nsf cf}hf/ h:t} l;of]x? lgd{lns/0f
ug{ ;lsG5 .
 !&) l8=;]= #$) l8=km= df ! 306f -cf]egdf /fv]sf] hDdf ;dodf ! 306fsf] nflu !&) l8=;]=
/ To;kl5 @ b]lv @=% 306faf6 lr:ofpg] cyjf
 !^) l8=;]= -#@) l8=km_ @ 306f -hDdf ;do # b]lv #=% 306f_

/f;folgs k|lqmofåf/f lgd{nLs/0f

pRr rfkåf/f jfliko lgd{nLs/0f jf ;'Vvf tfkåf/f lgd{nLs/0fsf] j}slNks ?k of] /f;folgs
lgd{nLs/0f xf] . olb ;fdfgx? lgd{nLs/0f ug'{ cfjZos 5 t/ pRr rflko jfkmåf/f cyjf ;'Vvf
tfkåf/f lgd{nLs/0f ubf{ ;fdfgx? laufg{ ;Sg] cj:yf ePdf jf pSt k|s[of pknAw gePdf jf rfn'
gePdf /f;folgs lgd{nLs/0f ug{ ;lsG5 . s]xL pRr :t/Lo ;+qmd0f lgjf/0f k|s[ofn] OG8f]:kf];{nfO{
-!) b]lv @$ 306f_ nfdf] ;Dk{s -exposer_ kl5 dfg{ ;lsG5 . ;fwf/0ftof ;+qmd0f lgjf/0fdf
/f;folgs lgd{nLs/0fsf] nflu Un"6/N8LxfO8 k|of]u ug{ ;lsG5 . @Ü b]lv $Ü Un"6/N8LxfO8 3f]ndf
cf}hf/x?nfO{ slDtdf !) 306f 8'afpg' k5{ . Nofk|f]:sf]k h:tf] tfkåf/f lgd{nLs/0f ug{ g;lsg]
pks/0fx?nfO{ o;sf] k|of]u ul/G5 . Un"6/N8LxfO8 ;DxfNbf ljz]if ?kdf Wofg k'¥ofpg' cfjZos 5 .
pks/0fx?nfO{ /f;folgs lgd{nLs/0f u/]kl5 /fd|f];Fu kvfNg' k5{ . lgd{nLs[t ;fdfgx? w'nfO{sf]
nflu lgd{lns[t kfgLsf] cfjZostf k5{ . olb w'nfO{ ul/Pg eg] o; k|sf/sf] 3f]nsf] cjz]ifn]]
Nofkf/f]:sf]ksf] efux? rnfpFbf laufg{ ;S5 . ;fy} n]G; wldnf] klg x'G5 .

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 7–5
/f;folgs lgd{nLs/0f u/]kl5 ;fdfgx? ga]l/sg ltgLx?nfO{ lems]/ lgd{nLs[t efF8f]df aGb u/L
e08f/ ug'{k5{ . -tflnsf &=@ n] Un"6/N8LxfO8 3f]n tof/ ug]{ tl/sf / To;nfO{ k|of]u ug]{ tl/sfsf]
af/]df lgb]{zg lbG5 ._

kmfObfx?
 Un"6/N8LxfO8 3f]n h}jLs kbfy{åf/f ;lhn} lgZs[o x'b}g .
 tfkåf/f lgd{nLs/0f ug{ g;lsg] Nofkf/f]:sf]K;\ h:tf pks/0fnfO{ of] ljlw k|of]u ug{ ;lsG5 .

gf]6M
 /f;folgs lgd{nLs/0f u/]sf] xfOkf]8ld{s ;'O{x? / l;l/~hx? k|of]u ug{ l;kmfl/; ul/+b}g lsgeg]
ltgLx?nfO{ pdfn]sf] kfgLn] wf]Pklg /f;folgs 3f]nsf] c+z afFsL /xg;S5 / o:tf ;'O{n] cf}ifwL
pkrf/ ubf{ lauf/ ug{;S5 .
 /f;folgs lgd{lns/0f u/]sf] ;fdfgx? lgd{lns[t kfgLn] dfq ;kmf ug'{k5{ . pdfn]sf] jf jfkm4f/f
lgZs[o u/]sf] kfgLn] ;kmf u/]df OG8f]:kf];x? x6\b}g . To;}n] lgd{lns[t ;fdfgx?nfO{ pdfn]sf] kfgLn]
kvfNg' x'b}g h;n] ubf{ lgd{lns[t pks/0fx? b'lift x'G5 .

lrq &=@M /f;folgs lgd{nLs/0fsf r/0fx?

!= lgd{nLs/0f ug'{kg]{ ;a} pks/0f tyf cGo ;fdfgx? b"if0f lgjf/0f ug]{, ;kmf ug]{ / ;'sfpg] .
/f;folgs 3f]ndf leh]sf] pks/0f tyf cGo ;fdfgx?af6 cfpg] kfgL ldl:;+bf To;sf] k|efjsf/Ltf
sd eP/ hfG5 .
@= /;fogsf] sDkgLsf] lgb]{lzsfcg';f/ Un"6/N8LxfO8 jf cGo /f;folgs 3f]n tof/ ug]{ cyjf

o;cl3 g} tof/ u/]sf] 3f]n k|of]u ug]{ t/ of] rflxF Dofb g;s]sf] / glau|]sf] olsg x'g'k5{ .
w]/}h;f] ahf/df pknAw Un"6/N8LxfO8 3f]n tof/ u/]sf] ldltaf6 slDtdf @ xKtf leqdf k|of]u
ug{ ;lsG5 . o;sf] nflu sDklgsf] lgb]{zg x]g'{k5{ . 3f]n tof/ ePkl5 To;nfO{ lasf]{ ePsf] ;kmf
efF8f]df /fVg] . o:tf] efF8f]df ;Fw} tof/ ePsf] ldlt / Dofb ;lsg] ldlt clÍt ug'{k5{ .
#= /fd|f] lgd{nLs/0f ug{sf] nflu aGb ul/Psf pks/0fx? vf]Ng] tyf w]/} efux? ePsf ghf]l8Psf
;fdfgx?sf]
;+qmd0f /f]syfd;a}
tyf ;txdf pQmkmf]3f]
:jf:Yo ;+:yfhGo x/d}n
nfx? ;Dks{nflu
Joj:yfkgsf x'g'kk'5{l:tsf. ;a} pks/0f tyf cGo ;fdfgnfO{ &–
df ;Gbe{ 3f]6ndf
k"0f{ ?kdf 8'afpg] . pks/0fsf ;a} efux? tyf cGo ;fdfgx? ;a} 3f]nsf] ;txeGbf d'lg /x]sf]
x'g}k5{ . s'g} klg srf}/fx? jf efF8fx? tndfly g/flv l;wf 7fpFdf /fVg] tyf To;df 3f]n eg]{ .

7–6 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
$= lgd{nLs/0fsf] nflu cfjZos ;do ;DaGwdf sDkgLsf] lgb]{zgx? kfngf ug]{ . ;fwf/0ftof olb
efF8f]x?df Un"6/N8LxfO8 3f]n eP To;nfO{ 5f]Kg] / pks/0f tyf cGo ;fdfgx? lehfpg slDtdf
!) 306f pQm 3f]ndf /xg lbg] . Psk6s ;do ;'? ePkl5 To;}df s'g} klg pks/0f tyf cGo
;fdfgx? yKg] jf x6fpg] sfo{ ug'{x'Fb}g .
%= pks/0f tyf cGo ;dfgx?nfO{ lgd{nLs/0f u/]sf] 7"nf] lkscK;\ -lnˆ6;{, lr6n kmf];]{K;\_ k|of]u
u/L 3f]naf6 lemSg] .

^= /f;folgs lgd{nLs/0faf6 pks/0f tyf cGo ;fdfgx?df afFsL /x]sf 3f]nsf c+zx? x6fpg
To;nfO{ qmd};Fu lgd{nLs/0f u/]sf] kfgLaf6 kvfNg] . o:tf] afFsL /x]sf 3f]nsf c+zx? 5fnf /
tGt'x?sf] nflu ljif x'G5 .

&= lgd{nLs/0f k|lqmof dxTjk"0f{ eP hlts} l7s tj/n] e08f/ ug'{ Tolts} dxTjk"0f{ 5 . pks/0f
tyf cGo ;fdfgx? lgd{nLs/0f u/]sf] 6«] jf efF8f]df /fVg] / e08f/ ug'{eGbf klxnf] tL ;fdfgnfO{
;'Vvf xfjfdf ;'sfpg] .

tL pks/0f tyf cGo ;fdfgnfO{ t'?Gt k|of]u ug]{ jf lasf]{ ePsf] ;'Vvf tyf lgd{nLs/0f ul/Psf]
;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf &–7
efF8f]df /fVg] / To;nfO{ ! xKtfleqdf k|of]u ug]{ .

lgd{nLs/0f ul/Psf ;fdfgx? e08f/0f

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf &–7
lgd{nLs/0f ul/Psf
;+qmd0f /f] ;fdfgx?
syfd tyf :jf:Yo ;+:yfhGo To:tf] 7fpFdf e08f/
kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ug' &–87fx?
{k5{ h;åf/f ;fdfgsf kf]sfx? jf efF
k'l:tsf
w"nf]d}nf], lr;f]kgf, hgfj/, dflg;sf] eL8 gx'g] tyf ls/fx?af6 ;'/lIft x'g'k5{ . o:tf e08f/ If]q
csf]{ 7fpF jf lgd{nLs/0f ePsf] 7fpF;Fu} 5g}f6 ug'{ /fd|f] x'G5 . lgd{nLs/0f ul/Psf] ;fdfg e08f/ ug]{
/ ;kmf la/fdLsf] pkrf/ ug]{ 5'§} 3]l/Psf] If]q /fd|f] x'G5 . sd ;'ljwf ePsf] 7fpFdf To:tf] e08f/ ug]{
If]q s]lGb|o cfk"lt{ ljefusf] Pp6f sf]7f dfq jf zNolqmof OsfO{ dfq x'g;S5 .

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 7–7
 e08f/ If]qnfO{ ;kmf, ;'Vvf, w"nf]/lxt, / kmf]x/ sk8fsf] w'nf] glg:sg] vfnsf]] x'g'k5{ .
 ;Dej ePdf tfkqmd / cfb|{tf lgoGq0f ug]{ . -nueu tfkqmd @$ l8=;]= / ;Dej ePdf ;fk]lIfs
cfb|{tf &)Ü eGbf sd kfg]{_ .
 lgd{nLs/0f u/]sf kf]sf tyf efF8fx? e"O{+eGbf @)–@% ;]=dL= -*–!) O~r_ dfly l;lnËaf6 $%
b]lv %) ;]=dL= -!*–@) O~r_ / aflx/L leQfaf6 !% b]lv @) ;]=dL= -^–* O~r_ 5f]8]/ /fVg] .
 e08f/sf] nflu sf8{af]8{ aS;x? k|of]u ug'{ x'Fb}g . sf8{af]8{ aS;x?af6 w"nf], 6'qmf6fqmL lg:sG5
/ o;n] ls/fx?sf] cf>o:yn aGg ;S5 .
 ldlt n]Vg] / cfk"lt{nfO{ qmd};Fu k|of]u ug]{ -first in first out_ . of] tl/sfn] ;Demg d2t k'U5 t/
kf]sfx?sf] lgd{nLs/0faf/] Uof/]06L ub}{g .
 o; If]qaf6 lgd{nLs/0f u/]sf] / pRr:tl/o ;+qmd0f lgjf/0f ePsf ;fdfgx? ljt/0f ug]{ .

lgd{nLs/0f ul/Psf ;fdfgx?sf] k|efjsf/L /xg] cjlw (Self Life)

;fdfgx?sf] k|efjsf/Ltf -;fdfgx? slt ;dosf] nflu lgd{nLs[t /xG5_ To;sf] lgd{nLs/0f;Fu
;DalGwt x'G5 . lgd{nLs/0f lgwf{/s tTj gePsf] x'gfn] s'g} sf/0fn] kf]sf jf efF8fx? b"lift geP;Dd
pQm ;fdfgx? lgd{nLs/0f ePsf] x'G5 . s'g} sf/0fa; a]l/Psf] If]q RoflQPdf kf]sfx? leHg] x'G5
cyjf To; kf]sf jf efF8f]df ;"Id ls6f0f'x? k|j]z ug{ ;S5g\ . o:tf cj:yfx? s'g} klg a]nf cfpg
;S5 .
gf]6M ;xL tl/sfn] e08f/ gu/];Dd lgd{nLs/0f u/]sf] ;fdfgsf] lgd{nLs[t cj:yf sfod
/xg ;Sb}g .
To;sf/0f lgd{nLs/0fsf] k|efjsf/Ltf lgDg tTjx?df e/ k5{ M
 a]g]{ ;fdfgx? jf efF8fx?sf] u'0f:t/ .
 k|of]u ug'{eGbf klxnf] kf]sfx?nfO{ xft nufPsf] k6s cg';f/ .
 pQm kf]sfx?df xft nufpg] JolQmx?sf] ;+Vof .
 kf]sfx? v'Nnf jf aGb tvtfdf e08f/ ul/Psf] cg';f/ .
 e08f/ If]qsf] cj:yf -h:tf] cfb|{tf / ;/;kmfO_ .
 Knfl:6s 8:6 se/ sf] k|of]u / aGb ug]{ tl/sfcg';f/ -P=cf]=cf/=Pg= !((@_ .
w]/}h;f] kf]sfx? af/Daf/ jf c;fjwfgLk"j{s xft nufpg] jf e08f/ ug]{ h:tf k|ToIf sf/0fn] b"lift
x'G5g\ . ;fdfgx?nfO{ cfjZos k/]sf] a]nf;Dd lgd{nLs/0f /flv /fVg,
 lgd{nLs/0f u/]sf] kf]sfnfO{ b"lift agfpg ;Sg] 36gfnfO{ /f]Sg] /
 To;nfO{ Knfl:6s se/ -emf]nfx?_ df /fvL ;'/lIft ug]{ .
s'g}klg lgd{nLs/0f u/]sf] ;fdfg k|of]u ug'{ cl3 a]l/Psf] kf]sfx?, gkmf6]sf], l;n glalu|Psf] tyf
;kmf / ;'Vvf -;fy;fy} kfgLsf s0fx? gePsf]_ ePsf] s'/f olsg ug'{k5{ . To;kl5 dfq ;fdfgx?
lgd{nLs[t cj:yf /x]sf] lglZrt ug{ ;lsg]5 (Gruendemann and Mangum 2001)
lgd{lns/0fsf] nflu ;do tflnsf agfPsf] v08df ;a} sd{rf/LnfO{ lgd{lns/0f ug]{ ;fdfgx?
lgd{lns[t ;fdfgx? ljt/0f s]Gb| CSSD df k7fpg ;lhnf] x'G5 . of] tl/sf ;fgf] :jf:Yo
;+:yfx?df Tolt Jojxfl/s x“'b}g .

7–8 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
 pRr:t/Lo ;+qmd0f lgjf/0f
HIGH LEVEL DISINFECTION *
ljifoj:t'M
 pRr:t/Lo ;+qmd0f lgjf/0f af/] hfgsf/L .
 pRr:t/Lo ;+qmd0f lgjf/0f ug]{ tl/sfx? .

e"ldsf
cf}hf/x?sf] b"if0f lgjf/0f ug]{ sfo{df lgd{lns/0f ug]{ ;a}eGbf pQd / k|efjsf/L tl/sf ePtfklg
slxn]sfFxL lgd{lns/0f ePsf] cf}hf/x? pknAw gx'g] cj:yfdf pRr:tl/o ;+qmd0f lgjf/0f Pp6}
dfq e/kbf]{ pko'St pkfo xf] . pRr:t/Lo ;+qmd0f lgjf/0f k|s[ofn] JofS6]l/of, km+ufO{, efO/; / Oi6
nufot ;Dk"0f{ ;"Id hLjf0f'x?nfO{ df5{ t/ o;af6 OG8f]:kf]/nfO{ eg] dfg{ ;Sb}g .

pRr:t/Lo ;+qmd0f lgjf/0f ljleGg tl/sfåf/f x'G5, h:t} M

!= pdfn]/ -boiling)
@= jfliks/0f tl/sfn] (steaming)
#= /f;folgs 3f]ndf cf}hf/x? 8'afP/ (soaking in chemical)

oL ;a} tl/sfx? k|efjsf/L agfpg /fd|f];Fu r/0fx? k"/f ug'{k5{ .

!= pdfNg' / jfliks/0f ug'{

pdfn]/ jf jfliks/0f b'a} k|s[ofåf/f ;"Id hLjf0f'x? dfg{sf] nflu jfliko tfk -moist heat) sf] k|of]u
x'G5 . zNolqmofsf] nflu k|of]u ug]{ cGo cf}hf/x? h:t}, Knfl:6ssf] Sofg'nf / l;l/~hnfO{ pdfn]/
clGtd k|zf]wg ug'{eGbf jfliks/0f ug]{ w]/} kmfObf x'G5 . ;fdfgnfO{ sd xfgL k'¥ofpg'sf] ;fy} w]/}
k|efjsf/L x'G5 / OGwg sd dfq nfUg] ePsf]n] w]/} vr{ klg nfUb}g . cf}hf/x? pdfNgsf] t'ngfdf
jfliks/0f ug{ yf]/} kfgL eP k'U5 / pdfNbf kfgLdf /x]sf] SoflN;odn] cf}hf/x?sf] /+udf c;/ u5{ .
t/ jfliks/0f ubf{ z'4 kfgLsf s0f dfq x'g] ePsf]n] wft'sf] cf}hf/x?sf] /+udf s]xL c;/ ub{}g .
jfkmåf/f pRr:t/Lo ;+qmd0f lgjf/0f ubf{ aGb ePsf] efF8f]df x'g] ePsf]n] cf}hf/x? b"lift x'g] sd
dfq ;Defjgf x'G5 .

kmfObfx?
 w]/} vr{ x'Fb}g .
 :jf:YosdL{x?nfO{ l;sfpg ;lhnf] 5 .

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 8–1
 s'g} /;fogsf] cfjZostf gkg]{ / s'g} /;fogsf s0fx? afFsL g/xg] .
 tfkqmdsf] >f]t ;fdfGo tyf pknAw x'g;Sg] .

jfliks/0fsf d'Vo a]kmfObfx?

Jffliks/0f ug{ cf}hf/x?nfO{ ldnfP/ /fVg'k5{ . jfliks/0f k|efasf/L agfpg tNnf] efF8f]df @) ldg]6
;Dd pdfNg k'Ug] u/L k|;:t dfqfdf kfgL /fVg'k5{ .
Wofg lbg'kg]{ s'/fx? M
s'g} klg cf}hf/ pRr:t/Lo ;+qmd0f lgjf/0f ug'{ cufl8 b"if0f lgjf/0f ug'{sf ;fy} l86h{]G6 jf ;fa'g
kfgLdf ;kmf ug'{kb{5 . h:t} M -lrq ^=@ x]g'{xf];\_
!= s'g} cf}hf/ jf cGo ;fwgx? ;kmf ug'{eGbf cufl8 afSnf] k~hf, r:df, df:s, Pk|f]g / aGb h'Qf
nufpg' k5{ .
@= /ut, z/L/af6 lg:s]sf] >fj / tGt'x? jf cGo b]lvg] kmf]x/ lgsfNg g/d a|z jf 6'ya|z k|of]u u/L
l86h]{G6 ePsf] kfgLdf /fd|f];Fu :qma ug]{ . l56f kg{af6 arfpg cf}hf/ tyf cGo ;fdfgx? ;kmf
ubf{ kfgL leq 8'afpg' k5{ . cf}hf/sf] w]/} efu ePdf lgsfn]/ ;kmf ug]{ . cf}hf/sf] bfFtdf, k]rdf /
kmf]x/ c8\lsg] s'gfsfKrfdf :qma u/]/ ;kmf ug'{k5{ .
#= cf}hf/df c8\s]/ /x]sf l86h]{G6x? ;a} /fd|f];Fu ;kmf kfgLdf kvfNg' kb{5 .
$= /;folgs pRr :t/Lo ;+qmd0f lgjf/0f ug{ cf}hf/x? xfjfdf jf ?dfnåf/f ;'Vvf ug'{k5{ xf]Og eg]
o;n] /f;folgs 3f]n kftnf] agfpg] x'gfn] o;sf] k|efjsf/LtfnfO{ ;d]t 36fpg] u5{ . cf}hf/x? h'g
pdfn]/ jf jfkmåf/f pRr:tl/o ;+qmd0f lgjf/0f ul/G5 eg] klxnf ;'Vvf ug{ cfjZos 5}g .

pdfn]/ pRr:t/Lo ;+qmd0f lgjf/0f ug]{ tl/sf

cf}hf/x? tyf cGo ;fdfgx?nfO{ pdfn]/ pRr:t/Lo ;+qmd0f lgjf/0f ug'{ k|efjsf/L / Jojxfl/s
tl/sf xf] . cf}hf/x?nfO{ @) ldg]6 kfgLdf pdfn]kl5 k|foh;f] AofS6]l/of, efO/;, Oi6, km+ufO{ h:tf
;"Id hLjf0fx? dfg{ ;s]tf klg OG8f]:kf];{x?nfO{ eg] dfg{ ;Sb}g .

lrq M*=!M pdfn]/ pRr:t/Lo ;+qmd0f lgjf/0f ug]{ r/0fx?

r/0f ! M pRr:tl/o ;+qmd0f lgjf/0f ug]{ cf}hf/x? klxn]
b"if0f lgjf/0f / ;kmf ug'{k5{ .
r/0f @ M ;kmf u/]sf cf}M hf/x? 8'afpFbf kfgL cf}hf/eGbf
b'O{ cf}+nf -@=% ;]=dL=_ dfly;Dd e/]sf] x'g'k5{ . ;a}
cf}hf/x? / srf}/fx? tyf /fv]sf cGo ;fdfgx? ;a}
kfgLdf k"/} b'afpg] jf kfgL e/]/ /fVg] . h:t}M srf}/f,
lunf;, jf cGo efF8fx? pdfNg' kg]{ eP d'vnfO{ dfly
kmsf{P/ /fVg] / kfgLdf b'afpg] .
;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;+Gbe{ k'l:tsf *–2
8–2 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
 M
r/0f # M efF8fsf] lasf]{ nufpg] / la:tf/} dGb tfkqmddf
kfgL pdfNg] -olb tfkqmd w]/} a9fPsf] v08df dl§t]n
klg w]/} vr} x'G5, kfgL l56f] ;'S5 / cf}hf/x? lau|g klg
;Sb5 .

r/0f $ M kfgL pDng ;'? ePkl5 @) ldg]6;Dd

pdfln/xg' k5{ o;sf] aLrdf kfgL jf cGo cf}hf/x? s'g}
klg yKg x'Fb}g .
M
r/0f % M ;a} ;fdfgx? @) ldg]6;Dd la:tf/} pdfNg]
w]/} l56f] pdfn]sf] 5 eg] kfgL jfkm eP/ p8\5 / efF8f]sf]
5]p al9 tfQ]/ ;fdfgx? lalu|G5 . cfuf] ;fgf] agfpFbf
dl§t]nsf] klg arfj6 x'G5 .

r/0f ^ M @) ldg]6 pdfln;s] M kl5 pRr:tl/o ;+qmd0f

lgjf/0f u/]sf] cf}hf/n] ;fdfgx? lgsfn]/ pRr:tl/o
;+qmd0f lgjf/0f u/]sf] efF8f]df /fVg] / w"nf] / ls6f0f'
kg{af6 arfpg lasf]{ /fd|/L aGb ug]{ . e08f/0f ug'{ cufl8
;fdfgx? ;'Vvf x'g' kb{5 . cf}hf/x? plDn;s]kl5 klg
kfgLdf /fvL /fVg' x'Fb}g lsgsL leh]sf] cf}hf/x? rf+8}
b"lift x'ghfG5 .
M

r/0f & M ;fdfgx? jf cf}hf/x?nfO{ t'?Gt k|of]u ug]{ jf

pRr:tl/o ;+qmd0f lgjf/0f u/]sf] efF8f]df /fv]/ /fd|/L
lasf]{ nufP/ /fVg] . pRr:tl/o ;+qmd0f lgjf/0f u/]sf]
cf}hf/x? plrt e08f/0f u/L grnfO{ /fv]df Ps xKtfleq
k|of]u ug{ ;lsG5 cGoyf k'gM k|z]fwg ug'{k5{ .
pdfNg] l6K;\x?
 lasf]{ ePsf] efF8f]df @) ldg]6;Dd pdfNg' k5{ .
 kfgL pdNg ;'? ePkl5 ;dosf] u0fgf ;'? ug'{k5{ .
 cf}hf/x? ;a} k"/f kfgLdf 8'a]sf] x'g'k5{ .
 ;do ;'? u/]kl5;+qmd0f
s'g/f]} sklg
yfd tyfcf} hf/x?
:jf:Yo ;+:yfhGojfkmf]xkfgL yKg' x'nflu
/d}nf Joj:yfkgsf b}g;+Gbe{. k'l:tsf *–3
 cf}hf/x? v'Nnf cj:yfdf /fVg] .

;fdfgx? lau|gaf6 arfpg] pkfox?

;fdfgx? k6s k6s pdfnL /xFbf pdfNg] efF8f]df ;]tf] nfOd ;N6 hDdf x'G5 . of] nfOd kfgLdf
ePsf] r"gfsf] efu xf] . of] x6fpg uf¥xf] x'G5 t/ ;fdfgx? / pdfNg] efF8fx?df of] ;]tf] kbfy{x?
hDdf x'gaf6 arfj6 ug{ lgDg pkfox? ckgfpg' k5{ M

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 8–3
r/0f ! M ;fdfgx?sf] jf efF8f]sf] r'gfsf] efu x6fpg kfgLsf] efF8f]df s]xL leg]u/ /fVg] /
pdfNg] .
-Infection Prevention a Reference Booklets for health care providers 2nd edition, page 56,
Engender health)
r/0f @ M kfgL k|of]u ug'{eGbf cufl8 kfgLnfO{ !) ldg]6 pdfNg] . o;/L kfgL plDn;s]kl5
r"Mgfsf] efu ;fdfg pdfn]sf] efF8f]sf] lk+wdf y]lu|G5 . To;kl5 dfq pdfNg' kg]{ ;fdfgx?
r/0f $M/fVg'k5{ .
r/0f # M lbge/L ToxL kfgL k|of]u u/L /fVg] .
r/0f $M cf}hf/x? pdfNg] efF8f] k|To]s lbgsf] cGtdf ;kmf ug]{ / ePsf] r"gfkfgL kmfNg'k5{ .

jfliks/0fåf/f pRr:tl/o ;+qmd0f lgjf/0f ug]{ tl/sf

cWoogdf k|of]u ul/Psf] jfliks/0f ug]{ efF8f] -lrq *=@_ df lgDg efux? ;dfj]z ul/Psf] 5 .
 em08} #! ;]=ld= uf]nf] ePsf] tNnf] efudf kfgL pdflnG5 .
 Ps, b'O{ jf tLgj6f uf]nf] efF8f] h;df )=% ;]=dL=sf] w]/} Kjfnx? x'G5 / ;f] Kjfnaf6 tNnf] efusf]
efF8f]df kfgL pdfNbf To;sf] jfkm dflysf] efF8f]x?df k:5 / kfgL km]/L ;f]xL efF8f]df v:5 / of]
efF8f] tNnf] kfgL pdfNg] efF8f]df ;xL ?kdf ldn]sf] x'g'k5{ .
 efF8f]sf] dflyNnf] efudf ldNg] Pp6f lasf]{ x'G5 .

lrq *=@M b'O{ tNn] jfliks/0f ug]{ ef“8F] -dMdM ksfpg] h:tf]_

lrq *=#M
lrq *=#M
!= ;+qpRr:t/Lo
md0f /f]syfd tyf;+:jf:Yo
qmd0f;+:yfhGo
lgjf/0f
kmf]x/d}nf ug] { ;fdfgx?
Joj:yfkgsf nflu ;+Gbe{b"k'ilf0f
:tsf *–4
lgjf/0f u/L ;kmf ug{'k5{ .

8–4 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
 @= efF8f]sf] tNnf] efu -Kjfn gePsf]_ df kfgL /fv]/
pdfNg] .
#= efF8f]df cf}hf/x? vf]n]/ ldnfP/ /fVg] .
$= eFf8f]sf] dflyNnf] efudf lasf]{ nufpg] / kfgL pdfNg] .
kfgL pDng yfn]kl5 b'O{j6f efF8fsf] aLraf6
jfkm cfpF5 / tfkqmd sd x'G5 t/ kfgL pDng]
tfkqmdnfO{ lg/Gt/ eg] agfpF5 / jfkm lg/Gt/
?kdf lgl:s/xG5 . olb tfkqmd a9L u¥of] jf cfuf]
7"nf] kf¥of] eg] kfgL l56f] jfkm eP/ p8\5 / OGwg
a9L vr{ x'g'sf] ;fy} k~hf klg lalu|G5 .
%= jfliks/0f ubf{ @) ldg]6;Dd ug'{k5{ / ;do lglZrt
ug{ 3l8 jf 6fOd/ k|of]u ug]{ ug'{k5{ .
^= nufO/fv]sf] lasf]{ lgsfn]/ Ps 7fpFdf pQfgf] kf/]/
/fVg] . dflyNnf] efusf] efF8f]b]lv Pp6f Pp6f u/L
lgsfNg] / lgsfn]sf] efF8f]nfO{ la:tf/} xNnfP/ efF8f]df
ePsf] kfgL tsf{pg] . pQfgf] kf/]sf] lasf]{ dfly
/fVg] t/ jfliks/0f u/]sf] k~hfsf] efF8f] slxNo}
klg l;wf e"O{+df g/fVg] lsgeg] efF8f]sf] d'lg
w]/} Kjfnx? ePsf] sf/0f ;fdfgx? b"lift x'G5 .
&= e08f/0f M lasf]{ ePsf] pRr:t/Lo ;+qmd0f lgjf/0f
u/]sf] efF8f]df e08f/ ug'{k5{ / Ps xKtfleq k|of]u
ul/;Sg'k5{ . olb Ps xKtfleq k|of]u ePg eg]
k'gM pRr:t/Lo jfliks/0f ug'{k5{ .

;Demg'xf];\ M efF8f]sf] tNnf] efudf k|z:t kfgL ePsf] jf @) ldg]6;Dd jfliks/0f ug{ k'Ug]
kfgL x'g'k5{ .

/f;fogsf] k|of]uåf/f pRr:t/Lo ;+qmd0f lgjf/0f ug]{ tl/sf

w]/}h;f] b]zx?df;+qmd0f /f]
b"isf0f
yfd tyf
lgjf/0f
:jf:Yo ;+:ug] { /;fogx?
yfhGo nflu ;+Gbe{k|k'foh;f]
ePtfklg
kmf]x/d}nf Joj:yfkgsf *–5
l:tsf b'O{ lsl;dsf /f;folgs tTj
k|of]udf NofOPsf] b]lvG5 . tL x'g\M Snf]l/g / Un"6/N8LxfO8 . olb cf}hf/ tyf ;fdfgx? klxn] g}
/fd|f];Fu wf]O{ kvfn]sf] 5 eg] oL /;fogx?n] pRr:t/Lo ;+qmd0f lgjf/0f ug{;S5 o;/L pRr:t/Lo
;+qmd0f lgjf/0f ubf{ cf}hf/ tyf ;fdfgx?sf] agfj6df e/k5{ ;fy} pRr:t/Lo ;+qmd0f lgjf/0f ug{
cfjZos ;/;fdfg / pSt sfo{ ug]{ JolQmsf] ;Lksf] klg cfjZos k5{ .

/;fogaf6 pRr:t/Lo ;+qmd0f lgjf/0f ug'{sf] kmfObf tyf a]kmfObfx?M

!= Snf]l/g 3f]nsf] kmfObfdWo] of] Pr=aL=eL=, Pr=;L=eL= / Pr=cfO{=eL= P8\; la?4 w]/} k|efjsf/L
5, l56f] sfd u5{ / ;lhn} / sd d"Nodf kfOG5 .

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 8–5
@= o;sf] d'Vo a]kmfObf eg]sf] Snf]l/gsf] dfqf w]/} ePsf] -h:t}M )=%Ü eGbf a9L ePsf]_ 3f]nn]
kmnfdsf] cf}hf/ pks/0f lvof nfUg' xf] . l:6n jf l:6nsf] hnk nufPsf] cf}hf/x? )=!Ü df @)
ldg]6 8'afP/ pRr:tl/o ;+qmd0f lgjf/0f ug{ ;lsG5 . o;/L ;+qmd0f lgjf/0f ug{nfO{ pDn]sf]
kfgLdf )=!Ü Snf]l/g 3f]n agfpg' kb{5 . olb wf/fsf] kfgL wldnf] cfPsf] 5 eg] kfgL pdfNg'eGbf
cufl8 5fGg' kb{5 . cf}hf/ tyf ;fdfgx? klxn] b"if0f lgjf/0f u/L ;fa'g kfgLn] kvfn]/ ;kmf /
;'Vvf ug'{k5{ .
Snf]l/g 3f]nn] l56f] sfd u5{ / Pr=aL=eL=, Pr=;L=eL= / Pr=cfO{=eL= P8\; la?4 w]/} k|efjsf/L
?kdf sfd ub{5 . ;fy} of] ;:tf] / ;lhn} kfO{G5 . t/ Pp6f d'Vo a]kmfObf eg]sf] of] /fd|f];Fu 3f]n]g
eg], )=%Ü df ;doeGbf a9L 8'afO{ /fVof] / s8f jf dfqf gldnfOsg agfof] eg] s'g} klg kmnfdsf]
cf}hf/, pks/0f lvof nfU5 . t/ :6]gn]; l:6nsf] jf o;sf] hnk nufPsf cf}hf/x? Knfl:6s af6fdf
agfOPsf] )=!Ü Snf]l/g 3f]ndf @) ldg]6 8'afP/ pRr:t/Lo ;+qmd0f lgjf/0f ubf{ cf}hf/x? lalu|+b}g .
pRr:t/Lo ;+qmd0f lgjf/0fsf] Snf]l/g 3f]n agfpFbf pdfn]sf] ;kmf kfgLdf agfpg' kb{5 / cf}hf/x?
klg Snf]l/g 3f]ndf Pr=Pn=l8= ug{sf] nflu 8'afpg'eGbf cufl8 b"if0f lgjf/0f u/L ;fa'g kfgLdf ;kmf
/ ;'Vvf u/]sf] x'g'kb{5 .
;Demg'xf];\ M /f;folgs kbfy{df ;'O{ lbg] l;of] / l;l/~hnfO{ pRr:t/Lo ;+qmd0f lgjf/0f ug'{
x'+b}g lsgeg] /f;folgs 3f]ndf 8'jfPsf ;fdfgx? pdfn]sf] kfgLdf w]/} k6s kvfn]kl5 klg
To;sf] s]xL efu (residue) afFsL x'G5 h;n] ;'O{ lbg] l;l/~hdf tfg]sf] cf}ifwLnfO{ s]xL laufg{
;S5 .
olb Snf]l/g 3f]nn] ;fdfgx?sf] /+u ab\n]sf] 5 jf lvof nfu]sf] 5 eg] o;nfO{ sd ug{ Snf]l/g
3f]naf6 pRr:t/Lo ;+qmd0f lgjf/0f -HLD_ u/]/ lgsfn]kl5 pdfn]sf] kfgLn] kvfNg] To;kl5 t'?Gt}
;'Vvf ug]{ .
pRr:t/Lo ;+qmd0f lgjf/0f ug{ agfPsf] Snf]l/g 3f]n lasf]{ nufPsf] efF8f]df x'g'k5{ olb lasf]{ nufPg
eg] o;sf] k|efjsfl/tfdf sdL x'g;S5 . olb pRr:t/Lo ;+qmd0f lgjf/0f ug{ agfPsf] Snf]l/g 3f]n
w]/}k6s k|of]u ul/of] / wldnf] b]lvof] eg] csf]{ gofF 3f]n agfpg' k5{ .
Un"6/N8LxfO8 (gluteraldehyde) M o;n] kmdf{N8LxfO8eGbf sd dffqfdf kf]Ng] u5{ t/ o;sf] 3f]n
agfpFbf cyjf k|of]u ubf{ o;sf] jfkmaf6 sd{rf/L / la/fdLnfO{ arfpg' k5{ . o;sf] k|of]u ubf{
sd{rf/Ln] k~hf nufpg], cfFvfdf l56f kg'{af6 arfpg], yf]/} ;do leq sfd ul/;Sg] / v'Nnf xfjf
ePsf] 7fpFdf sfd ug'{k5{ .
;Demg'xf];M\ Un"6/N8LxfO8 -gluteraldehyde_ 3f]ndf 8'afPsf cf}hf/x? pDn]sf] kfgLn] #
k6s;Dd /fd|/L kvfNg' k5{ . h;n] ubf{ cf}hf/df ePsf] o;sf] afsL efu -residue_ x6]/
hfG5 / 5fnf kf]Ngaf6 arfp+5 .
cNsf]xn / cfO8f]kmf]/; M cNsf]xn / cfO8f]kmf]/; ;:tf] / ;lhn} kfpg] ePtfklg o;nfO{
pRr:t/Lo ;+qmd0f lgjf/0fsf] nflu :t/o'Qm dflg+b}g . cNsf]xnn] efO/;nfO{ dfg{ ;Sb}g /
cfO8f]kmf]/;df :kf]l/;fO8n tyf :o"8f]df]gf; (Sporiacidal and Pseudomonas) a9]sf] kfOPsf] 5,

8–6 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
-kmfe]/f] !(*%, ?tfnf !((#_ . To;}n] dfly pNn]v ul/Psf pRr:t/Lo ;+qmd0f lgjf/0fsf] nflu k|of]u
ug]{ Un"6/N8LxfO8 jf Snf]l/g dfq k|of]u ug'{k5{ .
/f;folgs pRr:t/Lo ;+qmd0f lgjf/0f ug]{ d'Vo r/0fx?
 /ut / z/L/af6 lg:s]sf cGo t/n kbfy{sf] ;Dks{df cfPsf] cf}hf/x? klxnf b"if0f lgjf/0f
ug]{, /fd|f];Fu kvfNg] / ;'Vvf ug]{ .
 pRr:t/Lo ;+qmd0f lgjf/0f ug]{ 3f]ndf /fd|f];Fu k"/f 8'afpg] .
 @) ldg]6;Dd 8'afO{ /fVg] .
 pRr:t/Lo ;+qmd0f lgjf/0f u/]sf] jf lgd{nLs/0f u/]sf] cf}hf/ jf k~hf nufP/ dfq
pRr:t/Lo ;+qmd0f lgjf/0f ul//fv]sf] ;fdfg lgsfNg] .
 5fg]/ -olb kfgL wldnf] eP 5fGg'k5{_ pdfn]sf] kfgLn] /fd|f];Fu # k6s w'g] / xfjfdf
;'sfpg] .
 cf}hf/x? tof/ ePkl5 t'?Gt k|of]u ug]{ jf lasf]{ ePsf] efF8f]df e08f/ ug]{ .

/f;folgs 3f]nsf] e08f/0f

 /f;folgs ;+qmd0f lgjf/sx?nfO{ ;"o{sf] ls/0f gkg{] / lr;f] 7fpFdf e08f/0f ug'{k5{
 l;wf 3fd ePsf] jf w]/} tfkqmd ePsf] 7fpF, h:t}M l6gsf] 5fgf ePsf] sf]7fdf slxNo} klg e08f/
ug'{xF'b}g .
 /;fog /fv]sf] efF8f]nfO{ lj;h{g ug]{ tl/sf
 l;;fsf] efF8f] M ;fa'gn] w'g], ;'Vvf kfg]{ / k'gM k|of]u ug]{ cyjf kfgLdf kvfNg] / vfN8f]df
k'l/lbg] .
 Knfl:6ssf] efF8f] M ljiffn' kbfy{, h:t}M Un"6/N8LxfO8 /fv]sf] efF8f] slDtdf # k6s kfgLdf
kvfNg] / kl5 vfN8f]df k'l/lbg] .

k|of]u ul/;s]sf /f;folgs kbfy{ lj;h{g ug]{ tl/sf

kmf]x/ ePsf] /f;folgs 3f]nnfO{ xf]lzof/k"j{s kmf]x/ kmfNg] jf cf}hf/ kvfNg] 7fpFdf jf 9ndf jf
kfgLn] ;kmf ug{ x'g] vfnsf] rkL{df vGofpg] / kfgLn] kvfn]/ -ˆn; u/]/_ k7fpg] . o;f] ubf{ cfkm'nfO{
l56f kg'{af6 arfpF5 / afFsL ePsf] kmf]x/ kfgLn] /fd|f];+u kvfNg'k5{ . olb Snf]l/gsf] 3f]n 5 eg]
9n jf ;]lˆ66\ofÍdf gkmfNg] .

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 8–7
 tflnsf *=! /f;folgs ;+qmd0f lgjf/0f ug]{ 3f]n tof/ tyf k|of]u ug]{

8–8
pRr:tl/o ;+qmd0f lgjf/0f cyjf lgd{nLs/0f ug]{ /;folgs kbfy{
Pr=Pn=8L= lgd{nLs/0f
;fwf/0ftof kfpg] k|efjsfl/tf
cf+vfdf Zjf;k|Zjf; lvof ug{ ug{
;+qmd0f lgjf/0f k|efjsfl/tf s;/L agfpg] 5fnfdf kf]Ng] afF+sL /xg] cjlw
kf]Ng] gnLdf kf]Ng] nfUg] cfjZos cfjZos
ug]{ /f;folgs (shelf life)
;do ;do
Snf]l/g )=!Ü 3f]Ng] tl/sf w]/} nfdf] x'G5 x'G5 @) ldg]6 @) ldg]6 k|of]u gug]{ k|To]s @$
km/s km/s 5 ;do;Dd eGbf a9L dfq 306fdf km]g'{k5{
-Snf]l/g 3f]n k|of]u u/]df 8'afPdf / wldnf] ePdf
jgfpg] t/Lsfdf rfF8} k]mg'{k5{ .
x]g]{_
Un"6/N8LxfO8 @–$Ü km/s k|efjsf/L x'G5 x'G5 x'G5 x'Fb}g @) ldg]6 !) 306f k|To]s !$
-;fO{8]S;_ km/s 5 agfpg] kfp8/ 8'afpg] b]lv @* lbgdf
(Activator) km]g'{k5{ / wldnf]
ld;fpg' k5{ eP rfF8} km]g]{
.-sDkgL cg';f/_

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
 ;/;kmfO{
HOUSE KEEPING (
ljifoj:t'M
 :jf:Yo ;+:yfx?df ;/;kmfO{sf] dxTj
 ;/;kmfO{sf ;fwf/0f l;4fGtx?
 ;/;kmfO{df rflxg] 3f]nx?sf] tof/L
 pRr hf]lvd 7fpF sd hf]lvd 7fpFsf] ;kmfO{
 /ut / z/L/af6 lg:s]sf] t/n kbfy{x?sf] ;kmfO{
 la/fdLnfO{ k|of]u u/]sf /ut / cGo kmf]x/ nfu]sf sk8fx?sf] ;kmfO{ / o;sf] Joj:yf ug]{
:jf:Yo ;+:yfx?df w'nf], kmf]x/, ;'Id hLjf0f'x? hDdf eP/ ;+:yfsf] ;f}Gb{odf x|f; cfpg] tyf
k|lts'n jftfj/0f ;[hgf x'g'sf] ;fy} :jf:Yo ;+:yfhGo ;+qmd0fsf] ;|f]t klg x'G5 . To;}n] :jf:Yo
;+:yfx?df ;kmf / :j:Yo jftfj/0f agfO /fVgsf] nflu k|efjsf/L / bIf tl/sfaf6 ;/;kmfO{
ug'{ w]/} cfjZos 5 . -CHOU 2002)

e"ldsf M
;/;kmfO{ -house keeping_ eGgfn] :jf:Yo ;+:yfx?sf] ;a} efusf] ;/;kmfO{ eGg] a'lemG5 . h:t}
M– e"FO{, kvf{n, leQf / cf}hf/, 6]an, z}of ;fy} k|of]udf cfpg] n'ufx? Kfb{5g\ . :jf:Yo ;+:yfhGo
;+qmd0f /f]syfd pSt ;+:yfsf] leqL / aflx/L ;Dk"0f{ jftfj/0fsf] ;kmfO{df e/ kb{5 . ;'Id lhjf0f'x?
nfdf] ;do;Dd o:tf 7fFpx?df lhljt /xg ;S5 / o;sf] ;Dks{df c:ktfndf cfpg] lj/fdL, s'?jf
nufot :jf:YosdL{ / cGo sd{rf/Lx? ;+qmd0fsf] hf]lvddf x'g] ePsf]n] pgLx?sf] :jf:Yo ;'/Iffsf]
lgldQ ;/;kmfO{ x'g' clt h?/L 5 . ;/;kmfO{sf nflu sfd ug]{ sd{rf/Lx? t a9L g} hf]lvddf 5g\
lsgls pgLx? /ut, zl//af6 lg:sg] cGo t/n kbfy{, wfl/nf] cf}hf/ / b'lift j:t'x?;+u lgoldt
?kdf sfd ug'{kg]{ x'G5 .
:jf:Yo ;+:yfhGo ;+qmd0f Go"lgs/0fsf] nflu ;/;kmfO{sf sd{rf/Lx?n] ljleGg tl/sfn] ;kmf ug]{
h:t} ;fa'gkfgLn] ;kmf ug]{ jf ;+qmd0f lgjf/s 3f]nx? k|of]u u/L ;kmf ug]{ af/] /fd|/L a'em\g' kg]{
s'/f dxTjk"0f{ x'G5 . o;sf] nflu ;/;kmfO{sf sd{rf/Lx?n] b'lift 7fpF / jftfj/0fsf] ;kmfO{sf] qmddf
cfkm'nfO{ x'g;Sg] ;Defljt hf]lvdsf] af/]df klg a'em\g' h?/L x'G5 . ;/;kmfO{sf sd{rf/Lx?n] b'lift
;fdfg rnfpFbf ;Defljt hf]lvdnfO{ Go"lgs/0f ug{sf] nflu ;+qmd0f /f]syfdsf ;'/IffTds ;fdu|Lx?
k|of]u ug'{ clt cfjZos x'G5 .

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 9–1
;/;kmfO{sf ;fdfGo p2]Zox? M–

la/fdL, s'?jf, :jf:YosdL{ / ;d'bfonfO{ ;'Id ls6f0f'sf] ;Dks{ Go"g ug{] .

la/fdL / :jf:YosdL{x?nfO{ ;kmf ;'U3/ / /dfOnf] jftfj/0fsf] ;[hgf ug]{ .
w]/}h;f] :jf:Yo ;+:yfx?sf] sd hf]lvd ePsf 7fpFx? h:t} k|ltIffno, k|zf;lgs sfof{nox?nfO{
;fa'g kfgLn] dfq ;kmf u/] k'U5 t/ pRr hf]lvd :yfgx? hxfF w]/} /f]usf] ;+qmd0f x'g ;Sg] 7fpFFx?df
h:t} 8«]l;Ë ?d, pkrf/ sf]7f, zNos[of sf]7f, zf}rfnox?df )=%Ü Snf]l/g 3f]nn] sd;]sd lbgdf
@ k6s ;kmf ug'{k5{ . a9L hf]lvdo'St :yfgx?df b"if0f lgjf/ssf] ;fydf ;fa'g kfgLn] klg ;kmf
ug'{k5{ .

;/;kmfO{sf l;4fGtx? M
 eF'O{ 3f]6\g] -Scrubbing_M– ;'Id lhjf0f' / kmf]x/ d}nf x6fpg] Pp6f /fd|f] tl/sf xf] .
 ;kmfO{ -Cleaning_M– s'g} klg /f;folgs kbfy{ k|of]u ug'{eGbf cufl8 ;kmfO{ sfo{ ug{ clt
cfjZos 5 .
 ;kmfO{ ljlwsf] nflu ;fdfgsf] 5gf}6 ubf{ To;sf] pkof]lutf, k|efjsf/Ltf / d'Nodf e/ k5{ .
 ;kmfO{ ubf{ sd b'lift ePsf] 7fpFaf6 w]/} b'lift ePsf] 6fpFdf ;kmf ub}{ n}hfg'k5{ .
 ;kmfO ug]{ ;fdfgx? klg km/s km/s x'g'k5{ h:tf] k|ltIffnosf] leGb}, zf}rfnosf] leGb}
cflb .
 3fts ;'Id lhjf0f'sf] ;+qmd0fsf] +vt/fnfO{ sd ug{sf nflu ;'Vvf s'rf] nufpg] sfo{ ug'{
x'Fb}g ;fy} ;'Vvf sk8fn] k'5\g] / w"nf] emfg{] sfo{ klg ug'{ xF'b}g .
 ;kmfO{ ubf{ ;Fw} leh]sf] sk8f k|of]u ug'{k5{ .
 /f;folgs ;+qmd0f lgjf/s 3f]nsf] k|of]u ubf{ To;sf] nflu lbOPsf] lgb]{zg ckgfpg cToGt
h?/L 5 .
 ;/;kmfO{ ug]{ ljlw tyf ;kmfO{ tflnsf Toxfsf] j:t' / 7fpF cg';f/ e/ k5{ .
 lgoldt ;kmfO{, tflnsf cg';f/ u/]df To; 7fpFsf] ;kmfO{ :tl/o /fVg d2t u5{ . ljleGg
7fpFsf] ;/;kmfO{sf] nflu lgoldt ;kmf ug{ tflnsf agfpg' kb{5 / ;f]xL cg';f/ sfo{ ug'{
cfjZos k5{ .
 :jf:Yo ;+:yfsf ljleGg efux?df s'g} 7fFpx? sd / s'g} 7fpFx? h:t} Zff}rfnox? a9L g}
b'lift x'g] ePsf]n] oL a9L b'lift x'g] 7fpFx? lbgsf] tLg k6s ;kmf ug'{k5{ cyjf w]/} dflg;sf]
cfjt hfjt ePdf PseGbf a9L k6s klg ;kmf ug'{k5{ .

9–2 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
ljleGg 7fp“sf] ;/;kmfOsf sfo{tflnsf -house keeping schedule_
;kmfO{ ug]{ :yfg sfo{tflnsf
kvf{n em\ofn, l;lnË, kmf]x/ b]lvPdf ;fa'g kfgLsf] 3f]ndf sk8f lehfO{ t'?Gt ;kmf ug]{ .
9f]sf / 9f]sfsf] lgoldt ;kmfOsf] nflu ;kmf kfgLdf sk8f lehfP/ ;kmf u/] k'U5 .
x\of08nsf] -o:tf] 7fpFsf] ;kmfOsf] nflu b'if0f lgjf/s 3f]n cfjZos kb}{g_ o:tf]
7f+p sd} b'lift x'g]u5{ .
s';L{, jQL, 6]jn, vf6, ;fj'g kfgLsf] 3f]ndf sk8f lehfO{ k'5]/ ;kmf ug]{ . -/ut jf cGo
vf6sf] /]lnË, sfp06/ kmf]x/ nfu]df b'if0f lgjf/s 3f]n sk8fdf lehfP/ k'5]/ ;kmf ug]{_ pSt
sk8fn] lbgxF' ;kmf ug]{ -cfjZos k/]df PseGbf a9L k6s klg ;kmf
ug]{_
e'FO{ dksf] ;xfotfn] ;fa'gkfgLsf] 3f]nn]] lbgxF' ;kmf ug]{ . olb b'lift ePdf
b"if0f lgjf/s 3f]n dkdf -mop_ lehfP/ pSt dksf] ;xof]un] lbgxF'
;kmf ug]{ -cfjZos k/]df PseGbf a9L k6s klg ;kmf ug]{_
l;+s / rl{{k/{ zf}rfno b"if0f lgjf/s 3f]n sk8fdf lehfP/ pSt sk8fn] 3f]6\g] / ;kmf kfgLn]
-toilet_ kvfNg] . of] sfo{ lbgsf] tLg k6s ug]{ -cfjZos k/]df ;f]eGbf a9L
k6s ug]{_
kmf]x/ hDdf ug]{ efF8f] lbgdf Ps k6s jf cfjZos k/]df ;f]eGbf a9L k6s klg vfnL ug]{
vfnL ug]{
kmf]x/ hDdf ug]{ efF8f]sf] b"if0f lgjf/s 3f]n sk8fdf lehfP/ pSt sk8fn] 3f]6]/ o;df nfu]sf]
kmf]x/x? ;kmf ug]{ / kfgLn] kvfNg] . of] sfo{ lbgxF' ug]{ -cfjZos k/]df
PseGbf a9L k6s klg ug]{_
5t (ceiling) b"if0f lgjf/s 3f]n sk8fdf lehfP/ xKtfsf] Ps k6s ;kmf ug]{ -cfjZos
k/]df PseGbf a9L k6s klg ug]{_
pks/0fx? h:t} ;fa'g kfgLdf sk8f lehfO k'5\g] . olb b]lvg] u/L kmf]x/ ePdf ;fa'g
:6]:yf]:sf]k / An8 k|];/ kfgLn] wf]O{ kvfNg] . t/ o;df /ut jf cGo kbfy{n] b"lift ePdf b"if0f
skm lgjf/s 3f]nn] ;kmf ug]{ .
lj/fdLsf] sf]7f b"if0f lgjf/s 3f]nn] lbgxF' ;kmf ug]{ -cfjZos k/]df PseGbf a9L k6s
klg ug]{_
sfo{ljlw sf]7f sfo{ljlwsf] nflu k|of]u ePsf] pks/0fx? kmlg{r/x? b"if0f lgjf/s
3f]nn] k|To]s ljlwkl5 ;kmf ug]{ / b]lvg] u/L b"lift ePsf eP ;f]eGbf
a9L k6s cfjZostf cg';f/ b"if0f lgjf/s 3f]nn] ;kmf ug]{ .
lj/fdL hfRg] sf]7f b"if0f lgjf/s 3f]nn] lbgxF' ;kmf ug]]{ -cfjZos k/]df PseGbf a9L k6s
klg ug]{_
k|of]uzfnfsf] sfp06/ b"if0f lgjf/s 3f]n sk8fdf lehfP/ pSt sk8fn] lbgxF' ;kmf ug]{
-cfjZos k/]df PseGbf a9L k6s klg ;kmf ug]{_
kbf{x? lgoldt ?kdf kbf{sf] ;kmfO ug'{k5{ t/ kmf]x/ b]lvPdf t'?Gt w'g'k5{
sfk]{6 lbgx'F Eofs'd lSng/n] ;kmf ug]{ .

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 9–3
 zNos[of sf]7fdf s'rf] nufpg' jf ;'Vvf dk ug{ x'bg} ;w} leh]sf] sk8fn] ;kmf ug'k{ 5{ .

zNos[of sf]7fsf] ;kmfO{sf] sfo{tflnsf

;kmfO{ ug]{ :yfg ;do ul/g'kg]{ sfo{
lj/fdL hf+Rg] lj/fdLsf] ;]jf z'? /fte/Lsf] w'nf] x6fpg sk8fdf kfgLn] lehfO lbgxF'
a]8, 6]an, s';L{, x'g' cufl8 k'5\g' k5{ .
aQL, 6«nL, e'O{
cflb
ck/];g 6]jn, lj/fdLsf] ;]jf z'? b'if0f lgjf/s 3f]nn] k'5\g'k5{ . ;Defljt ;+qmldt t/n
k|f]l;8\of]/ 6]an, ePkl5 Ps lj/fdLsf] kbfy{x?nfO{ t'?Gt ;kmf ug]{, olb yf]/} dfq kf]lvPsf]
dfof] 6]an, ;]jf ;lsPkl5 csf]{ ePdf )=% % sf] Snf]l/g 3f]ndf lehfPsf] sk8fn]
lj/fdLsf] ;]jf z'? kf]lvPsf] kbfy{ x6fpg] . olb w]/} g} kf]lvPsf] ePdf
ug'{ cufl8 )=% % sf] Snf]l/g 3f]n pSt kf]lvPsf] efudf vGofpg]
/ s]xLa]/kl5 )=% % sf] Snf]l/g 3f]ndf lehfPsf]
sk8fn] pSt 7fpF k'5\g'k5{ .
kmf]x/ hDdf ug]{ tLg rf}yfO{ efu vfnL ul/xfNg' k5{ .
efF8f] el/P kl5
kmf]x/ hDdf ug]{ k|To]s lbg b'if0f lgjf/0f u/]sf] efF8f] /fVg'k5{ .
efF8f]sf] ;kmfO{
kvf{n k|To]s lbg ;fj'g kfgLn] ;kmf ug{'k5{ .
zNos[ofdf k|To]s lbg sk8f b'if0f lgjf/s 3f]ndf 8'afO ;kmf ug{'k5{ .
k|of]u x'g] aQL
k"0f{ ;kmfO{ zNos[of ;lsPkl5  b'if0f lgjf/0fsf] efF8f]x? x6fpg] ;kmf ug]{
lbgx'F ug]{ ug{'k5{ .
 k|To]s lbg b'if0f lgjf/0f u/]sf] efF8f]x?
/fVg'k5{ .
 kmf]x/ hDdf ug]{ efF8f]x? x6fpg] / k|To]s lbg
b'if0f lgjf/0f u/]sf] efF8f]x? /fVg'k5{ .
b'lift ePsf] n'ufx? gr'lxg] efF8f]df /fv]/ aflx/
lgsfNg] ug{'k5{ . b'if0f lgjf/s 3f]ndf sk8f
lehfO{ ;a} efux? h:t} sfp06/, 6]an, aQLx?
k'5\g'k5{ .
 k'5\bf dflysf] efuaf6 tnlt/ ;kmf ug{'k5{ .

9–4 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
;/;kmfO{sf ;fdfgsf] 5gf}6 tyf k|of]u
;/;kmfO{sf ;fdfgx? ljleGg lsl;dsf x'G5g\ tfklg 5gf}6 ubf{ lgDg s'/fx?df Wofg k'¥ofpg
cfjZos 5 h:t} M–
 ck]lIft k|of]hg (intended use)
 o;sf k|efjsf/Ltf (efficacy)
 :jLsfo{tf (acceptability)
 ;'/lIftkg (safety)
 d"No (cost)

lgDg 3f]nx?f/f ;/;kmfO ug{ ;lsG5 M

 ;fa'g kfgL
 b'if0f lgjf/s 3f]n -)=%% Snf]l/g 3f]n jf cGo b'if0f lgjf/s 3f]n_
 b'if0f lgjf/s 3f]n / ;fa'g ld;fPsf] . h:tf] ;fj'g / Snf]l/g jf cGo b'if0f lgjf/s 3f]n .

Snf]l/g 3f]n agfpbf ckgfpg' kg]{ ;fjwfgL :

emf]n Snf]l/g -Sodium Hypochorite_ ;aeGbf pQd / ;:tf] ;+qmd0f lgjf/s xf] . Snf]l/g 3f]n
agfpbf v'Nnf 7fpFdf -well ventilated_ 7fpFdf agfpg' k5{ . Snf]l/g 3f]n agfpFbf cGo /;fog;+u
ld;fpFbf ;fjwfgL ckgfpg' k5{ h:tf] Snf]l/g / Pdf]lgof jf Pdf]lgod Snf]/fO8 jf Pl;8;+u ld;fpg'
xF'b}g . oL /;fogx? ldl;g uPdf Snf]l/g Uof; pTkGg x'G5 pSt UofF;n] jfsjfs nfUg], cfFvfaf6
cfF;' cfpg], 6fpsf] b'Vg] jf ;f; km]g{ ckm\7\of/f] x'g ;S5 . o:tf] cj:yf ePdf pSt 7fpFaf6 t'?Gt
aflxl/g' k5{ .

;kmfO{ ug]{ ljlw

sfof{no, k|ltIffnox? lhjf0f'4f/f b'lift gx'g] ePsf]n] ;+qmd0f x'g] ;Defjgf sd x'G5, o:tf
7fpFx?df kfgLdf lehfPsf] sk8fn] lbgx'F k'5\g] ug'{k5{ / xKtfsf] Ps k6s ;fa'g kfgLn] ;kmf u/]
k'U5 .
 zf}rfno h:tf a9L g} b'lift x'g] 7fpFx? lbgdf Ps k6seGbf j9L ;kmf ug'{kg]{ x'G5 .
 eF"O{ ;kmf ubf{ s"rf] gnufO{ ljleGg lsl;dsf] 3f]ndf lehfPsf] sk8fn] k'5\g' pko'Qm x'G5 .
 ;kmfO{ ubf{ sd kmf]xf]/ ePsf] 7fpFaf6 w]/} kmf]xf]/ ePsf] 7fpFdf ;kmf ub}{ nfg'k5{ .
 ;kmfO{ ubf{ dflyNnf] efuaf6 tNnf] efudf ;kmf ug'{k5{ .
 zNolqmof ug]{ 7fFpdf olb ;lsG5 eg] lr;f] Eofs'd lSng/ (wet vaccum cleaner) k|of]u
u/]df pQd x'G5 .
 ;kmfO{ ug]{ lgoldt tl/sfn] tflnsf agfO{ u/]df pQd x'G5 .

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 9–5
;/;kmfO{ ;'b[l9s/0f ug{sf] lgldQ lgDg sfo{x? ug{ h?/L 5 :
 ;kmfO{sf] gLlt tyf of]hgf agfpg]
 ;kmfO{sf] tflnsf agfpg] / ;Dk"0f{ ;/;kmfO{ ug]{ sd{rf/Lx?nfO{ /fd|/L hfgsf/L u/fpg] /
sfdsf] afF8kmfF8 ug]{
 lgoldt lgl/If0f / ;'kl/j]If0f ug]{ / ;'wf/ ub}{ n}hfg] .

lj/fdLsf] ;]jf ug]{ 7fpFsf] ;kmfO{ :

 la/fdL hfFRg] j]8, 6]jn, s';L{, aQL, 6«nL, e'FO{ cflbnfO{ la/fdLsf] ;]jf z'? x'g' cufl8 /ft
e/Lsf] w'nf] x6fpg sk8fdf kfgLn] lehfO lbgxF' k'5\g'k5{ . To;kl5 lj/fdLsf] ;]jf z'?
ePkl5 Ps lj/fdLsf] ;]jf ;lsPkl5 csf]{ lj/fdLsf] ;]jf z'? ug'{ cufl8 ck/];g 6]jn,
k|f]l;8\of]/ 6]jn, dfof] 6]jn, jf cGo b'lift x'g ;Sg] 7fpFx?df ;+qmd0f lgjf/s 3f]nn] k'5\g'
k5{ .
 /ut jf z/L/sf cGo t/n kbf{y kf]lvPsf] 5 eg] ;Defljt ;+qmldt t/n kbfy{x?nfO{ t'?Gt
;kmf ug]{, o;f] u/]df ;+qmd0f /f]syfdsf] ;fy} b'3{6gfx?af6 klg jRg ;lsG5 . olb yf]/} dfq
kf]lvPsf] ePdf )=%% sf] Snf]l/g 3f]ndf lehfPsf] sk8fn] kf]lvPsf] kbfy{ x6fpg] . olb w]/}
g} kf]lvPsf] ePdf )=%% sf] Snf]l/g 3f]n pSt kf]lvPsf] efudf vGofpg s]xLj]/kl5 )=%%
sf] Snf]l/g 3f]ndf lehfPsf] sk8fn] pSt 7fpF k'5\g'k5{ .
 kmf]x/x? hDdf ug]{ efF8f]x? tLg rf}yfO{ efu el/Pkl5 vfnL u/L xfNg'k5{ .
 lj/fdLsf] ;]jf sfo{ ;lsPkl5 ;j} efux? lj/fdL hfFRg] a]8, 6]jn, s';L{, aQL, 6«nL, e'O{ cflb
nfO{ )=%% sf] Snf]l/g 3f]nn] ;kmf ug'{k5{ .
 kmf]x/x? hDdf ug]{ efF8f]x?nfO{ )=%% sf] Snf]l/g 3f]nn] ;kmf ug'{k5{ .
 ck/];g sf]7fsf] ;kmfO{ ubf{ dfly pNn]v ul/Psf] ;fy} k|To]s xKtf l;lnËsf] ;kmfO{ )=%%
sf] Snf]l/g 3f]nn] ;kmf ug'{k5{ .
 e]G6Ln];gx? P/ sG8L;g nufotnfO{ -Air Conditioner_ ;fa'g kfgLdf sk8f lehfO{ lgoldt
;kmf ug'{k5{ .
gf]6M
l;=l8=l;= !(** cg';f/ ˆo"ldu]zgaf6 ;kmf ug]{ ljlwnfO{ x6fOPsf] 5 .
NMS vol I-2010 cg';f/ klg ˆo"ldu]zg af6 ;kmf ug]{ ljlwnfO{ x6fOPsf] 5 .

kmf]x/x? jf8{af6 lgsfNg]

:jf:Yo ;+:yfsf] ljleGg efuaf6 kmf]x/x? pTkfbg x'G5 / ;f]xL cg';f/ o;nfO leGbfleGb} k|sf/sf]
efF8f]df hDdf ul/Psf] x'G5 . oL kmf]x/x?nfO{ k|To]s l;km\6 jf kmf]x/ efF8f]df tLg r}fyfO{ el/Pkl5
jf cfjZostf cg';f/ aflx/ lgsfNg'k5{ . o;f] ubf{ h'g lsl;dsf] kmf]x/ xf] ;f] kmf]x/x?nfO{ 5'6\6f
5'6\6} cj:yfdf g} aflx/ lgsfNg'k5{ . kmf]x/x?nfO{ ld;fpg] sfo{ ug'{ xF'b}g . o;/L kmf]x/ aflx/ lgsfNbf
lj/fdLx?sf] eL8 gePsf] ;dodf ljz]if u/L ljxfg jf ;fFem lgsfNg'k5{ . lj/fdL jf lj/fdLsf]

9–6 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
cfkmGtnfO{ rf]6k6s nfUgaf6 hf]ufpg' k5{ . kmf]]x/x?nfO{ gr'lxg] efF8f]df lasf]{ nufP/ dfq lgsfNg'
k5{ . kmf]x/ lgsfNg] JolQmn] cfkm\gf] ;'/Iffsf] nflu JolQmut ;'/IffTds pks/0fx? h:t} df:s, 6f]kL,
Knf:6Ls ufpg jf Pk|f]g, a'6 (h'Qf), df]6f] k+hf k|of]u ug'{k5{ . kmf]x/ 5f]Psf] k+hf nufPsf] xftn] cGo
;kmf efux? h:t} 9f]sf, 9f]sfsf] ga cflb 5'g' xF'b}g . kmf]x/ lgsfNbf ;kmf ul/Psf] efF8f] pSt 7fpFdf
/fVg'k5{ / kmf]x/ ePsf] eFf8f] lgsfNg'k5{ . kmf]x/nfO{ w]/} rnfpg] sfo{ ug'{ xF'b}g .

n'ufx?sf] ;/;kmfO{ / Joj:yfkg

n'ufx?sf] ;/;kmfO{ tyf Joj:yfkgdf n'ufx? ;'/lIft tl/sfn] hDdf ug]{, Ps 7fpFaf6 csf]{ 7fFpdf
n}hfg] / /ut jf cGo t/n kbfy{ nfu]sf] jf gnfu]sf] 5'6\ofP/ w'nfO{ ug]{ tyf ;DalGwt :yfgdf
ljt/0f ug{'k5{ . n'uf rnfpg] w'nfO{ ug]{ sfo{ ubf{ ;kmfO{ ug]{ sd{rf/Lx?sf] ;'/Iffsf] nflu ;w} df]6f]
k+hf, cf+vfsf] ;'/Iffsf] nflu rZdf, 6f]kL, Knf:6Ls Pk|f]gsf] ;fy} a'6 k|of]u ug'{k5{ . zNos[of ubf{
k|of]u ePsf] ;a} n'ufx? b]lvg] u/L kmf]x/ geP klg ;w} w'g'kb{5 . k|of]u ePsf sk8fx?df hlt;Sbf]
sd xft nufpg' k5{ . n'ufx? em6\sfNg] sfo{ ug{ xF'b}g o;f] u/]df n'ufdf nfu]sf lhjf0f'x? xfjfdf
p8\g uO{ lhjf0f' km}lng] 8/ x'G5 . n'ufx? 5'6\ofpFbf, Ps 7fpFaf6 csf]{ 7fpFdf n}hfFbf w'nfO{ ubf{
wfl/nf] cf}hf/, l;of] jf rSs' jf cGo ;fdfg klg x'g;Sg] s'/fnfO{ ljrf/ u/L Wofgk"j{s rnfpg' k5{ .

n'ufsf] w'nfO{
lj/fdL tyf sd{rf/Ln] k|of]u u/]sf] jf zNos[ofdf k|of]u ePsf] ;a} n'ufx? h:t} tGgf,
l;/fgLsf] vf]n 8«]K; cflb k'gM k|of]u x'geGbf klxn] /fd|f];+u w'g'k5{ .
 n'ufnfO{ b'if0f lgjf/0f ug'{ cfjZos 5}g t/ b'lift n'ufx?sf] w'nfO{ ubf{ ;'/IffTds pks/0fx?
-Personal Protective Equipment PPE_ k|of]u ug'{ clt cfjZos 5 . /Ë p8\g] kbfy{
-Bleach_ n] n'ufsf] /Ë p8\g] ePsf]n] k|of]u ul/Fb}g t/ cGo /Ë gp8\g] 3f]n pknAw ePsf]
b"if0flgjf/0fsf] nflu k|of]u ug{ ;lsG5 . clt g} b"lift jf ;+qmldt n'ufx? b"if0f lgjf/0f ubf{
/fd|f] x'G5 . olb ;]tf] sk8f k|of]u ul/of] eg], sk8fsf] /Ë p8\g] ;d:of x'b}g .
 w]/} b"lift jf /ut jf cGo t/n kbfy{ nfu]sf] sk8f 5'6\6} w'g'k5{ .
 sk8f wF'bf emf]n ;fa'g k|of]u ubf{ /fd|f] x'G5 .
 n'uf wf]O;s]kl5 ;'Vvf ug{ 3fddf ;'sfpg' Hofb} /fd|f] x'G5 .
 n'uf ;'ls;s]kl5 o;df Kjfn jf RofltPsf] 5 ls egL hfF+r ug'{k5{, olb Kjfn jf RofltPsf]
eP l;nfP/ k|of]u ug]{ jf kmfNg'k5{ .
 8«]K; jf lng]gx? k|of]usf] nflu :t/ lgwf{/0f ug{ cfjZos 5 o;sf] nflu 8«]K; Kjfn k/]df
Ps km'6 :SjfP/ efusf] sk8fdf kfFr 7fpFdf dfq 6fNg ;lsg] 5 cyjf sk8fsf] @) k|ltzt
dfq 6fn]sf] x'g'k5{ .

Gff]6: Kjfn k/]sf] sk8fnfO{ 6fNg] sfo{nfO{ lg?T;flxt ug'{k5{ lsgls o;n] sk8fsf] df]6f]kgf
a9fpF5 / lgd{lns/0f ubf{ jfkm l5g{nfO ufx|f] k5{ .

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 9–7
  To;kl5 cGtdf :qL -Iron_ u/]/ k6\ofP/ e08f/ ug'{k5{ . zNos[ofdf k|of]u x'g] n'ufx?
lgd{lns/0f ug'{kg]{ ePsf]n] :qL ug'{ xF'b}g o;f] ugf{n] :qL ubf{ sk8fx? Hofb} ;'Vvf x'g]
ePsf]n] lgd{lns/0f k|s[ofnfO{ k"0f{tf lbg ;Sb}g .
 ;kmf ePsf n'ufx?nfO{ ;'/lIft tl/sfn] e08f/ ug'{sf] ;fy} cfjZos dfqfdf dfq ljt/0f
ug]{ .
 lj/fdLsf] sf]7fdf cgfjZos n'ufx? /fVg' x'Fb}g .
 lj/fdLsf] la5\of}gf kmf]x/ ePdf ;+qmd0f lgjf/0f 3f]nn] ;kmf u/]/ dfq ;kmf tGgf cf]5\ofpg'
k5{ .
 ;kmf n'ufx? / kmf]x/ n'ufx? 5'6\6f 5'6\6} /fVg'k5{ .
 ;kmf n'ufx? ;kmf b/fhdf e08f/ ug'{k5{ / cfjZostf cg';f/ ljt/0f ug'{k5{ .
:jf:Yo ;+:yfsf] Ifdtfcg';f/ n'uf sk8fx?sf] Joj:yf ug{'[k5{ .
n'ufsf] ;fy;fy} k|of]u ePsf ;'/IffTds pks/0fx? h:t} Pk|f]g, rZdf, a'6, ufpg, 6f]kL cflb klg
;kmf ug'{ kb{5 . olb oL ;fdfgx?df b]lvg] u/L kmf]x/ jf z/L/sf] t/n kbfy{ nfu]sf] v08df )=%%
Snf]l/g 3f]ndf lehfP/ ;fa'g kfgLn] /fd|/L ;kmf ug'{ k5{ / ;'Vvf u/]/ k|of]u ug'{k5{ . sfuhsf] 6f]kL,
df:s, Pk|f]gx? k'gM k|of]u ug'{ xF'b}g, To;}n] logLx?nfO{ w'g' cfjZos 5}g .

s]lGb|o lgd{lns[t ;fdfg ljt/0f zfvf

Central Sterile Supply Department (CSSD)

kl/efiff
s]lGb|o lgd{lns[t ;fdfg ljt/0f zfvfn] :jf:Yo ;+:yfsf] ljleGg OsfOdf lj/fdLsf] ;]jfdf k|of]u
ePsf cf}hf/, pks/0fx? k'gM k|of]usf] nflu lng], e08f/ ug]{, k|zf]wg ug]{ u5{ . o; s]lGb|o zfvfn]
lj/fdLsf] ;]jf / ;'/Iffdf s]lGb|t eP/ u'0f:t/Lo ;fdfgx? ljt/0f ug]{ sfo{sf] lhDd]jf/L lnPsf] x'G5 .
ljleGg k|sf/sf ;fdfgx? h:t} 8«]l;Ë ;]6, lng]gx? -sk8fx?_, zNos[ofsf nflu k|of]u x'g] ljleGg
k|sf/sf cf}hf/ pks/0fsf ;]6x?, k+hfx? cflb o; zfvfåf/f k|;f]wg ul/ ljleGg OsfOx?df ljt/0f
ul/G5 . of] zfvfn] lgd{lns[t cf}hf/ pks/0f tyf cGo ;fdfgx? ljt/0f / lgoGq0f ug]{ ePsf]n]
:jf:Yo ;+:yfhGo ;+qmd0f /f]syfd ug{ dxTjk"0f{ e"ldsf v]n]sf] x'G5 .
s]xL :jf:Yo ;+:yfx?sf ljleGg OsfOx?df cfkm\gf] cfkm\gf] lgd{lns/0f ug]{ Joj:yf ePsf] kfOPsf]
klg 5 t/ s]lGb|o :t/df ;fdfgx?sf] k|zf]wg / ljt/0f ePdf u'0f:t/Lo / Ps?ksf] ;]jf CSSD n]
k|bfg ub{5 . o;f] x]bf{ of] vlr{nf] h:tf] b]lvP klg eljiodf of] lskmfolt / e/kbf]{ x'g cfpF5 . of]
s]lGb|o zfvfsf] :yfkgfsf] nflu Joj:yfkgnfO{ o;sf] dxTjaf/] cjut u/fO{ k|fyldstf lbO{ :yfkgf
ug'{k5{ .

p2]Zo
 lj/fdLsf] ;]jfsf] nflu lgd{lns[t ;fdfgx?sf] Pp6} ;|f]taf6, u'0f:t/Lo, k|efjsf/L, ldtJooL
tl/sfn] ;a} OsfOx?df ljt/0f ug]{
9–8 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
  :jf:Yo ;+:yfdf cfjZos ;fdfgx?sf] 5gf}6 ug{ lg0f{o lngsf] nflu ;xof]u ug{]
 :jf:Yo;+:yfdf cfjZos ;fdfgx?sf] u'0f:t/ lgwf{/0f ug{ ;xof]u ug]{
 ;fdfgx?sf] lgd{lns[t /xg] cjwL (Dofb) ;lsg] ldlt n]Vg] / ;]6sf] gfd klg n]jn ug]{
 g;{ jf cGo sd{rf/Lx?sf] cfkm\gf] OsfO cg';f/ ;]jfsf] nflu ;dosf] art x'g]
 :jf:Yo ;+:yfsf ;+qmd0f /f]syfd sld6Ldf k|efjsf/L ;xeflutf hgfpg]]

CSSD sf]7fsf] 5gf}6 ubf{ Wofg lbg'kg]{ s'/fx? M

 :yfg 5gf}6 ubf{ ck/];g sf]7f jf k|f]l;8\of]/ sf]7fsf] glhs} 5fg]df ;lhnf] / k|efjsf/L
x'G5 .
 sf]7f 5gf}6 ubf{ kfgLsf], lah'nLsf], xftsf] ;/;kmfO{sf], zf}rfnosf] ;'ljwf ePsf] x'g'k5{ .
 sf]7f ;kmf ug{ ;lhnf], e'O{ glrlKng] vfnsf] x'g'k5{ .
 eF'O{ b/fh jf cGo :yfgx? ;+qmd0f lgjf/0f 3f]nn] ;kmf ug{ldNg] vfnsf] x'g'k5{ .
 pHofnf]sf] /fd|f] Joj:yf ePsf] x'g'k5{ .
 sf]7fsf] 5gf}6 ubf{ kmf]x/, Kofs ug]{ / lgd{lns[t ;fdfg /fVg ldNg] u/L e/;s 5'6\6f 5'6\6}
sf]7fsf] Joj:yf ug{;s] /fd|f] x'G5 .
 sf]7fdf w'nf], ls/fx?sf] k|j]z gx'g] u/L agfOPsf] x'g'k5{ .
 ;fdfgx? k|zf]wg ug{sf] lgldQ cfjZos ;fdu|Lx?sf] k|;:t dfqfdf pknAw x'g'k5{
 e08f/0fsf] lgldQ aGb b/fhsf] Joj:yf x'g'k5{ .
 ;+qmldt / lgd{lns[t j:t'x? Pscsf{df b'lift x'gaf6 arfpg' k5{ .
 sf]7f w]/} cf]l;nf] x'g' xF'b}g .
 b'lift ;fdfgx? / lgd{lns[t ;fdfg lng] / lbg] leGb} :yfg tf]Sg'k5{ .
 ;fdfgx? cf];fbf{ JolQmut ;'/Iffsf pks/0fx? k|of]u ug'{k5{ / lgd{lns[t / b"lift ;fdfgx?
cf];f{g] a]Unfa]Un} 6«nL k|of]u ug'{k5{ . lgd{lns[t ;fdfg cf];fbf{ ;Fw} 6«nL g} k|of]u ug'{k5{ .
 sf]7fdf w]/} dflg;x?sf] cfjthfjt x'g' xF'b}g .
 sd{rf/Lx?n] ;w} JolQmut ;'/Iffsf pks/0fx? k|of]u ug'{k5{ .

sd{rf/Lsf] Joj:yf
:jf:Yo ;+:yfsf] cfjZostf cg';f/ sd{rf/Lsf] Joj:yf ug'{k5{ . ;]jfsf] rfk ePcg';f/ @$ 306f
;]jf ;'rf? Ufg{ kg]{ cj:yfdf tLg l;km\6sf] sd{rf/Lsf] Joj:yf ug'{k5{ . k|To]s l;km\6df ;kmfO{ ug]{,
KoflsË ug]{ lgd{lns/0f ug]{ / e08f/ ug]{ sd{rf/L pknAw x'g'k5{ .
lgd{lns[t tyf b"lift ;fdfgx?sf] k|zf]wg sf]7f lrq ! df b]vfP adf]lhd Joj:yfkg ug{ ;s];Dd
k|of; ug'{k5{ .

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 9–9
 b'lift ;fdfgx? lng], ;kmf ug]{ / lgd{lns/0f ug]{ sf]7fdf sfd ug]{ 7F“psf] Joj:yfkgM
lrq !
a]Un} sf]7f ePdf Pp6} sf]7f ePdf

;fdfgx? b"if0f lgjf/0f, ;kmfO, ;'Vvf ug]{, Kofs ug]{ sfo{x? o; ;Gbe{ k'l:tsfsf] ljleGg
v08x?df pNn]v eP adf]lhd ug'{kb{5 . tnsf] lrq @ df ;fdfgx?nfO{ bf]xf]/f] sk8fdf
- - - -double
- wrapping _ _ _ _s;/L Kofs
_ ug{ ;lsG5
- eGg] af/] pNn]v u/]s_ f] 5 M M M M M
lrq @

   



9–10 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf ( 11
;+q;+md0f
qmd0f
;+q/f]md0f
/f]ssyfd
yfd
/f]styf
yfd
tyf:jf:Yo
:jf:Yo
tyf :jf:Yo
;+:;+yfhGo
:yfhGo
;+:yfhGo
kmf]kmf]x/d}
x/d}
kmf]
nfnxf/d}
Joj:yfkgsf
Joj:yfkgsf
nf Joj:yfkgsf
nflu
nflu;Gbe{
nflu
;+;Gbe{
qmd0f
;Gbe{
k'lk':tsf
/f]
l:tsf
sk'yfd ((k'11l11
l:tsftyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ ( 11
:tsf
 lSnlgsn k|of]uzfnfdf ;+qmd0f
/f]syfdsf cEof;x?
INFECTION PREVENTION PRACTICES IN
CLINICAL LABORATORY
!)
ljifoj:t'M
 k|of]uzfnfsf sd{rf/Lx?nfO{ ;+qmd0faf6 x'g] ljz]if vt/fx?
 k|of]uzfnfsf sd{rf/Lx?nfO{ nfUg ;Sg] cfsl:ds rf]6k6s
 lSnlgsn k|of]uzfnfx?df ;+qmd0f /f]syfdsf cEof;x?

e"ldsf
s'g} klg k|of]uzfnfdf sfd ug]{ :jf:YosdL{n] /ut cyjf ;DefJo ;+qmd0f x'g] j:t'x?, t/n
kbfy{ 5'g' kg]{ x'G5 . To;}n] k|of]uzfnfdf sfd ug]{ :jf:YosdL{x? cfsl:ds rf]6k6s nfUg]
hf]lvddf x'G5g\ . olt dfq geO{ k|of]uzfnfsf] sfd ug]{ :jf:YosdL{x? /f]u pTkGg u/fpg ;Sg]
-pathogenic microorganism_ lhjf0f'x? xft nufO hfFr ug'{ kg]{ ePsf] x'gfn] a9L g} vt/f x'G5 . o;
If]qsf :jf:YosdL{x?sf] nflu ljleGg txsf hLjg ;'/Iff -biosafety levels_ sf] nflu dfu{ lgb]{lzsfx?
lgsfn]sf 5g\ . tL dfu{ lgb]{lzsfx? w]/} ljlzi6 vfnsf 5g\ / o; lgb]{lzsfdf :jf:YosdL{n] x/]s
;dodf k|of]u ug'{kg]{ pks/0f tyf ljlwx?af/] pko'Qm tl/sfn] j0f{g ul/Psf] 5 . ?l6g afof]s]ldl:6«,
lSnlgsn Kofyf]nf]lh / An8 a}+s h:tf vt/f x'g] If]qx?sf] nflu ;fwf/0f ;+qmd0f /f]syfd lgb]{lzsf
tyf l;kmfl/; ljsf; ul/Psf] 5 .
Pr=cfO{=eL=÷P8\; cfpg' cufl8 tyf ;g\ !(() df Ifo/f]usf] nflu ljleGg cf}iflwx? cfPkl5
k|of]uzfnfaf6 ;+qmd0f x'g] dfqfdf s]lx sdL cfPsf] lyof] . -h:t}M ;+o'Qm /fHodf k|lt jif{ k|lt xhf/df
nueu # hgfdf c;/ kYof]{ ._ -lu|:6 tyf OD;nfO !((!_ ljsf;f]Gd'v b]zdf o;sf] cj:yf Psbd
km/s 5 . pbfx/0fsf] nflu xfn}sf] d'lha -@))#_ sf] k|ltj]bgdf s/fFrLdf $$ c:ktfnsf] k|of]uzfnf
dWo], kfls:tfgsf] s]jn @ k|of]uzfnfdf -$=%Ü_ dfq k~hf k|of]u ePsf] / ;+qmd0f lgjf/0f &
j6f -!^Ü_ k|of]uzfnfdf ePsf] lyof] . cem s]jn ;ft k|of]uzfnf -!^Ü_ df OlG;g]/]6/sf] Joj:yf
lyof] .

kl/efiffx?
 k|of]uzfnfaf6 x'g] ;+qmd0fM :jf:YosdL{af6 k|of]uzfnfdf x'g] lqmofsnfksf] sf/0fn] / ;f] qmddf
cfsl:ds rf]6k6saf6 x'g] ;+qmd0fnfO{ g} k|of]uzfnfaf6 x'g] ;+qmd0f elgG5 .
 h}ljs ;'/Iff sIf (Biological safety cabinets) - (BSCs)M of] o:tf] sIf xf] h;df ;]jf
k|bfgstf{x?nfO{ / jftfj/0fnfO{ ;+qmd0f x'gaf6 arfj6 ub{5 . To;}n] of] k|0ffnLn] hLjf0f'x?nfO{
lgis[o kfg]{ / jftfj/0fnfO{ klg ;'/lIft ug{ ;lsG5 . oL sIfx? ljleGg k|sf/sf x'G5g\, ! b]lv

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 10–1
 $ r/0fsf x'G5g\ . ltgLx? ;aeGbf sd ;+qmd0f x'g;Sg] hLjf0f'x?af6 ;'/Iff x'gb]lv lnP/ k|f0f
3fts hLjf0f'x?af6 ;'/Iff ug{ k|of]u ul/G5 .

k|of]uzfnfaf6 pTkGg x'g] ;+qmd0fsf k|sf/x?

ljleGg dfWodåf/f /f]usf hLjf0f'x? -Pathogenic organism_af6 ;+qmd0f x'G5 . w]/}h;f] lgDg
dfWodåf/f x'g] ub{5 M
 Inhalation: ;+qmldt tTjx? ld;fpg], lk:g] jf 3f]Ng] ubf{ jf To:tf j:t' hnfpFbf lg:sg] UofF;
;fjwfgL gckgfPsf sd{rf/Lx?n] Zjf; ln+bf z/L/leq hfg] ub{5 .
 Ingestion: sd{rf/Lx? lgDg lsl;dn] ;+qmldt x'g;S5 M
– yfxf gkfOsg xft d'vdf /fVbf
– b"lift j:t'x? -k]lG;n, snd_ jf cf}+nfx? -gË 6f]Sbf_ d'vdf /fVbf
– k|of]uzfnfdf vfFbf, lkpFbf jf w'd|kfg ubf{ cyjf ;xL tl/sfaf6 ;/;kmfO{ gubf{ -xftsf]
;/;kmfO{df x]nrqm¥ofO{+ ubf{_ jf
– lkk]6af6 tfGbf -k|of]uzfnfaf6 x'g] ;+qmd0fsf] 36gfsf] !#Ü oxL d'vaf6 lkk]6df tfGbf
x'G5 ._
 3fp x“+'bfM tLvf b'lift j:t'x? -;'O{, 5'/L, rSs' tyf km'6]sf b"lift l;;fx?_ af6 crfgs 3f]Rbf jf
rf]6k6s nfUg' g} k|of]uzfnfaf6 x'g] ;+qmd0fsf sf/0f x'g\ .

gf]6M ;fwf/0ftof ltvf j:t'x? k|of]u x'g] lalQs} xf]lzof/Lsf ;fy ;Dxfn]/ t'?Gt glhs} /x]sf
tLvf j:t'x? /fVg] ef“8f]df /fVg'k5{ .
 5fnf tyf Zn}lids (Mucous) lemNnL b"lift x'g'M d'v, gfssf] Kjfn tyf cfFvf / xft v'6\6fb]lv
cg'xf/;Dd 5fnfdf ePsf] 3fp vl6/fdf b"lift t/n kbfy{ l56f kgf{n] /f]usf hLjf0f'x?
-Pathogenic organism_ ;g{;S5 .

gf]6M d'vdf nufpg] ;fwf/0f Surgical df:s cyjf shield nufpgfn] o:tf vt/fx? sd ug{
;lsG5 .

;+qmd0f /f]syfdsf ;fdfGo lgb]{zgx?

 kmf]x/d}nf Joj:yfkg dfkb08 cg';f/ lj;{hg ug]{ .
 /ut, zl//sf t/n kbfy{ tyf Kofyf]h]lgs ;"Id ls6f0f'x?sf gd"gfsf efF8f]x? 5'Fbf gofF hfFr
ug]{ k~hfx? nufpg] .
 k|of]uzfnfdf vfg, lkpg, w'd|kfg ug{ / ;[Ëf/sf] ;fdfgx? k|of]u ug{ dgflx ug]{ . skfn nfdf]
gkfNg] olb kfNg' k/]sf] v08df /fd|/L afFWg] .
 c:ktfn jf gd"gf kl/If0fsf] nflu k|of]u ul/g] /]lk|mh]/]6/df vfg]s'/f e08f/ gug]{ .
 d'vaf6 lkk]6 tfGg lgif]w ug]{ . pko'Qm d]sflgs ;fdfgx? -h:t}M ;Szg aNa_ sf] k|of]u ug]{ .

10–2 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
 rfn' /x];Dd ;]lG6«ˆo"h gvf]Ng] .
 /ut ;+sngdf 6\o"asf] d'vnfO{ sk8f jf ?dfnn] ;a}+ aGb ug]{ jf vf]Nbf To;nfO{ s'g}klg
JolQmsf] ;fd'Gg]af6 6f9f /fVg] .
 sfo{If]qnfO{ b}lgs b"if0f lgjf/0f ug]{ cyjf b"lift ePdf, h:t}, s'g} j:t' kf]v]kl5 )=%Ü Snf]l/g
3f]nn] ;kmf ug]{ .
 olb /ut, z/L/sf t/n kbfy{ otfptf b]lvPdf jf t/n kbfy{df ;+qmldt tTjx?sf] ;Defjgf
ePdf ;'/Iffsf] nflu cg'xf/df df:s / uuN; nufpg] .
 tLvf j:t'x? /fVgsf] nflu Kjfn gkg]{, gr'lxPsf] lasf]{ efF8f]x? (puncutre proof container)
k|of]u ug]{ .
 ;+qmd0f x'g] vfnsf] kmf]x/ lasf]{ ePsf] efF8f]x?df /fVg] .
 k|of]uzfnfsf :jf:YosdL{x?n] Pk|f]g, df:s, 6f]kL, h'Qf -aGb_ nufpg]
 5fnfdf 3fp vl6/f 5 eg] Band Aid sf] d4tn] 3fp 5f]Kg] .
 ;+qmd0f /f]syfd tyf kmf]x/d}nf Joj:yfkg ;DalGw hfgsf/L jf tflnd lbg] .
 s]xL u/L s'g} b'3{6gf ePdf cfkm'eGbf hfgsf/nfO l/kf]{6 ug]{ .
 k|of]uzfnfsf] eF'O{ b'if0f lgjf/s 3f]nn] k'5\g ldNg] u/L e'O{df 6fon nufpg] .
 :jf:YosdL{x?nfO{ x]kf6fOl6; aL sf] vf]k nufpg] .
 l;l/Ghaf6 l;of] glgsfNg], lasf]{ gnufpg], gjË\ofpg] .

/ut tfGg]
/ut lemSg] sfo{ Ps k|sf/n] a9L vt/f x'G5 lsgeg] w]/}h;f] k|of]u x'g] ;'O{x? -!* b]lv @@ uh_
nfdf] x'G5 / k|of]u eO;s]kl5 To;df s]xL dfqfdf /ut afFsL /xG5 . ;+o'Qm /fHo cd]l/sfdf tLvf
j:t'n] 3f]r]/ rf]6 nfu]sf !,((# 36gfdWo] @!Ü /ut lems]sf] cj:yfdf ePsf] -e]g; jf cf6]{l/on
An8sf] gd"gf / lkmË/ lxnl:6s_ O{=kL=cfO{= g]6sf] !((( sf] k|ltj]bgdf pNn]v 5 . Eofs'd 6\o'a An8
sn]Szg l;of], l8:kf]h]an l;of], jf l;l/~h, jf a6/ˆnfO{ ;'O{ k|of]u u/]tfklg g;faf6 /ut lemSbf
*)Ü eGbf a9L l;of]n] 3f]Rg ;Sb5 .

/utsf] gd"gf ;°ng ubf{ Wofg lbg'kg]{ s'/fx?M

 kl/If0f ubf{ k~hf nufpg] .
 la/fdLx? c;xof]uL -s]6fs]6L, dfgl;s c;/ k/]sf la/fdL_ ePdf c?sf] d2t lng] .

/St ;+rf/ s]Gb|df ;+qmd0f /f]syfd

:jf:Yo ;+:yfsf] k|sf/ cg';f/ /St ;+rf/ s]Gb|sf] Joj:yf ePsf] x'G5 . t/ w]/}h;f] 7fFpdf /St ;+rf/
;]jf :jf:Yo ;+:yfeGbf km/s 7fpFdf Joj:yf ul/Psf] x'G5 . /St ;+rf/sf] nflu ljleGg cfjZostfx?
x'G5g\ . tLdWo] ;+qmd0f /f]syfdsf] b[li6sf]0fn] lgDgfg';f/ Joj:yf ul/Psf] x'g'kb{5 M

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 10–3
 /utsf] clt g} cfjZos k/]sf] cj:yfdf dfq /St ;+rf/ ug'{kb{5 .
 /ut bfg lbg'cl3 /StbftfnfO{ /uthGo ;+qmd0f ePsf] 5 5}g /fd|/L olsg ug'{kb{5 .
 /St ;+rf/ ug'e{ Gbf klxn] /utdf x'g ;Sg] ljleGg lsl;dsf] ;+qmd0fjf/] hfFr ug'{kb{5 h:t} Pr
cfO eL x]kf6fOl6; aL h:tf cGosf] glhtf gcfpGh]n ;Dd /St ;+rf/ ug'{ xF'b}g .
 /ut tfGbf / /ut hfFr ubf{ ;Fw} hfFr ug]{ k+hf k|of]u ug'{kb{5 .
 /ut tfGbf jf hDdf ubf{ b'lift x'gaf6 arfpg Aseptic t/Lsf ckgfpg' kb{5 / 5fnfnfO{
PlG6;]K6Lsn] ;kmf ubf{ uf]nfsf/ -center to outer_ tl/sf ckgfpg' kb{5 .

:jf:YosdL{sf] ;'/Iffsf] nflu lgDg sfo{ ug'{kb{5 M

 :jf:YosdL{x? /ut;+u sfd ug'{ kg]{ tyf l;of] tyf cGo ltvf j:t'x?sf] ;Dks{ x'g ePsf]n]
;+qmd0f x'g] ;Defjgf j9L x'G5 o;af6 jRg'sf] nlfu JolQmut ;'/Iffsf pks/0fx? h:t} k+hf,
km]; l;N8 cflb k|of]u ug'{kb{5 .
 s]xL u/L /ut kf]lvPsf] v08df )=% % sf] Snf]l/g 3f]n /utdf ;f]em} vGofpg' kb{5 / !) b]lv
#) ldg]6 ;dokl5 pSt 3f]ndf 8'afPsf] sk8fn] ;kmf ug'{kb{5 . o;f] sfo{ ubf{ df]6f] k+hf k|of]u
ug'{kb{5 .
 /ut lj;{hg ubf{ l56f cfpg ;Sg] xF'bf xf]l;of/L x'g'kb{5 / JolQmut ;'/Iffsf] pks/0fx? k|of]u
ug'{ kb{5 .
 l;of] l;l/Ghx? tyf /utsf] emf]nfnfO{ g5]l8g] efF8f]df hDdf ug'{kb{5 . / of] efF8f]nfO{ c6f]Sn]e
u/]/ dfq lj;{hg ug'{kb{5 .
/St ;+rf/ ug'{eGbf klxn] /utnfO{ pko'St tfkqmddf e08f/ ug'{ kb{5 / Ps 7fpFaf6 csf]{ 7fpFdf
n}hfbf lr;f] afs; -cold box_ k|of]u ug'{ kb{5 . Dofb ;dfKt ePsf] /ut k|of]u ug{' gx'g] ePsf]n]
;do ;dodf Dofb hfFr ul//xg' kb{5 . Dofb ;dfKt ePsf] /utnfO{ ;'/lIft tl/sfn] lj;h{g
ug'{kb{5 . /utsf] emf]nf / 6\o"anfO{ gr'lxg] aGb ug{ ;lsg] eFf8f]df hDdf ug'{kb{5 .

10–4 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
 ;+qmd0f /f]syfd Joj:yfkg ;'b[l9s/0f
STRENGTHENING INFECTION
PREVENTION MANAGEMENT !!
ljifoj:t'
 ;+qmd0f /f]syfd Joj:yfkgsf] ;'b[l9s/0f ug]{ k|s[of cjnDag ug]{
 sfo{ ;Dkfbg ;'wf/sf] nflu ckgfpg' kg{] r/0fx?sf] cEof; ug]{
 ljleGg u'0f:t/ ;'wf/sf 6'nx?sf] k|of]usf] cEof; ug]{
 sfo{ ;Dkfbgdf leGgtf kQf nufpg]
 sfo{of]hgf tof/ ug]{
 ;+qmd0f /f]syfd u'0f:t/ ;'lglzrtfsf] nflu u'0f:t/ ;'wf/ ;ldlt u7g ug]{ .

e"ldsf
u'0f:t/Lo ;]jfsf] nflu ;+qmd0f /f]syfd Psbd} dxTjk"0f{ x'G5 . ;+qmd0f /f]syfdsf] dxTj / u+eL/
k|s[ltsf ;+qmd0f tyf /f]ux? ;g{af6 arfpg ;lsG5 eGg]af/]df clwNnf] efux?df lj:t[t ?kdf
j0f{g ul/;lsPsf] 5 . ;+qmd0f /f]syfd dxTjk"0f{ ePtfklg w]/}h;f] :jf:Yo ;]jfdf ;+nUg JolQmx¿n]
dfkb08 cg';f/ plrt lsl;dn] o;sf] Joj:yfkg u/]sf] kfO{Gb}g / o;nfO{ dfkb08 adf]lhd sfo{
ug{ :jf:YosdL{x?sf] k|of; dfq kof{Kt xF'b}g . o;sf] nflu Joj:yfkg kIfn] Hofb} dxTjk"{0f e"ldsf
v]Ng'kg]{ x'G5 . o;sf] nflu lgDg s'/fx¿ ug{ cfjZos x'G5M
!= ;+qmd0f /f]syfdsf] Joj:yfkg ;DaGwL sfo{ ug{ :jf:Yo ;+:yfnfO{ tof/L cj:yfdf /fVg] .
@= :jf:y ;]jf k|bfg ubf{ ;+qmd0f /f]syfdsf] pkfo cjnDag ug]{ .

;+qmd0f /f]syfdsf] Joj:yfkg ;DaGwL sfo{ ug{ :jf:y ;+:yfnfO{ tof/L cj:yfdf /fVg] . u'0f:t/
;'wf/ 6'nx? kl/lzi6 A df x]g'{xf];\ .
tfnLd kl5 ;+qmd0f /f]syfdsf] Joj:yfkg ;DaGwL sfo{ ug{ lgDg s'/fx¿ ug'{k5{ .
!. ;+qmd0f /f]syfdsf] nflu cfjZos kfgLsf] Joj:yf ug]{ .
@. cfjZos cf}hf/ tyf pks/0fsf] Joj:yf ug]{ .
#. cfjZos ;fdfu|L tyf supplies -h:t} PlG6;]lK6s, k~hf_ sf] Joj:yf ug]{ .
$. cf}hf/ ;kmf ug]{ jf lgd{nLs/0f ug]{ sIf jf :yfgnfO{ tof/L cj:yfdf /fVg] .
%= :jf:Yo ;+:yfnfO ;kmf ;'U3/ /fVg] .
^. ;+qmd0f /f]syfd cg'udg / clen]v /fVg] (record keeping)]
:jf:y ;]jf k|bfg ubf{ ;+qmd0f /f]syfdsf] pkfo cjnDag ug{' k5{ . h:t} :
!. plrt tl/sfn] xftsf] ;/;kmfO{ ug]{ .
@. :jf:Yo ;]jf k|bfg ubf{ pko'St ;'/Iff ;fdu|Lx?sf] k|of]u ug]{ .

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 11–1
#. cf}hf/ tyf cGo ;/;kmfO{sf] nflu Snf]/Lg 3f]nsf] k|of]u ug]{
$. k|of]u ul/Psf cf}hf/ tyf pks/0fsf] plrt ;/;kmfO{ ug]{ .
%. lgd{nLs/0f jf pRr :t/Lo ;+qmd0f lgjf/0f ul/Psf cf}hf/sf] k|of]u ug]{ .
^. zNolqmof ;DaGwL sfo{ ubf{ lgd{lns[t k~hfsf] k|of]u ug]{ .
&. lgd{nLs/0f tyf pRr:t/Lo ;+qmd0f lgjf/0f ul/Psf cf}hf/ tyf ;fdfg plrt tl/sfn] e08f/
ug]{ .
*. ;]jf lbg] sIf, zNolqmof sIfsf] /fd|/L ;/;kmfO{ ug]{ .
(. ;]jfsf] s|ddf k|of]u ePsf n'ufsf] ;+sng tyf ;kmfO{ /fd|/L ug]{ .
!). :jf:Yo ;+:yfhGo kmf]x/nfO{ plrt tl/sfn] ;+sng tyf lj;{hg ug]{ .
o;sf] nflu tfnLd/uf]i7Lsf] cjlwleq g} ljleGg 6'nx?sf] k|of]u u/]/ ;+qmd0f /f]syfd ;DaGwL sfo{sf]
n]vfhf]vf u/]/ cEof; ug'{k5{ . o;sf] k|of]usf] af/]df lj:t[t hfgsf/L kfgf g+= !!–% df lbOPsf] 5 .
:jf:Yo ;+:yfdf dfly pNn]v ul/P adf]lhd ;j} kIfsf] Joj:yfkg ePdf dfq ;]jfsf] u'0f:t/
;'lglZrt ePsf] dfGg ;lsG5 . :jf:YosdL{x?n] tflnd/uf]i7L cjlwdf oL ;a}sf] af/]df 1fg, l;k /
Jojxf/df ptfg{' kg]{af/] hfgsf/L kfO;s]sf x'G5g\ . t/ o;sf] Jojxfl/s kIfnfO{ lg/Gt/ ;'b[l9s/0f
ub}{ n}hfg'k5{ .
;+qmd0f /f]syfd Joj:yfkgsf] ;'lglZrt ug{ ;'b[l9s/0fsf] nflu tfnLd dfq lnP/ kof{Kt gx'g]
s'/f w]/} jif{sf] cg'ejn] b]vfO;s]sf] 5 . tfnLd ;+rfng ubf{ ljleGg k|sf/n] ug{ ;lsG5 h:t}M
:jf:YosdL{nfO{ :jf:Yo ;+:yfeGbf aflx/ lgDtf] u/]/ jf tfnLd 6f]nL g} ;DjlGwt :jf:Yo ;+:yfdf uP/
:jf:YosdL{ nufot cGo ;Dk"0f{ sd{rf/Lx?nfO{ ;d]6]/ (Onsite whole site approach_ tfnLd/uf]i7L
;+rfng ul/G5 . Onsite whole site approach ckgfpbf Joj:yfkg kIf ;d]t ;+nUg x'g] xF'bf ;+qmd0f
/f]syfdsf] dxTj /fd|/L a'em\g] xF'bf tfnLd/uf]i7LkZrft k|efjsf/L ?ddf Joj:yfkg ug{ / ;+qmd0f
/f]syfd ug{ ;lsG5 . of] tl/sf ckgfpFbf ;+:yfsf] oyfl:yltsf] cWoog u/]/ To;sf] ;'wf/sf] nflu
;+:yfut cEof;x? ul/g] x'gfn] w]/} dxTjk"0f{ x'g cfpF5 . Onsite whole site approach df ;+qmd0f
/f]syfd Joj:yfkgsf] nflu lgoldt ?kdf :jf:Yo ;+:yfsf ;a}n] nuftf/ k|of; ul//xg' kg]{ cEof;df
hf]8 lbg] ePsf]n] o;nfO{ a9fjf lbg' cfjZos b]lvPsf]5 .
;+qmd0f /f]syfdsf] Joj:yfkg ;+:yfut ?kdf g} ;'b[9 ug'{ Onsite whole site approach k|efjsf/L
ePsf] s]xL ;+:yfx?sf] pbfx/0fx? 5 . To;}n] of] tl/sfnfO{ :jf:Yo ;+:yfdf lj:t[t ?kdf nfu" ug{
;s]df o;sf] qmlds ;'wf/sf] cEof; ul//x]df o;nfO{ lgoldt sfo{qmdsf] ?kdf n}hfg ;s]df :jf:Yo
;+:yfsf] d'xf/ km]g{ Ps gofF km6\sf] dfg{ ;lsg] lyof] . of] t/Lsf ;DalGwt ;+:yfsf ;Dk"0f{ sd{rf/Ln]
o;sf] ;'wf/sf] af/]df lrGtg dgg u/]/ u'0f:t/ ;'wf/sf] sfo{of]hgf agfpg] ePsf]n] klg of] tl/sf
k|efjsf/L x'G5 . sfo{of]hgfnfO{ sfof{Gjog ug{ lg/Gt/ ?kdf d"Nof+sg ug]{ k|s[of ckgfOG5 .
o;f] u/]df pSt sfo{ ;Dkfbgsf ;'wf/sf] sfo{of]hgf ;Dk"0f{ sd{rf/Lx?n] cfkm}n] agfPsf] x'gfn]
cfkm\gf]kgsf] cfefif x'G5 / o;n] ult lnG5 . xf]Og eg] tfnLd lng] JolQ dfqn] ;Dk"0f{ ;+:yfsf]
;+qmd0f /f]syfdsf] Joj:yfkg h:tf] hl6n sfo{ ;DkGg ug{ ;Dej xF'b}g . o;sf nflu lgDgfg';f/sf]
r/0fx? ckgfP/ sfo{ ;Dkfbgdf ;'wf/ u/L u'0f:t/ ;'lglZrt ug{ ;lsG5 . of] k|s[of Ps lg/Gt/
ul/g'kg]{ cEof; xf] .

11–2 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
;+qmd0f /f]syfd Joj:yfkgsf] sfo{;Dkfbgdf ;'wf/ ug{ ckgfpg'kg{] r/0fx?
(steps to improve performance in infection prevention management)
x/]s :jf:Yo ;+:yfn] u'0f:t/Lo ;]jf k|bfg ug{ ;d'bfosf] cfjZostf, cfˆgf] Ifdtf / pknAw ;'ljwf
cg';f/ nIo lgwf{/0f u/]sf] x'G5 . ;dosf] kl/jt{g / ;d'bfosf] dfu ;+u;+u} nIfdf klg kl/jt{g
x'b} hfG5 . ;f]xL nIfnfO{ k"/f ug{ x/]s :jf:Yo ;+:yfx¿n] ljleGg ;]jfx¿ k|bfg ub}{ cfPsf x'G5g\ .
o;/L :jf:Yo ;]jf lbg] qmddf :jf:Yo sfo{stf{x¿n] :jf:Yo ;+:yfsf] nIo k"/f ug{ s] s:tf sfo{x?
ug'{ kg]{ xf] < xfn s] eO/x]sf] 5 < To;nfO{ lg/Gt/ ?kdf d'Nof+sg u/L cem s;/L ;'wf/ ug{] eg]/
Jojl:yt tl/sfn] sfd ug'{k5{ .
sfo{ ;Dkfbgdf ;'wf/ ug{ ljleGg r/0fx? ckgfpbf sfo{x? Jojl:yt / ;/n tl/sfn] ug{ d2t k'U5 .
;fy} ;d:ofsf] jf:tljs sf/0f jf d'Vo h/f -h8_ ;Dd k'Ug d2t u5{ . sfo{ ;Dkfbgdf ;'wf/ ug]{
af6f]n] :jf:Yo ;+:yfsf] / :jf:Yo sfo{stf{x?sf] cfjZostf k"/f ug{ d2t k'¥ofpF5 .

sfo{ ;Dkfbg ;'wf/ ug]{ k|lqmof M

sfo{ ;Dkfbg ;'wf/ ug{ ;lhnf]sf] nfuL ljleGg r/0fx? ljsl;t ul/Psf] 5 . sfo{ ;Dkfbg ;'wf/
ug{] af6f]sf] 9f+rf kfgf g+= !!–$ df x]g'{ xf];\ . oL r/0fx?sf] cfwf/ lnP/ sfo{ ubf{ sfo{ ;Dkfbgdf
Jojl:yt tl/sfn] ;'wf/ ug{ ;lhnf] x'G5 . sfo{ ;Dkfbg ;'wf/sf r/0fx? lgDg cg';f/ 5g\ M

!= ck]lIft sfo{ ;Dkfbg (desired performance):

ck]lIft sfo{ ;Dkfbg eGgfn] ;+:yfn] xfl;n ug{ rfx]sf] u'0f:t/Lo ;]jfx? x'g\ . oL s'/fx¿ /fli6«o
tyf cGt/f{li6«o dfkb08n] lgwf{/0f ul/lbPsf] x'G5 . ck]lIft sfo{ ;Dkfbgsf] dfkb08, dfkb08 jf
lgb]{lzsf cg';f/ x'g'k5{ . :jf:Yo ;+:yfsf] ck]lIft sfo{sf] k|efjsf/L ;Dkfbg ug{ sd{rf/Lx¿n] cf–
cfk\mgf] lhDd]jf/Lx¿af/] :ki6 ¿kdf a'´g clt cfjZos 5 . ;+qmd0f /f]syfdsf] /fli6«o dfkb08 g}
o;sf ck]lIft sfo{ ;Dkfbg cfwf/ xf] .

@= sfo{ ;Dkfbgsf] n]vfhf]vf

:jf:Yo ;+:yfn] dfkb08 cg';f/ ;+qmd0f /f]syfd Joj:yfkgsf] pkfox¿ k|bfg ul//x]sf] 5 ls 5}g
egL a]nf a]nfdf n]vfhf]vf ug'{k5{ . o;/L n]vfhf]vf ubf{ pQm :jf:Yo ;+:yfaf6 lbOPsf ;+qmd0f
/f]syfd ;Gbe{df u|fxs jf lj/fdL ;Gt'i6 5÷5}g < lSnlgsn ;]jf lbg] k|lqmof dfkb08 cg';f/
eO/x]sf] 5÷5}g < /]s8{ /fd|f]÷7Lsl;t /flvPsf] 5÷5}g cflb x]l/G5 . o:tf] n]vfhf]vf # b]lv $
dlxgfsf] cGt/fndf ug'{k5{ .
sfo{ ljj/0f tyf lgb]{lzsfsf] cfwf/df tof/ ul/Psf] u'0f:t/ ;'wf/ 6'nx? k|of]u u/]/ :jf:Yo ;+:yfsf]
;+qmd0f /f]syfd Joj:yfkgsf] n]vfhf]vf ug{ ;lsG5 . o:tf] n]vfhf]vf cfkm}n] -self assessment_,
;fyLx?af6 -peer assessment_ tyf ;+:yfdf sfo{ ug]{ eGbf aflx/sf ;DalGwt JolQm jf lgsfoaf6
ug{ ;lsG5 .
o; tflnddf ;+nUg gul/Psf] eP klg, lj/fdL÷:ofxf/stf{ u|fxs;+usf] cGt/jf{tf{ tyf ;d'bfosf]
ljrf/÷wf/0ffnfO{ lnP/ n]vfhf]vf ug'{ /fd|f] x'G5 .

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 11–3
 sfo{ ;Dkfbg ;'wf/sf] nflu ckgfpg' kg{] r/0fx?

11–4
;xof]uL ;+:yf / AolQmx¿sf] ;xdtL lng] / sfod /fVg]

r/0f !
ck]lIft sfo{ ;Dkfbg

r/0f # r/0f $ r/0f % s r/0f % v

leGgtf d'n sf/0fx¿ ;dfwfgsf pkfox¿ pkfox¿sf]
yfxf kfpg] kQf nufpg] sfof{Gjog ug]{
sfo{ ;Dkfbgdf sfo{ ;Dkfbgdf b]lvPsf]
leGgtf x'g'sf] sf/0f leGgtfnfO{ sd ug{ s]
r/0f @ s] xf] < ug{ ;lsG5 <
sfo{ ;Dkfbgsf]
n]vfhf]vf

r/0f ^ sfo{ ;Dkfbgsf] cg'udg / d'NofÍg

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf] nflu ;Gbe{ k'l:tsf !!–5
#= leGgtf s] xf] kQf nufpg]M
;+qmd0f /f]syfd Joj:yfkg ;DaGwL ck]lIft sfo{ ;Dkfbgsf] cfwf/df s'g} :jf:Yo ;+:yfsf] sfo{
;Dkfbgsf] n]vfhf]vf ul/;s]kl5 d'Vo leGgtf s] s] xf] eg]/ kQf nufpg' kb{5 . oL leGgtfx¿
;+qmd0f /f]syfd Joj:yfkgdf ;'wf/ ug{sf] nflu Ps df}sfsf] ¿kdf lng'k5{ . olb leGgtfx¿ w]/}
b]lvPdf To;nfO{ k|fyldstfsf] cfwf/df ldnfpg' k5{ . Ps k6sdf g} w]/} leGgtfx¿nfO{ ;dfwfg ug{'
eGbf k|fyldstfsf] cfwf/df %–& j6f hlt leGgtfx¿nfO{ lnP/ ;dfwfg ug{ k|of; ug'{k5{ .

$ ;d:ofsf] d"n sf/0f kQf nufpg] (finding root cause)

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/ d}nf Joj:yfkgsf ;Gbe{df ck]lIft sfo{ ;Dkfbg
/ jf:tljs sfo{ ;Dkfbg aLr cGt/ ePdf ;d:of ePsf] dflgG5 . o;/L ck]lIft / jf:tljs
sfo{ ;Dkfbg aLr cGt/ ePdf Tof] s] sf/0fn] ePsf] xf] eg]/ yfxf kfpg'k5{ . t/ aflx/af6
df]6fdf]6L tl/sfn] x]g]{lalQs} ;d:ofsf] d"n sf/0f;Dd k'Ug ;ls+b}g . ck]lIft sfo{ ;Dkfbg (desired
performance) / jf:tljs sfo{ ;Dkfbg (actual performance) aLrdf leGgtf b]lvPdf, pQm
leGgtfsf] d"n sf/0f kQf nufpg :jf:Yo ;+:yfsf ;a} hgf a;]/ n]vfhf]vf÷ljZn]if0f ug'{k5{ . olb
;d:ofsf] jf:tljs sf/0f;Dd k'Ug ;lsPg eg] ToxfF ul/Psf ;a} k|of;x¿ lg/y{s x'g ;S5g\ .
;d:ofsf] d"n sf/0fdf k'u] kl5 To;sf ;dfwfgsf ljleGg pkfox¿sf] vf]hL ug{ ;lsG5 .
;d:ofsf] d"n sf/0f kQf nufpg ælsg=====lsg=====<Æ cyf{t æs] sf/0fn] of] ;d:of ePsf] xf]nf<
egL r/0fa4 ?kdf d"n sf/0f kQf gnfu] ;Dd k|Zg ug]{ ug{'k5{ . k|foMh;f] o:t} kfFr kN6;Dd ubf{
d"nsf/0f;Dd k'Ug] ;Defjgf w]/} x'G5 .
;d:ofsf] d"n sf/0f :Jff:YosdL{n] sfo{ ug]{ jftfj/0f, ;+:yfsf] ;xof]u, ;/–;fdfu|Lsf] pknAwtf,
p;sf] 1fg / ;Lk tyf sfo{ ug]{ rfxgf h:tf s'/fdf e/kg]{ ePsf]n] ;f] tx;Dd k'u]/ d"n sf/0f kQf
nufpg' k5{ .

% ;dfwfgsf pkfox?sf] 5gf}6 tyf sfof{Gjog (selecting and implementing interventions):

o;/L ;+qmd0f /f]syfd tyf :jf:y ;+:yf hGo kmf]x/d}nf Joj:yfkgdf leGgtf cyf{t ;d:of x'g'sf]
d"n sf/0fx¿ kQf nfu]kl5 ;f]xL cg'?k pko'Qm ;dfwfgsf] pkfo vf]Hg'k5{ . o:tf ;dfwfgsf] vf]hL
tyf sfof{Gjog ;a} :jf:YosdL{ tyf cGo sd{rf/Lx¿sf] ;+o'Qm k|of;jf6 :jf:y ;+:yf leq}af6
ul/g'k5{ . t/ sltko ;d:ofx¿sf] ;dfwfgsf] nflu :jf:Yo ;+:yf Joj:yfkg ;ldlt, lhNnf, If]q
tyf s]lGb|o tx;Ddsf] klg ;xof]u lng'kg]{ x'G5 .
s'g} klg lqmofsnfk ubf{ ;fwg tyf ;|f]tx¿, ;DefJotf, ;fGble{stf tyf sd{rf/Lsf] ;xdtLdf
k|fyldstfsf] cfwf/df ug'{k5{ . s'g} ;d:ofsf] ;dfwfg cfkm\gf] IfdtfeGbf aflx/sf] ePdf bL3{sflng
of]hgf agfO{ afx\Ø ;xof]usf] nflu k|of; ug'{k5{ .
lqmofsnfkx¿nfO{ ;DkGg ug{ :jf:Yo ;+:yfsf sd{rf/Lx? / :jf:Yo ;+:yf Joj:yfkg ;ldltsf
;b:ox?sf] cfk;L 5nkmnaf6 sfo{ of]hgf tof/ ug{'k5{ . sfo{ of]hgfsf] gd'gf kl/lzi6 v df
lbOPsf] 5 .

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 11–5
sfo{of]hgf tof/ ug]{
klxrfg ul/Psf lqmofsnfkx?nfO{ Jojl:yt 9Ëaf6 tyf ;dod} sfof{Gjog ug{sf nflu o;sf]
lj:t[t sfo{of]hgf tof/ ug'{k5{ . sfo{of]hgfdf lqmofsnfkx?nfO{ k|fyldstfsf cfwf/df qmda4?kdf
pNn]v ug'{k5{ / s'g sfd slxn] / s;n] ;DkGg ug]{ eGg] klg :ki6 ?kdf pNn]v ug'{k5{ . ;fdfGotof
o:tf] sfo{of]hgf Ps cfly{s jif{sf nflu tof/ ug'{k5{, t/ k|To]s dlxgf jf k|To]s rf}dfl;s
cjlwdf ;DkGg ug'{ kg]{ lqmofsnfkx? sfo{of]hgfdf :ki6 pNn]v x'g'k5{ . ;+qmd0f /f]syfd tyf
:jf:Yo ;+:yfhGo kmf]x/ d}nf Joj:yfkgdf ;'wf/ ;DaGwL sfo{sf] dfl;s÷rf}dfl;s÷jflif{s ;dLIffsf]
cfwf/df sfo{of]hgfdf klg cfjZostf cg';f/ ;+zf]wg ub{} hfg'k5{ . cu|Ld ?kdf tof/ ul/Psf]
jflif{s sfo{of]hgfdf ;dfj]z ul/Pafx]s dfl;s ;dLIffaf6 k|fKt lgisif{sf cfwf/df cGo sltko
ultljlwx? klg ;~rfng ug'{ kg]{ x'g;S5 . To;}n] o:tf ultljlwx?nfO{ ;dfj]z u/]/ x/]s dlxgfsf]
lj:t[t sfo{of]hgf ;d]t tof/ ug'{k5{ . sfo{ of]hgfsf] gd'gf kl/lzi7 …vÚ df lbOPsf] 5 .

^ sfo{ ;Dkfbgsf] cg'udg tyf d"Nof°g (monitoring and evaluating performance):

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/ d}nf Joj:yfkg ;DaGwL ;d:of ;dfwfg ug{ ul/Psf
lqmofsnfkx¿jf6 s] slt ;'wf/ eof] eGg] s'/fsf], ;+:yfsf k|d'v jf :jf:Yo sfo{stf{x? jf dflyNnf]
txsf ;'kl/j]Ifsx?af6 a]nf a]nfdf cg'udg eO/xg'k5{ . olb sf/0fjz cfzf ul/Pcg'?k ;'wf/
Nofpg ;lsPg eg] k'gM lsg To:tf] ePsf] xf] sf/0f kQf nufO{ ;dfwfgsf] plrt pkfo vf]Hg'k5{ .

;+qmd0f /f]syfd Joj:yfkgdf u'0f:t/ ;'wf/

:jf:Yo ;]jfsf] u'0f:t/ ;'wf/sf ultljlwsf] klxrfg tyf ;~rfng r/0fa4 ?kdf ug'{kg]{ x'G5 / o:tf
ultljlw Ps k6s dfq ;DkGg u/]/ ;w}Fe/L u'0f:t/Lo ;]jf k|jfx ug{ ;Dej x'Fb}g . of] s'/f ;+qmd0f
/f]syfd Joj:yfkgsf] u'0f:t/ ;'wf/df klg nfu' x'G5 . æu'0f:t/ ;'wf/Æ Pp6f lg/Gt/ rln/xg] k|lqmof
xf] . cyf{t\ u'0f:t/ ;'wf/sf ultljlwx? lg/Gt/ ?kdf ;w}Fel/ ;~rfng ug'{kg]{ x'G5 . tn lbOPsf]
lrqdf u'0f:t/ ;'wf/ rqm cyf{t u'0f:t/ ;'wf/sf r/0fx? / k|To]s r/0fcGtu{t ;Dkfbg ug'{kg]{
sfdx?af/] hfgsf/L lbOPsf] 5 M
Dffkb08sf cfwf/df
jt{dfg l:yltsf] n]vf
hf]vf / cfjZostf
klxrfg

k|ult cg'udg tyf ultljlw klxrfg

d"NofÍg Uf'0f:t/Lo
tyf sfo{ of]hgf
:jf:Yo ;]jf lgdf{0f

sfo{ of]hgfcg';f/
ultljlw ;~rfng

11–6 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
:jf:Yo ;+:yfdf u'0f:t/ ;'wf/ 6f]nL lgdf{0f
:jf:Yo ;+:yfsf] sfo{of]hgf cg';f/ u'0f:t/ ;'wf/sf sfo{x? ;DkGg ug]{ / u'0f:t/Lo :jf:Yo ;]jf
k|bfg ug]{ sfo{df :jf:Yo ;+:yfsf ;Dk"0f{ sd{rf/Lsf] ;dfg e"ldsf / lhDd]jf/L x'G5 . :jf:y ;]jf lbg]
qmddf ;+qmd0f /f]syfd Ps clt g} dxTjk"0f{ u'0f:t/ ;'wf/sf] sfo{ xf] . ;+qmd0f /f]syfd nufot cGo
u'0f:t/ ;'wf/sf] sfo{ ug{ :jf:Yo ;+:yfsf sd{rf/L / :jf:Yo ;+:yf Joj:yfkg ;ldltsf ;b:ox?
dWo]af6 Pp6f ;fgf] 6f]nL u7g u/]/ u'0f:t/ ;'wf/sf ;Dk"0f{ ultljlwsf] /]vb]v ug]{ lhDd]jf/L lbg
pko'Qm x'G5 . o;} 6f]nLn] cfˆgf] :jf:Yo ;+:yfaf6 lg/Gt/ ?kdf u'0f:t/Lo :jf:Yo ;]jf k|bfg eO/x]sf]
5 eGg] ;'lgZrt ug'{k5{ .
Joj:yfkg dxfzfvfn] u'0f:t/ ;'wf/ ;DaGwL lgb]{lzsfdf ljleGg txsf :jf:Yo ;+:yfx?n] lgDgfg';f/
u'0f:t/ ;'wf/ 6f]nL u7g ug'{k5{ eg]/ pNn]v u/]sf] 5 .

u'0f:t/ ;'wf/ 6f]nLsf] u7g

:jf:Yo ;+:yf u'0f:t/ ;'wf/ 6f]nL ;+Vof
:jf:Yo rf}sL :jf:Yo rf}sL k|d'v ! hgf
c=g=dL=÷c=x]=a= ! hgf
:jf:Yo rf}sL Joj:yfkg ;ldltaf6 ! hgf
dlxnf :jf:Yo :jo+;]ljsfdWo]af6 ! hgf
pkef]Qmf jf ;]jfu|fxLaf6 ! hgf
hDdf M % hgf
k|fylds :jf:Yo s]Gb| k|fylds :jf:Yo s]Gb| k|d'v ! hgf
x]Ny cl;:6]06÷c=x]=a= ! hgf
:6fkm g;{÷c=g=dL= ! hgf
k|fylds :jf:Yo s]Gb| Joj:yfkg ;ldltaf6 @ hgf
dlxnf :jf:Yo :jo+;]ljsf dWo]af6 ! hgf
pkef]Qmf jf ;]jfu|fxLaf6 ! hgf

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 11–7
11–8 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
 v08 v

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 11–9
11–10 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
 :jf:Yo ;+:yfhGo kmf]x/ d}nf
Joj:yfkg
HEALTH CARE WASTE MANAGEMENT !@
ljifoj:t'M
 :jf:Yo ;+:yfhGo kmf]x/ d}nf Joj:yfkgsf] e"ldsf
 :jf:Yo ;+:yfhGo b"lift tyf b"lift gePsf] kmf]x/ j:t' Jojl:yt ug]{ ljlwx?
 ;fn tyf dfgj tGt'x?nfO{ la;h{g

e"ldsf
:jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkg ;+qmd0f /f]syfdsf] Ps cleGg c+u xf] . o;n] ;+qmd0f
/f]syfddf dxTjk"0f{ e"ldsf v]N5 . kmf]x/x?nfO{ /fd|/L Joj:yfkg ul/Pg eg] cl3Nnf] v08x?df
pNn]v ul/Pcg';f/ hlt;'s} u'0f:t/Lo ;]jf lbPklg k"0f{ u'0f:t/Lo ;]jf dfGg ;lsb}g . o;sf]
Joj:yfkg /fd|f] ePdf :jf:Yo ;+:yf ;kmf ;'U3/ tyf cfgGbbfoL x'G5 . lj/fdLx?nfO, :jf:Yo ;+:yfdf
cfpg] JolQmx?nfO / sd{rf/Lx?nfO ljleGg lsl;dsf] ;+qmd0faf6 jrfpg ;lsG5 . lj/fdLx? tyf
p;sf cfkmGt / ;d'bfonfO{ klg ;+qmd0fjf6 jrfpg ;lsG5 / :jf:Yo ;+:yfsf] jftfj/0f :jR5 tyf
/d0fLo x'G5 . lj/fdLn] lgw{Ss ;fy ;]jf lng] / ;]jfk|bfosnfO{ klg cfkm\gf] sfo{If]q cfgGbbfoL ePdf
sfd ug{ xf};nf ldN5 / pgLx?nfO klg uj{ x'G5 . kmf]x/d}nf Joj:yfkgdf :jf:Yo ;+:yfdf ;+nUg
sd{rf/Lx? -8fS6/, g;{, ;xfos sd{rf/Lx?, Joj:yfkgsf sd{rf/Lx?_, la/fdLx? / s'?jfx?sf]
7"nf] e"ldsf x'G5, o;sf] nflu kmf]x/ d}nf Joj:yfkg af/] ;j}n] lgod kfngf ug'{ cTofjZos 5 .
kmf]x/d}nf Joj:yfkgdf nfk/jfxL u/]df ljleGg /f]usf] ;fy} x]kf6fOl6; aL, ;L, Pr=cfO{=eL=h:tf
eofgs ;+qmd0fx?sf] hf]lvd x'G5 . o;sf/0f kmf]x/d}nf Joj:yfkgsf]] dxTj w]/} 5 .
:jf:Yo ;+:yfhGo kmf]x/ d}nf eGgfn] :jf:Yo ;]jfjf6 lg:sg] ljleGg k|sf/sf kmf]x/d}nfx?nfO{
j'emfp+b5 . To; cGt{ut lj/fdLx?sf] ;]jf ubf{ cfpg] kmf]x/d}nf, k|of]uzfnf ;]jf tyf cg';Gwfg
ubf{ lg:sg] kmf]x/x? x'g\ . :jf:Yo ;+:yfhGo kmf]x/d}nf d"ntM b'O{ k|sf/sf x'G5g\ . ljZj:jf:Yo
;+u7gsf] cg'dfg cg';f/ :jf:Yo ;+:yfhGo kmf]x/x?df *)Ü ;fdfGo, !%Ü ;+qmldt, !Ü wfl/nf,
ltvf, #Ü /;folgs jf cf}iflwhGo, !Ü eGbf sd /]l8of]PlS6e, ;fO6f]6lS;s, k|];//fOH8 j6\6fx?,
km'6]sf kf/fo'St ydf{ld6/ tyf Jof6/L h:tf kmf]x/x? x'G5g\ . ctM kmf]x/x?sf] plrt Joj:yfkg
ePdf, vt/fhGo kmf]x/x?sf] dfqf Hofb} sd x'G5 . kmf]x/x?nfO{ lgDdfg';f/ Joj:yfkg ug{ ;lsG5M
 kmf]x/ sd ug]{ -Minimization of waste_
 kmf]x/ 5'6\6f 5'6\6} hDdf ug]{ -Segregation_
 kmf]x/ hDdf tyf e08f/0f ug]{ -Collection &Storage_

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 12–1
  kmf]x/ Ps 7fFpjf6 csf]{ 7FFfpdf cf];f{g]{ -Transportation_
 kmf]x/sf] pkrf/ jf b'if0flgjf/0f -Treatment and disposal_ tyf lj;{hg
kmf]x/ sd ug'{ -Minimization of waste_
kmf]x/ sd ug'{ eGgfn] kmf]x/sf] pTkfbgnfO{ g} /f]s nufpg' jf o;sf] k|of]udf s6f}tL ug'{ xf] .
kmf]x/x?sf] sdL ug]{ lglt lnPdf, lgdf{0fstf{n] cgfjZos ;fdfgx?sf] cfjZos x'b}g / To:tf] vfnsf]
;fdfgx?sf] pTkfbg ug'{ gkg]{ x'gfn] To:tf j:t' lgdf{0f ug]{ vr{ sd x'g] ePsf]n] kmfObfhgs x'G5 .
o;sf] nflu Joj:yfkg / Jojxf/ kl/jt{gsf] nflu ljz]if /0flglt ckgfpg' kg]{ x'G5 . kmf]x/x?sf]
sdL ug]{ ljsNk eg]sf] g} o:sf] k|of]unfO gsfg]{ /0flglt xf] . of] nIo k|flKtsf] nflu sfo{ljlwdf
-procedural_ kl/jt{g Nofpg kb{5 . xfdLn] sfd ug]{ If]qdf slt kmf]x/ pTkfbg x'G5 eGg] lgDg s'/fdf
e/ kb{5 h:t}M xfd|f] Jojxf/ s:tf] 5< xfdL k'gM k|of]u x'g] jf k|of]u u/]/ kmfNg] -disposable_;fdfg
k|of]u u5f}{< sd{rf/Lx?nfO s'g} ;'rgf k7fpbf sfuhdf n]v]/ k7fp5f}+ jf O d]n -E-mail_ u5f}{< lrof
lkpgsf] nflu cfkm\g} sk jf ;kmf ug{ ;lsg] sk k|of]u u5f}{ jf Ps k6s k|of]u u/]/ kmfNg] sk k|of]u
u5f}{< cflb . o;/L cgfjZos j]sf/sf j:t'x? k|of]u ug{sf] nflu ;fdfgx?sf] vl/b ug]{ k|s[ofdf
kl/jt{g Nofpg], cgfjZos ;fdfg hDdf ug{df lgoGq0f ug]{ / vt/gfs j:t'x?sf] pTkfbg sd ug'{
kb{5 . o;/L j]sf/L jf kmf]x/ -waste_ j:t'x?sf] sd ug]{ qmddf :jf:Yo ;]jfsf] u'0f:t/df ;Demf}tf
ug'{ x'b}g / ;]jfsf] kx'Frdf klg sdL cfpg eg] lbg' x'b}g . kmf]x/x?nfO lgDgfg';f/ sdL ug{ ;lsG5 M
 kmf]x/x?nfO ;|f]tdf g} sdL ug'{ -;fdfgsf] lsgd]n / k|of]udf kl/jt{g ug'{, sfo{ljlwdf
kl/jt{g Nofpg'_
 k'g{rlqmo / k'g{k|of]u ul/g] j:t'x?sf] k|of]udf k|fyldstf lbg'

kmf]x/x?nfO ;|f]tdf g} s6f}tL ug'{

kmf]x/x?sf] s6f}tL ug'{ eGgfn] o;sf]] k|of]u k"0f{ ?kdf lgd"{n ug'{ jf sd kmf]x/sf] pTkfbg ug'{ xf] .
pbfx/0fsf] nflu ;/;kmfOsf] nflu k|of]u ul/g] j:t'x?sf] vl/b lgltdf k'g/fjnf]sg ug]{, o;f] ubf{
;fdfgsf] u'0f:t/ / jftf/0fdf kg]{ c;/nfO{ ;Demf}tf -compromise_ ug'{ x'b}g . kmf]x/x?sf] sdL
;fdfgsf] km]/jbn u/]/ jf ;+;f]wg u/]/ klg ug{ ;lsG5 . ;fdfgx?sf] vl/b ubf{, o;n] kmf]x/sf]
dfqfdf ;d:of Nofpg ;Sg], ljiffn' w'Fjf pTkGg x'g ;Sg], tL ;fdfgsf] k|of]un] xflg k'¥ofpg] jf
pkrf/ ;]jf ;'ljwf nfdf] ;do lbO/xg ;lsg] jf g;lsg] eGg]jf/] ;fawfgLk"j{s Wofg k'¥ofpg' kb{5 .
pbfx/0fsf] nflu kf/fo'St ydf{ld6/x? jbnfdf l8lh6n jf On]S6|f]lgs ydf{ld6/x? k|of]u ug'{ kb{5 .
;fdfgx?sf] KoflsËdf klg sdL Nofpg ;lsG5 . lj/fdLsf] ;]jfljlwdf ;fgf ;fgf kl/jt{gx? NofP/
klg kmf]x/sf] pTkfbgdf sdL Nofpg ;lsG5 . o;sf pbfx/0f lgDgf 5g\M
 ;]jf k|bfosn] 8\]l;Ë, ;kmfO tyf lgd{lns[t sfo{ljlw ckgfpgsf] lgldQ cfjZos ;fdfgx?sf]
tof/L ubf{ klxn] g} ljrf/ k'¥ofpg' kb{5 . lgd{lns/0f ug{ / k'g{k|of]usf] nflu cgfjZos /
j9L ;fdfgx? /fVg' x'b}g . o;f] u/]df cgfjZos ;fdfgx? b'lift x'gjf6 jrfpg ;lsG5 .
 kmf]x/x? hDdf ug]{ ef8f]x? s'g s'g :yfgdf /flvPsf] 5 eGg] jf/] k'g/fjnf]sg ug'{ kb{5 .

12–2 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
s6f}tLsf yk lgtLx?
 ;fdfx?sf] vl/bdf s6f}tLM ;fdfg vl/b ubf{ sd kmf]x/ pTkfbg x'g] tyf sd vt/f x'g]
vfnsf] 5gf}6 ug]{
 /f;folgs eGbf ef}lts t/Lsf ckgfpg ;lsg] vfnsf] ;kmfO ;fdfgx? vl/b ug]{ -/;folgs
eGbf jfkm4f/f ;+qmd0f lgjf/0f Autoclving ug]{_
 kmf]x/sf] pTkfbgdf /f]syfd ug]{ -;]jf ubf{ jf ;kmfO{ ubf{_

k'g{rlqmo / k'gM k|of]u ul/g] j:t'x?sf] k|of]udf k|fyldstf lbg'

k'g{rlqmo / k'g{k|of]u ul/g] j:t'x?sf] k|of]un] :jf:Yo ;+:yfhGo kmf]x/x?sf] dfqfdf sdL cfp5 o;f]
ubf{ lj/fdLsf] ;]jfsf] u'0f:t/ / :jf:YosdL{x?sf] ;'/IffnfO{ Wofgdf /fvL s]xL ;fdfgx?sf] k'g{k|of]u
ug{ ;lsb}g . /]l8of]PlS6e j:t'x? 4f/f b'lift Knf:6Ls, Sofy]6/, Ps k6s dfq k|of]u ul/g] k+hfx?,
l;l/Ghx? / l;of]x? k'g{rlqmo tyf k'g k|of]u ug{ ;lsb}g . k|of]u lrlsT;lso tyf cGo pks/0fx?
lgd{lns/0f u/]/ dfq k'g k|of]u ug{ ;lsG5 h:t} Jn]8x?, l;;fsf jf]tnx? / efF8f]+x? . k|of]u ePsf
k'gM k|of]u ug{ ;lsg] ;fdfgx?nfO{, k'g k|of]u ug{ g;lsg] ;fdfg eGbf cnu} /fVg' kb{5 / lgd{lns/0f
ug'{ kb{5 . k'g k|of]u x'g] ;fdfgx?, lgd{lns/0f u/]kl5, ;kmf u/]/ dfq k'g{rqmLosf] nflu k7fpg'
kb{5 . :jf:Yo ;+:yfx?n] k|efjsf/L k'grlqmo kmf]x/ Joj:yfkgsf]] nflu uxg Wofg k'¥ofpg' kb{5
/ o:sf] pTkfbg x'g] :yfgjf6 g} kmf]x/x?nfO cnUn} efF8f]df hDdf ug'{ kb{5 . k'g{rlqmo ;fdfgx?
lgDgfg';f/ 5g\M
 l;;f
 Knf:6Ls
 cn'ldlgodsf j6\6fx?, kmnfd
 sfuh / sf8{ jf]8{x?
k'g{rlqmo sfo{qmd z'? ug'{ eGbf klxn] pko'{St ;fdfgx?sf] ;Defljt k|of]u jf/] k'g/fjnf]sg ug{
l;kmfl/; ul/Psf] 5 .

kmf]x/x?sf] k[ylss/0f -cnu ug]{_ -Segregation_

kmf]x/x?sf] k[ylss/0f eGgfn] kmf]x/x?sf] pTkfbg x'g] 7fFp b]lv o;sf] k|s[lt cg';f/ cnu cnUu}
hDdf ug]{, e08f/ ug]{, / lj;{hg ug{sf] lgldQ Ps 7Ffpjf6 csf]{ 7fFpdf cf];f/ k;f/ -transport_
ubf{ ;Dd cnu cnu Joj:yfkg ug]{ k|s[of j'lemG5 . kmf]x/nfO{ pTkfbg :yfgdf cnUu} /fVg', ;'/lIft
s6f}tL -safe minimization_ ug'{ o;sf] d'Vo l;4fGt xf] / of] sbd g} :jf:Yo;+:yf hGo kmf]x/x?sf]
/ ;kmn Joj:yfkgsf] dxTjk"0f{ c+u xf] . jf:tjdf o;n] kmf]x/x?sf] dfqfnfO sd gu/]/ xflgsf/s
kmf]x/x?nfO{, ljz]if k|sf/sf] pkrf/ ug{] sfo{df Wofg k'¥ofpg d4t ub{5 . :jf:Yo ;+:yfhGo
kmf]x/x?nfO{ pTkfbg x'g] 7fFpdf g} cnUu cnUu /fVgsf] nflu s8fOsf ?kdf l;kmfl/z ul/Psf] 5 .
pbfx/0fsf] nflu ;'O nufO;s]kl5 l;of] / l;l/Gh Pp6f ef8f]df / Kofs]h ul/Psf Knf:6Ls jf

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 12–3
sfuhx? cnUu} ef8f]df hDdf ul/g' k5{ . o:t} u/L lj/fdLsf] a]8 ;fO8df, zNos[of sf]7fdf, jf8{df,
k|of]uzfnfdf jf hxf hxf+jf6 kmf]x/ lg:sG5, ToxL g} kmf]x/x?nfO 5'6\6f 5'6\6} /fVg' kb{5 . vt/f
gePsf kmf]x/x? h:t} sfuh, l;;f, Knf:6Ls, kmnfdx? k'g{rqmLo ug{ ;lsg] vfnsf kmf]x/x? x'g\ .
vt/f gePsf h}ljs kmf]x/x? -h:t} vfgfhGo, ju}rfsf kmf]x/x?_ nfO{ sDkf]i6 u/L dnsf] ?kdf
k|of]u ug{ ;lsG5 . ;+qmldt / ;+qmldt gePsf kmf]x/x?nfO slxn]klg ld;fP/ /fVg' x'b}g, olb
;+qmldt kmf]x/x?nfO{ c;+qmldt kmf]x/ ;+u ld;fP/ /fv]df ;+qmldt kmf]x/x?sf] dfqf j9\5, ;+qmldt
kmf]x/nfO{ hlt ;Sbf] sd ug'{ kb{5 .
olb kmf]xx?sf] k[ylss/0f plrt tl/sfn] ul/Psf] v08df :jf:Yo ;+:yfhGo xflgsf/s kmf]x/x?sf]
Joj:yfkg ug]{ vr{df w]/} s6f}tL ug{ ;lsG5 . hf]lvdo'St / hf]lvd gePsf kmf]x?x?sf] k[ylss/0fn]
:jf:Yo ;+:yfhGo kmf]x/x?sf] kl/rfng ug]{ sd{rf/Lx?nfO{ ;+qmd0fsf] hf]lvd sd x'G5 . xflgsf/s
kmf]x/x?sf] k|s[lt cg';f/, pkrf/ / lj;{hgsf] Joj:yfkg ug]{ tl/sfx? ckgfpg kb{5 . :jf:Yo
;+:yfhGo kmf]x/x?sf] k|ls|tL cg';f/ cnUu} kmf]x/ hDdf ug{ g]kfn ;/sf/sf] Health Care Waste
Management Guideline 2014 cg';f/ ljleGg /Ësf] ef8f]x? g} x'g'kb{5 . h:df kmf]x/sf] k|sf/sf]
lrGx a'lemg] u/L n]lvPsf] x'g' kb{5 . o:tf efF8f]x? df]6f] / alnof] vfnsf x'g' kb{5, efF8f]x?
lgDgfg';f/ 5fGg' kb{5 M
 efF8f]x? kmf]x/x? kmfNgsf] / lgsfNgsf] nflu pko'St x'g'kb{5 / s'g lsl;dsf] kmf]x/ hDdf
ug]{] xf] ;f]xL cg';f/sf] agfOPsf] x'g'kb{5 .
 olb efF8f]sf] ljsf]{ 7]Ng] vfnsf] -retractable_ 5 eg], nfdf] lrD6fsf] Joj:yf ul/g'kb{5 h;n]
ubf{ kmf]x/x? ef8f]df /fVbf slxn] klg xftn] 7]Ng' gk/f];\ .
 efF8f]df ePsf] k|of]u ePsf] kmf]x/x? vGofpbf o;sf] jflx/L ;tx b'lift x'g ;Sg] ePsf]n]
o;sf] lgdf{0f ubf{ g} b'lift x'g] ;Defjgf sd ePsf] efF8f] agfpg' kb{5 .
 emf]lnnf] kbfy{x?sf] nflu gr'lxg] / g5]l8g] vfnsf] efF8f] x'g'kb{5 . sf8{jf]8{sf efF8f]x? of]
k|of]hgsf] nflu pko'St x'b}g . olb sf8{jf]8{sf] efF8f] k|of]u ug]{ xf] eg], cGt{/fli6«o dfGotf
k|fKt sf8{jf]8{sf] efF8f] -Safety Box_ k|of]u ug{ ;lsG5 .
 ;j} k|sf/sf efF8f]x? aGb -sealed_ ubf{ gr'lxg] vfnsf] x'g'kb{5 .
 efF8f]x? Ps 7fpjf6 csf]{ 7fFpdf n}hfbf ;Dd ;'/lIft cj:yfdf aGb x'g] vfnsf] x'g' kb{5 .
 efF8f]x? ;'/lIft / ;lhnf] tl/sfn] k|of]u ug{ ;lsg] x'g'kb{5 .
 :jf:Yo ;+:yfhGo kmf]x/x?sf] k[ylss/0fsf] ;j} ljz]if sfo{ljlw -procedure_, Kofs]h ug]{,
n]jn ug]{ jf/] ;j} d]l8sn / ;xof]uL sd{rf/LnfO hfgsf/L u/fpg' kb{5 . kmf]x/x?sf] k|sf/
cg';f/ efF8f] /flvPsf] ;fysf] leQfdf ljleGg k|sf/sf kmf]x/x? /fVg] jf/] pNn]v ul/Psf]
hfgsf/Lx? 6f:g], of] sfo{ ;j} ljefu jf jf8{x?df /flvPsf] x'g'kb{5 .

12–4 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
k[ylss/0f lgDgfg';f/ ul/g' kb{5 M
 kmf]x/sf] ;|f]t lbgx'F sxf+ sxf+ x'g ;S5 egL olsg ug'[kb{5 h:t} jf8{, lj/fdL j]8, zNos[of
sf]7f, k|of]uzfnf, kmfd]{;L / cGo kmf]x/ lg:sg] sf]7fx? . d]l8sn / ;xof]uL sd{rf/Lx?nfO{
Ps} k|sf/sf] hfgsf/L lbg'xf];\ . hfgsf/L u/fpbf gd| Jojxf/ ug'{xf];\ .
 :jf:Yo ;+:yfhGo kmf]x/, 3/fo;L kmf]x/x? kmfNg] 7f+pdf kmfNbf ;'/lIft / ;+qmd0fsf] hf]lvd
x'g jf gx'g] af/] lglZrt x'g'xf];\ .
 l;kmfl/; ul/Psf] sfo{ljlwx? ;xL tl/sfn] Kffngf ePsf] 5 5}g egL lgoldt n]vfhf]vf
ug'{xf];\ .

o;sf cnfjf lgDg s'/fx?df klg Wofg k'¥ofpg' kb{5M

 ;j} ltvf tyf wfl/nf kmf]x/x? Ps} 7fFpdf hDdf ug'{kb{5 . o:tf efF8fx? jlnof] vfnsf]
Knf:6Ls tyf 6Lgn] jg]sf g5]l8g] / gr'lxg] vfnsf] -Pucture proof container_ / ljsf]{ /fd|/L
jGb x'g] vfnsf] x'g'kb{5 . b'j{];lgx? Jff6 jrfpg l;of] tyf l;l/Ghsf efF8f]nfO{ pgLx?sf]
kx'+r eGbf 6f9f /fVg kb{5 .
 clt ;+qmd0f hGo kmf]x/x? hDdf ug]{ ef8f] tyf emf]nfx?df cGt{/fli6«o dfGotf k|fKt lrGx
k|of]u ul/Psf] x'g'kb{5 .
 kf/f, Sof8ldod h:tf hf]lvdo'St kmf]x/x?nfO{ 5'6\6} hDdf ug'{ kb{5 .
 kmf]x/ k[ylss/0fsf] lgldQ l;kmfl/; ul/Psf ljleGg /+usf ef8f]x? tyf cGt{/fli6«o dfGotf
k|fKt lrGxx? M
kmf]x/ k[ylss/0fsf] lgldQ l;kmfl/; ul/Psf ljleGg /+usf ef8f]x? tyf cGt{/fli6«o dfGotf
k|fKt lrGxx? M
Eff8f]sf]
kmf]x/x?sf] k|sf/ / lrGxx? kmf]x/sf] pbfx/0fx?
/·
hf]vLd gePsf h}ljs xl/of] Vffgfx?, 3f+;kftx?, kmn tyf km'nx?
t/Lsfn] uNg] -s'lxg]+_
kmf]x/x?
hf]vLd gePsf hf]vLd gePsf k'g{rlqmo Uff8f h}ljs t/Lsfn] guNg] kmf]x/x?M k'g{rlqmo
hf]:jf:Yo
vLd gePsfof]Uo kmf]x/x? lgnf] of]Uo kmf]x/x? h:t}M Knf:6Lssf ef8fx?,
:jf:Yo
;+:yfhGo ;+ : yfhGo l;l;, sfuh, /a/ cflb .
kmf]kmf]xx/x?
/x?

cGo hf]vLd gePsf xNsf h}ljs t/Lsfn] guNg] / k'g{rlqmo

kmf]x/x? lgnf] of]Uo gePsf kmf]x/x? h:tf]M 6lNsg]
Knf:6Lsx?, -ljz]if u/L vfgf Kofs
ePsf_

ljz] if /f]Wofg
;+qmd0f syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 12–5
k'¥ofpg' kg]{
:jf:Yo ;+:yfhGo
hf]vLd gePsf
:jf:Yo ;+:yfhGo
ljz] if Wofg
kmf]x/x?
k'¥ofpg'if kg]
ljz] Wofg
{ k|of]uzfnfjf6 lg:s]sf /ftf] Dffgj cË / o;sf c+zx?, zNos[of u/L
;+:yfhGo vt/gfs kmf]x/x?
k'¥ofpg'
:jf:Yo lgsflnPsf c+ux?, af]g Dof/f]
kg]{ :jf:Yo
kmf]x/x?
;+:yfhGo
kmf]x/x?
vt/f Û k|of]uzfnfjf6
lg:s]sf vt/gfs
ljz]if Wofg kmf]x/x?
k'¥ofpg' kg]{ Hf]flvdo'St b'lift wfl/nf /ftf] 3f]Rg] tyf wfl/nf kmf]x/x? h:t}M l;of]x?,
:jf:Yo ;+:yfhGo kmf]x/x? l;of] h8fg -fixed needle_ ePsf l;;fsf
l;l/Gh x?, 5'/Lx? -scalpels_, Jn]8x?,
kmf]x/x? l;;fx? 3f]Rg jf sf6\g] a:t'x?

vt/f Û b'lift wfl/nf

kmf]x/x? . gvf]Ng'xf]nf .
cf}iflwhGo kmf]x/x? /ftf] k|of]u gePsf, Dofb ;dfKt ePsf
cf}iflwx?
;fO6f]6lS;s cf}iflwx? /ftf] SofG;/ /f]usf] pkrf/df k|of]u ePsf
kmf]x/x? h:t}Malkylated substances, anti
metabolic, antibiotics, plant alkaloids
;+qmldt / Hofb} and hormons cflb
g} ;+/f]qsmldt
;+qmd0f yfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:ts !)–6
hf]kmf]
vLd x/x? gePsf
:jf:Yo ;+:yfhGo vt/f Û vt/gfs kmf]x/x?
kmf]x/x?
;+qmldt vt/f Û ;+qmldt kmf]x/x? v}/f] Pr cfO eL x]kf6fOl6;, a|';Lnf]l;;\, 6L
mldt g}/ Hofb}h:t} /utsf Jofux?,
;+/qHofb} lj, /]ljh clb 4f/f ;+qmldt lj/fdLx?n]
qmldt k+hfx?, l;l/Ghx?
g};+q;+mldt k|of]u u/]sf] skf;, 8«]l;Ë ubf{
kmf]x/x? k|of]u ePsf Knf:6/, sk8fx?, cf]5\ofg,
kmf]x/x? Jof08]h, /ut 4f/f b'lift ;fdfgx? .
;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGoInfectious
kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:ts !)–6
vt/f Û vt/gfs kmf]x/x?
ljz]if Wofg vt/f Û Hofb} ;+qmldt g} v}/f] k|of]uzfnfdf lhjf0f'x?sf] l6 jL sf] cyjf
k'¥ofpg' kg]{ kmf]x/x? cGo sNr/ (culture) ubf{ pTkGg Hofb} g}
:jf:Yo ;+:yfhGo ;+qmldt kmf]x/x?
kmf]x/x?

12–6 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf

cGo vt/gfs
 cGo vt/gfs vt/f Û cflwsfl/s kx]nf] Kff/f h:tf -heavy metals_ kmf]x/x?,
kmf]x/x? JolQmx?n] dfq lj;{hg Uof;o'St j6\6fx?, Jof6/Lx? tyf
ul/g] kmf]x/x? /;folgs kmf]x/x?

/]l8of]PlS6e
mf]x/x? /]l8of]/]lP8of]lS6e
PlS6e vt/f Û /]l8of]PlS6e sfnf] /]l8of]y]/fkLdf k|of]u ul/g], emf]n, 7f];
kmf]x/x? kmf]x/x? tyf Uof;o'St cf}iflwx? h:t}M sf]jfN6,
kmf]x/x? 6]lSgl6od, cfof]l8g cflb

gf]6M l;kmfl/; ul/Psf] /+Ësf] ef8f] pknAw gePsf] v08df s'g} klg /Ësf] ef8f]df lglb{i6 ul/Psf
vt/gfs lrGxx? pNn]v ug'{ kb{5 .
:jf:Yo ;+:yfdf kmf]x/x?sf] juL{s/0f ug]{ sfo{, o;sf] pTkfbg, pkrf/ ug]{, lj;{hg ug]{ s'/f, pSt
;+:yfsf] jftfj/0fdf k"0f ?kdf e/ kg]{ s'/f xf] . kmf]x/x?sf] k|sf/ cg';f/ ;Dej eP ;Dd l;kmfl/;
ul/Psf k[ylss/0f t/Lsf ckgfpg' kb{5 . dfly pNn]lvt t/Lsfn] kmf]x/x?sf Joj:yfkg ug{ ;lsPg
eg] sd ;] sd hf]lvdo'St / hf]lvd gePsf kmf]x/x? 5'6\ofpg h?/L x'G5 .

kmf]x/x? hDdf ug]{ / e08f/0f ug]{

kmf]x/x? lg:sf;g ePsf] 7f+pdf y'kf/]/ /fVg' x'b}g, o;nfO{ lgoldt ?kdf tf]lsPsf] 7f+pdf e08f/
ug{' kb{5 / lj;{hgsf] nflu n}hfg' kb{5 . kmf]x/ e08f/ ug]{ 7f+pdf vt/fsf] lrGx pNn]v ug'{ kb{5 .
kmf]x/ e08f/ sf]7f ;+:yf leq :yfkgf ul/Psf] x'g' kb{5 / of] e08f/, lj/fdLsf] sf]7f, k|of]uzfnf,
zNos[of sf]7f, k|zf;lgs sf]7f / cGo dflg;x?sf] kx+'r glhs x'g' x'b}g . e08f/ sf]7fdf rf+jL
nufO jGb ug]{ Joj:yf x'g' kb{5 . e08f/ sf]7f lgdf{0f ubf{ :jf:Yo ;+:yfn] lgDg s'/fsf] lhDd]jf/L
k"j{s Wofg lbg' kb{5M
 e08f/ sf]7f k|z:t pHofnf] ePsf], v'Nnf, xfjf ;+rfng x'g] e]G6Ln];g ePsf] x'g'kb{5 .
kmf]x/x? e08f/ ubf{ kf]lvg] rLhx? gkf]lvg] u/L agfPsf] x'g'kb{5 .
 lgoldt ;kmfOsf] nflu kfgLsf] Joj:yf x'g'kb{5 .
 kmf]x/sf] ;'/Iffsf] nflu cflwsfl/s JolQmx?nfO{ dfq e08f/df cfjt hfjt ug]{ cg'dlt
lbg'kb{5 .

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 12–7
  kmf]x/ cf];f/ k;f/sf] nflu uf8L cfjt hfjt ug{ ;Sg] u/L jf6f]sf] Joj:yf x'g'kb{5 .
 kmf]x/x?nfO{ 3fd, kfgL, xfjfx'/L / jf9Ljf6 jrfpgsf] nflu ;f]xL cg';f/sf] ;'/Iffsf] Joj:yf
x'g' kb{5 .
 e08f/ sf]7f :jf:Yojw{s x'g'kb{5 . o;sf] nflu lgoldt ;kmfO, ;+ef/ ug{' / kmf]x/x?
kf]lvPsf] v08df b'if0f lgjf/0f ug{' ;Sg' kb{5 .
 ;kmfO{ ug]{ pks/0fx?, ;'/IffTds sk8fx? / kmf]x/ hDdf ug]{ emf]nf jf ef8f]x? e08f/ glhs}
/ ;lhn} pknAw x'g] u/L /flvg' kb{5 .
 ;fwf/0f / ;+qmd0fhGo s'lxg] kmf]x/x?nfO nfdf] ;do;Dd e08f/ ug'{x'b}g o:tf kmf]x/x?
s'lxP/ b'u{Gw km}nfpg] ePsf]n] @$ 306f leq g} lj;{hg u/L;Sg' kb{5 .
 kmf]x?x? e08f/0f ubf{ k[ylss/0f sfo{nfO{ oyfjt sfod /fVg' kb{5 .
 yf]/} kmf]x/ pTkfbg ug]{ ;+:yfx?n] e08f/0f ug{sf] nflu jlnof], gr'lxg] vfnsf] ef8f] k|of]u
ug{ ;lsG5g\ . tL kmf]x/x? jf6 b'{uGw cfpg ;Sg] ePsf]n] 5'6\6} 7fp+df Joj:yf ug'{ kb{5 .
kmf]x/ e08f/ ubf{ o;sf] k|s[lt cg';f/ pko'St lrGxx?sf] n]jn ul/g' kb{5 .

kmf]x/ cf];f/ k;f/ -transport of waste_

:jf:Yo ;+:yfhGo kmf]x/x? hDdf ug]{ / kmf]x/ pTkfbg :ynjf6 e08f/ / lj;{hgsf] nflu cf];f/
k;f/ ug{ ;lhnf] ;/n tl/sfn] cfjthfjt ug{ ;lsg] u/L agfOPsf] x'g' kb{5 . :jf:Yo ;+:yfhGo
kmf]x/d}nf Joj:yfkgsf] of]hgf th'{df ubf{ kmf]x/d}nf hDdf ug]{ sfo{qmd :yflkt ul/g' kb{5 .
kmf]x/d}nf ;+sng ;+u ;DjlGwt sd{rf/Lsf gfOs]sf] nflu s]xL ;'emfjx? l;kmfl/; ul/Psf] 5, tL
lgDgfg';f/ 5g\M
k|To]s ;qdf -Shift_ k|To]s sf]7fx?jf6 kmf]x/x? hDdf ug'{ kb{5 . ;j} k|sf/sf kmf]x/x? hDdf ug]{
;do k|To]s ;qsf] z'?df x'g'kb{5 . k|To]s ;qdf hDdf ug{ c;lhnf] ePdf lbgsf] Ps k6s hDdf
u/]/ lglb{i6 ul/Psf] e08f/ :yndf n}hfg' kb{5 . -kmf]x/sf] dfqf cg';f/ l56f] klg ug{ ;lsG5_
kmf]x/ hDdf ug]{ efF8f]+ lgsfn] kl5 ;f]xL cg';f/sf] efF8f] pSt 7fpdf km]l/ hDdf ug{sf] lglDt t'?Gt}
/fVg' kb{5 . kmf]x/x? lgsfln;s]kl5 kmf]x/ /fVg] efF8f]df, jfSnf] / 7"nf] Knfl:6ssf] emf]nf -:jLs[t
dfkb08 cg';f/ ePsf]_ /fVg'kb{5 . kmf]x/ /fVg] efF8f] a/fa/ ;kmf ug'{kb{5 .
kmf]x/ hDdf ug]{ ;kmf efF8f]x? kmf]x/ pTkfbg x'g] ;j} 7fpFx?sf] nflu pknAw x'g'kb{5 .
:jf:Yo ;+:yfhGo kmf]x/x? lj;{hg ubf{ pTkfbg ePsf] 7fpFjf6 :jf:Yo ;+:yfsf] e08f/ :yndf
-onsite transport_ hDdf ug]{ / ;+:yfjf6 jflx/ Nof08lkmN8 -off-site transport_ jf cGo 7fpFdf
clGtd lj;{hg u/]/ Joj:yfkg ug]{ u/L of]hgf agfpg' kb{5 . kmf]x/x? cf];f/ k;f/ ubf{ o;sf] k|sf/
cg';f/ 5'6\6f 5'6\6} cj:yfdf pRr hf]lvdo'St kmf]x/ cg';f/ Joj:yfkg ug'{ kb{5 .

12–8 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
;+:yfleq cf];f/ k;f/ -on-site traspsort of waste_

kmf]x/ pTkfbg :Yfnjf6 e08f/ jf pkrf/:yndf n}hfbf 6«nLdf u'8fP/ n}hfg] ug'{ kb{5 . lSnlgsn
kmf]x/x? cf];f/ k;f/ ubf{ ;Dej eP ;Dd lj/fdLsf] eL8 sd ePsf] ;dodf ug'{ /fd|f] x'G5 .
hf]lvdo'St/;+qmldt, b'lift gePsf] kmf]x/x? km/s km/s 6«nLdf cf];f{g' kb{5 . kmf]x/x? cf];f{bf ;kmf
:yfgx? jf8{x?, k|of]uzfnf, zNos[of sf]7f / sfo{ljlw ul/g] sf]7fx? b'lift x'g ;Sg] ePsf] x'gfn]
o;jf6 sd ug{ ljz]if jf6f] k|of]u ug'{kb{5 . 6«nLx?M
 ;lhn} kmf]x/ hDdf ug{ / lgsfNg ;lsg] x'g' kb{5
 kmf]x/sf] emf]nfx? Rofltgjf6 arfpg o;sf] s'gfx? wfl/nf] jf ltvf] gePsf] x'g' kb{5
 ;kmf / ;lhn} ;kmf ug{ ;lsg] vfnsf]] x'g' kb{5 .
 :jf:Yo ;+:yfleq kmf]x/ cf];f{g] uf8Lx? ;+qmd0f lgjf/s 3f]n h:t} Snf]l/g, lkmgf]nn] lbgx'F
;kmf ug'{ kb{5 / kmf]x/ cf];fg]{ JolQmx?n] JolQmut ;'/IffTds pks/0fx? k|of]u ug'{ kb{5 .

:jf:Yo ;+:yfjf6 jflx/ kmf]x/ cf];f/ k;f/ ug]{ -off-site traspsort of waste_

:jf:Yo ;+:yfhGo kmf]x/x? pSt ;+:yfjf6 jflx/ lgsfNgsf] lgldQ ;'/lIft KoflsË, pko'St n]jn
nufpg] sfo{ / s]lGb|o kmf]x/ pkrf/ :yn jf Nof08lkmN8 ;fO6df n}hfgsf] nflu clwsf/ lng] sfo{
klg :jo+ :jf:Yo ;+:yfsf] lhDd]jf/L x'g cfpF5 . o;sf] nflu k|of]u x'g] uf8L ;fdfg nf]8 ug{ /
lgsfNg] ;lhnf] x'g] vfnsf] / kmf]x/x? gkf]lvg], gr'lxg] vfnsf] x'g'kb{5 . pSt uf8Ldf kmf]x/ cf;fg{]
JolQmsf] gfd / 7]ufgf pNn]v ul/Psf] x'g'kb{5 . uf8Ldf xflgsf/s jf ;+qmldt kmf]x/sf] lrGx klg
c+lst ul/Psf] x'g'kb{5 .
:jfYo ;+:yf leq jf ;+:yf jflx/ lSnlgsn kmf]x/ cf];f/ k;f/ ubf{ b'3{6gfj; kf]lvg] jf r'lxg] x'g
uPdf o;sf] lhDd]jf/L :jf:Yo ;+:yf v'b x'g]5 . :jf:Yo ;+:yfhGo kmf]x/ Joj:yfkgsf] of]hgf ubf{
kmf]x/ gkf]lvg] gr'lxg] ul/ o;sf] ;'/lIft Joj:yfkgsf] of]hgf agfOPsf] x'g'kb{5 . o;sf] Joj:yfkgsf]
nflu ;+jlGwt JolQm cfsl:ds Joj:yfkgjf/] tflnd lnPsf] x'g'kb{5 / o;jf/] slxn], s;/L, sxf+
c?sf] ;xof]u lng] eGg] jf/] klg hfgsf/L /fVg' kb{5 . kmf]x/x? kf]lvPdf o;sf] Joj:yfkgsf] nflu
cfjZos ;+qmd0f lgjf/0f 3f]n, jfN6Lg, ;fj]n, s'rf], emf]lnnf] rLh ;f]:g] sk8fx?, cg'xf/ 5f]lkg]
df:s, k+hfx?, Ps k6s k|of]u ul/g] k'/f z/L/ 9fSg] n'uf -ufpg h:tf]_, 6r{, Psk6s k|of]u ug{ dfq
ldNg] efF8f]x?, pko'St n]jn ul/Psf] kmf]x/ /fVg] Knf:6Lssf] emf]nfx? ;lhn} pknAw x'g] x'g'kb{5 .

kmf]x/sf] pkrf/ / lj;{hg -Waste Treatment and Dosposal_

kmf]x/x?sf] pkrf/ / lj;{hg ljlw jftfj/0fLo / dfgljo -cfdhgtfdf_ k|efj kfg]{ kIf ;fy} ;DjlGwt
b]zsf] sfg'g cg';f/ klg e/ kb{5 . :jf:Yo ;+:yfhGo kmf]x/x?sf] dfqf x]bf{ w]/}h;f] xflgsf/s gx'g]
kmf]x/x? x'G5g\ / tL dWo] k'gMk|of]u jf k'g{rqmLo ljlw ckgfpg ;lsG5 . kmf]x/x?nfO ;xL t/Lsfn]
k[ylss/0f u/]sf] v08df yf]/} kmf]x/x? dfq xflgsf/s x'g] ePsf]n] yf]/} kmf]x/x?df dfq ljz]if Wofg
k'¥ofpg' kg]{ x'G5 . xflgsf/s / ;+qmldt kmf]x/x?nfO{ l;kmfl/; ul/Psf] ljlw cg';f/ pkrf/ ug'{kb{5 .

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 12–9
Psk6s pkrf/ ul/Psf kmf]x/x?nfO{ k'gM juL{s/0f u/]/ ;f]xL cg';f/ lj;{hg ug'{kb{5 . kmf]x/x?sf]
pkrf/sf] nflu xfn pknAw ljsNkx? w]/} ;lhn} k|of]u ug{ ;lsg] / s]xL hl6n vfnsf 5g\ . xfn
:jf:Yo ;]jfhGo kmf]x/x?sf] Joj:yfkgsf] k|ljlw kl/jt{g x'b} cfPsf] 5 . ;f]xL cg';f/ ;'/lIft,
k|efjsf/L, jftfj/0f d}qL, nfut / b]zsf] cfjZostf cg';f/, n]vfhf]vf / d"Nof+sg u/L j}slNks
pkrf/sf] ljlw k|of]udf Nofpg'{ kb{5 . :jf:Yo ;+:yfhGo kmf]x/x?sf] pkrf/ ubf{ lgDg s'/fx?df Wofg
k'¥ofpg' kb{5M
 wfl/nf] kmf]x/x?jf6 3f]r]/ x'g] rf]6k6s nfUg g;Sg] vfnsf] x'g'kb{5
 kmf]x/x?sf] dfqf 36fpbf xflgsf/s kbf{yx? lg:sg' x'b}g
 kmf]x/x? lj;{hg ug]{ Nof08lkmn pko'St x'g'kb{5 h;n] ubf{ kmf]x/x? hldgd'lg r'x]/
 jftfj/0fdf g/fd|f] k|efj gk/f];\ .
 ;+qmd0f km}nfpg] ;Defjgf NffO{ sd ug'{kb{5 .
 kmf]x/x? pkrf/ ePsf] olsg ug{' kb{5 .
 kmf]x/x?sf] a/fa/ n]vfhf]vf ug]{ / clen]v /fVg] ug'{ kb{5 .
 kmf]x/ pkrf/ k|s[of ckgfP gckgfPsf] olsg ug'{ kb{5 .
 Joj;flos -occupational_ :jf:Yo / ;'/Iff dfkb08 k'/f ePsf] x'g'kb{5 .
 cfktsflng ca:yfdf ;'/lIft ljsNk vf]Hg' kb{5 .
olb c6f]Sn]e k|of]u ePsf] 5 eg], o;sf] sfo{ 7Ls eP gePsf] jf/]df slDtdf jif{df Ps k6s
hf+r ug'{ kb{5 .

lgDg tl/sf ckgfP/ kmf]x?x?sf] lj;{hg ug{ ;lsG5M

s= h}ljs k|ljlw -Biological Procedure _
v= c6f]Sn]e -Autoclave_
u= /;folgs ;+qmd0f lgjf/s -Chemical disinfection_
3= OGSofK;'n];g -Encapsulation _
ª= :oflg6/L Nof08lkmn -Sanitary Landfill_
r= Uff8]/ -Burial_
5= ;]lK6s sls+|6 eN6 -Septic concret vault_
h= hnfpg] -Incineration_
em= lglZqmo jgfpg] -Inertization _

s= h}ljs k|ljlw -Biological Procedure_

sDkf]i6LË – :jf:Yo ;+:yfjf6 lg:s]sf ;fwf/0f, vt/f gePsf h}ljs kmf]x/x?nfO{ sDkf]i6 dn
agfpgsf] nflu l;kmfl/; ul/Psf] 5 . sDkf]i6LË ubf{ k|fs[lts, h}ljs tl/sfn] ljleGg lsl;dsf
lhjf0f', ls/fx?, u8\of}nf h:tf h}ljs a:t'x?jf6 ul/G5 . of] ljlw cfhsn w]/} ?rfOPsf] 5 . of] ljlw

12–10 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
;kmntfk"j{s Joj:yfkg ePdf l56f], ;'/lIft / ;kmf tl/sfn] dn agfpg ;lsG5 . o;sf] Joj:yfkg
/fd|f] gx'bf b'{uGw cfpg], ls/fx? a9\g], cg]s lsl;dsf] b'lift u/fpg] lhjf0f'x?sf] j[l4 x'g] ub{5 h;n]
ubf{ jftfj/0fdf g/fd|f] c;/ kb{5 / lgDg :t/sf] sDkf]i6 dnsf] pTkfbg x'g hfG5 . u'0f:t/Lo h}ljs
dn agfpgsf] lgldQ lgDg cfwf/e"t cj:yfx? sf] h?/t kb{5 M
 vfg]s'/fsf] pko'St ;|f]t
 po'St tfkqmd
 kfgL /
 clS;hg -clS;hg4f/f un]/ dn aGg]_

v= c6f]Sn]e -Autoclave_
c6f]Sn]e k|];/ lbP/ afkm4f/f lgd{lns/0f ug]{ k|s[of xf] . of] k|s[of ckgfpbf sd tfkqmddf tf]lsPsf]
;dodf kmf]x/sf] ;j} efudf jfkmnfO{ ;f]em} ;Dks{ u/fP/ ul/G5 / kmf]x/sf] b'if0f lgjf/0f ul/G5 .
:jf:Yo ;+:yfdf d]l8sn cf}hf/ tyf ;fdfgx? lgd{lns/0f ug{ k|of]u x'g] c6f]Sn]e g} o; k|s[ofdf
k|of]u ul/G5 . :jf:Yo ;+:yfx?df of] ljlw nfdf] ;do b]lv d]l8sn cf}hf/x?sf] k'gM k|of]usf] nflu
lgd{lns/0fsf] nflu rln cfPsf] 5 . c6f]Sn]e ;fdfGotof pRr ;+qmldt kmf]x/x?sf] lhjf0f'sf] pkrf/
ug{ k|of]u x'G5 h:t}M Microbial culture / wfl/nf a:t'x? . ljZj :jf:Yo ;+u7gsf] cg';f/ k|efjsf/L
tl/sf ;Dk"{0f lsl;dsf] lhjf0f'x? lgliqmo ug{, gi6 ug{ %-* s] hL kmf]x/ pkrf/ ug{sf] lglDt !@!
l8u|L ;]lN;o; df #) ldg]6 ;Dd /fv]df ;j} kmf]x/j:t'df jfkm k'Ug ;S5, t}klg k|efjsf/L jfkmsf]
;Dks{sf] nflu ljleGg s'/fx?df lge{/ ub{5 h:t}M ;do, tfkqmd, k|];/, kmf]x/sf] dfqf, KoflsË u/]sf]
t/Lsf, -packing density_, c6f]Sn]e ul/g] ;fdfgsf] lsl;d, ;fdfg /flvg] emf]nf jf ef8f] cflbdf klg
e/ kb{5 . c6f]Sn]e 7Ls tl/sfn] ePsf] 5 5}g egL olsg ug{sf] nflu o;sf] nflu lglb{i6 ul/Psf]
lgod kfngf ug'{ kb{5 . lhjf0f'x? gi6 jf lgliqm{o ePsf] hfFr ;do ;dodf ul/xg'kb{5 . c6f]Sn]e
7Ls tl/sfn] ePsf] olsg ug{ /Ë kl/jt{g x'g] 6]k ;fdfgsf] lelq efudf /fv]/ klg hfFFr ug{ ;lsG5 .
o;sf] ;fy} lhjf0f' g} /fv]/ klg c6f]Sn]esf] hfFr ug{ ;lsG5 .
zNos[ofsf] ;fdfgsf] nflu k|of]u x'g] c6f]Sn]e / kmf]x/ Joj:yfkgsf] nflu k|of]u x'g] c6f]Sn]e
km/s km/s x'g'kb{5 .

u= /f;folgs b'if0flgjf/0f -Chemical disinfection_

pRr ;+qmldt kmf]x/x?sf] pkrf/sf] nflu /;folgs ;+qmd0f lgjf/0f 3f]ns? k|of]u ug{ ;lsG5 .
lhjf0f'x?nfO lgis[o jf gi6 ug{sf] lglDt clN8xfO8, Snf]l/g / lkmgf]n sDkfp08 k|of]u ug{ ;lsG5 .
oL kbf{yx? emf]lnnf] ;+qmldt kmf]x/x?sf] nflu k|of]u ul/g] eP tfklt 7f]; kmf]x/sf] nflu klg k|of]u
ug{ ;lsG5 . /;folgs tl/sf vf;u/L /ut, lb;f k;fj cflbsf] nflu k|of]u ug{ pko'St x'G5 .
dfga c+u jf tGt'x? gf; ug{sf] nflu tftf] cNsfnL k|of]u ug{ ;lsG5 . s]df]y]/fkLsf cf}iflw gi6
ug{ /;folgs tl/sfn] unfpg' kb{5, h:t}M ;f]l8od xfOkf]Snf]/fO6 cflb /;folgs tl/sfn] gi6 ug{
;lsG5 .

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 12–11
3= OGSofK;'n];g -Encapsulation_
OGSofK;'n];g ljlwdf kmf]x/x?sf] efF8f]df hDg] vfnsf] kbf{yx? ld;fP/ To;sf] d'vnfO 6flnG5 -seal_ .
of] ljlwdf jlnof] vfnsf] kf]lnlygsf] -high density polyethylene_ jf wft'sf] 8«d k|of]u ul/G5 . pSt
8«ddf wfl/nf] cf}hf/ jf l;of]x?, cf}iflwhGo kmf]x/, /;folgs kmf]x/x?sf] dfqf rf/ efusf] tLg efu
el/P kl5 o;df hDg] vfnsf] kbf{y h:t} Knf:6Ls kmf]d, lj6'ldlgo; :of08, l;d]06 df]{6/ jf clay
o; ef8f]df vGofOG5 . o;df vGofOPsf ;fdfgx? ;'Vvf ePkl5 o;sf] d'v 6fn]/ ;'/lIft t/Lsfn]
lj;{hg ul/G5 . vt/gfs kmf]x/x?nfO sd ug{ / ;fdfgx? vf]Hg] dflg;x?sf] kx'+r x'gjf6 arfpg
of] ljlw k|efjsf/L x'G5 . of] ljlw ljz]if u/L cf}iflwhGo / wfl/nf kmf]x/x? lj;{hg ug{ pkof]uL x'G5 .

ª= :oflg6/L Nof08lkmn -Sanitary Landfill_

:oflg6/L Nof08lkmn o:tf] ljlw xf] h;df kmf]x/x?nfO 5'6\6} jftfj/0fdf lj;{hg ug{sf] nflu
k|fljlws tj/n] lgdf{0f u/]sf] x'G5 . h;n] ubf{ df6f], hldgsf] ;tx, hldg d'lgsf] kfgL] nfO b'lift
agfpb}g . of] ljlwdf kmf]x/x?n] xfjfnfO b'lift ub}{g, b'u{Gw km}lnb}g / cfd hgtfsf] ;f]em} ;Dks{df
x'b}g . :oflg6/L Nof08lkmndf s]xL b'lift kmf]x/ / cf}iflwhGo kmf]x/x? lj;{hg ug{ ;lsG5 . :oflg6/L
Nof8lkmnsf] nflu clt cfjZosLo tTjx? o; k|sf/ 5M
kmf]x/x? cf];f{g] / sfd ug]{ 7f+p ;lhn} cfjt hfjt ug{ ;lsg] x'g' kb{5 .
kmf]x/ lj;{hg sfo{sf] lbgx'+ x'g] s[ofsnfknfO lgoGq0f ug]{ JolQm pknAw x'g' kb{5 .
Nof8lkmndf kmf]x/ lj;{hg sfo{ z'? ug'{ eGbf klxn] o;sf] nflu pko'St 7f+psf of]hgf agfpg' kb{5
/ Joj:yfkg ug{sf] nflu ljleGg km]hdf ljefhg ug'{ kb{5 .
kmf]x/sf] v/fj kfgL hldg / o;sf] 5]plt/ ghfcf];\ eGg] p4]Zon] hldgnfO pko'St t/Lsfn] 6fNg'
-seal_ kb{5 . :oflg6/L Nof08lkmnsf] hldg d'lgsf] kfgLsf] ;|f]t eGbf %) ld6/ 6f9f x'g' kb{5 .
o;sf] nflu Nof8lkmn Uof; lgoGq0fsf] nflu jftfj/0f d"Nof+sg ug]{ 7f+p -envirnmnetal monotoring
point_ x'g' kb{5 / hldg d'lgsf] kfgLsf] u'0f:t/ x]g{ af]/ xf]n -bore hole_ x'g'kb{5 .

kmf]x/sf] emf]lnnf] kbf{y hDdf ug]{ / pkrf/ ug]{ kof{Kt / k|efjsf/L t/Lsf ckgfOg' kb{5 .
:oflg6/L Nof08lkmn If]qdf yf]/} yf]/} u/L kmf]x/x? km}nfpg], hldgdf lyRg] -compaction_ / kmf]x/nfO
lbgx'+ df6f]n] 5f]Kg] sfo{ /fd|/L ;+rfng ug'{ kb{5 .
:oflg6/L Nof08lkmnnfO tf/jf/ nufO ;'/lIft /fVg'kb{5 h;n] ubf{ cglws[t JolQmx?, hgfj/ /
r/fx?sf] kx'+r gxf];\ .
Nof08lkmnsf] k|To]s km]h k'/f ubf{ dflyNnf] ;txsf] kfgL hldg d'lg hfg g;Sg] u/L agfpg' kb{5 .

r= uf8\g] -Burial_
xflgsf/s kmf]x/x? ljz]if k|sf/n] agfOPsf] vfN8f]df uf8\g ;lsG5 . of] k|s[of ;fgf] ;fgf] :jf:Yo
;+:yfx? b'u{d:yfgsf]] nflu, c:yfoL SofDkx?sf] nflu cGo ljsNk gePsf] :yfgsf] nflu l;kmfl/;

12–12 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
ul/Psf] 5 . o;sf] nflu @ b]lv % ld6/ ulx/fO / ! b]lv @ ld6/ rf}8fO ePsf] vfN8f] vGg' kb{5 .
vfN8f]sf] cfwf/ kfgLsf] ;tx eGbf @ ld6/ dfly x'g' kb{5 . kmf]x/ kmfn] kl5 k|To]s k6s !) b]lv
#) ;]lG6ld6/ df6f]n] 5f]Kg' kb{5 . olb df6f]n] 5f]Kg ;Dej gePdf r'gfn] kmf]x/nfO 5f]Kg' kb{5 . olb
s'g} k|sf/sf] dfxfd/L h:t} Ojf]nf efO/; km}lnPdf df6f] / r'gf b'j}n] 5f]Kg' kb{5 . kmf]x/sf] dfqf
hldgsf] ;txeGbf #) b]lv %) ;] dL dfly k'Ub5, vfN8f]nfO df6f]n] k'g]{ / s+lqm6n] aGb ug]{ / csf]{
vf8n vGg'kb{5 .
vf8n vGbf kfngf ug'{ kg]{ lgodx? lgDg 5g\ M
 la;h{g ug]{ 7fpFdf k|j]z ug{ lgif]w ug'{k5{ . -hgfj/ tyf s]6fs]6Lx? hfgaf6 /f]Sg rf/}tkm{
tf/sf] 3]/f nufpg' kb{5 ._
 vfN8f]df /flvPsf] kmf]x/x?df ;fdfgx? Vf]htnf; ug{ cfpg]x?nfO /f]Sgsf] nflu, o;sf] k|of]u
ubf{ Nof08lkmnsf sd{rf/Lx?n] ;'kl/j]If0f ug'{ kb{5 .
 uf8\g] If]qnfO{ pknAw ePdf sd kfgL l5g]{] vfnsf] Ps lsl;dsf] df6f] -clay_ n] 3]g]{ .
 cf}iflwhGo kmf]x/x? Jff /;folgs kbf{yx? ! s] hL eGbf a9L uf9\g' x'b}g .
 uf9\g] 7f+p af9L cfpg] 7fpdf x'g' x'b}g .
 uf9\g] 7fpdf af/ nufpg' kb{5 / vt/fsf] lrGx n]v]/ /fVg' kb{5 .
 gbL, tfn / kfgLnfO{ b"lift x'gaf6 arfpg o:tf If]qx? vfg]kfgLsf] >f]teGbf slDtdf %) dL6/
6f9f /xg'k5{ .
gf]6M b"lift tyf xflgsf/s kmf]x/nfO{ dfq uf8\g' cfjZos x'G5 .
o:tf] kmf]x/ uf8\g] If]q vf;u/L sd kl/df0fsf] kmf]x/sf] nflu ePsf]n] l;ldt ;do -!–@ jif{_ sf]
nflu dfq Jojxfl/s x'G5 . o; ;doleq sd{rf/Ln] o:tf kmf]x/ la;h{gsf] nflu :yfoL tl/sf vf]Hg'
/fd|f] x'G5 .
;Demg'xf];\ M 7"nf] kl/df0f -! s]=hL=eGbf a9L_ sf] /;folgs -emf]n_ kmf]x/nfO{ Ps}k6s uf8\g'
x'Fb}g . s]lx lbgsf] cGt/fndf uf8\g'k5{ .
r/0f ! M pko'Qm :yfg kQf nufpg] . -dfly x]g'{xf];\_
r/0f @ M ! dL6/ -# lkm6_ juf{sf/ tyf @ dL6/ -^ lkm6_ ulx/f] vfN8f] vGg] . vfN8f]sf] tNnf] efu
water level eGbf @ dL6/ -^ lkm6_ dfly x'g'k5{ .
r/0f # M b"lift kmf]x/nfO{ vfN8f]df la;h{g ug]{ / kmf]x/nfO{ k|To]s lbg !) b]lv #) ;]=dL= -$–^
O~r_ w"nf]df6f]n] 5f]Kg] . w"nf]df6f]sf] clGtd kq %)–^) ;]=dL= -@)–@$O~r_ sf] x'g'k5{ .
ufF8]sf] kmf]x/af6 b"u{Gw cfpgaf6 /f]Sg, ls/fx?sf] cfsif{0faf6 arfpg tyf hgfj/x?n]
vf];|g]af6 arfpg kmf]x/nfO{ vfFb]/ /fVg' -compact_ k5{ .

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 12–13
 lrq !)=!M kmf]x/ uf9\g] jf ;fn gfn lj;{hg ug]{ vf8nsf] gd'gf

;fngfnnfO{ 7Ls tl/sfn] la;h{g

:jf:Yo ;+:yfdf k|;"ltsf] pkrf/ lb+bf, olb ;fngfnnfO{ tTsfn la;h{g ug{ ;lsPg eg] To;af6
;]jf lgsfo, lj/fdL, kl/jf/sf ;b:ox? tyf hg;d'bfonfO{ ;+qmd0f ;g]{ 7"nf] ;Defjgf x'G5 . kmf]x/n]
jftfj/0fnfO{ klg b"lift agfpF5 .
olb ;fngfnnfO{ l7s tl/sfn] la;h{g ul/Pg eg] To;nfO{ s's'/ tyf cGo hgfj/x?, r/fx?n]
aflx/ nUg] df}sf kfpF5 / rf/}lt/ lkmhfpg ;S5 . o; 36gfn] ;]jf lbg] lgsfonfO{ nfhdbf]{ x'G5 /
o;n] ;+qmd0f km}ng] vt/f a9\5 . ;j{k|yd b"lift gePsf kmf]x/ j:t'nfO{ s]lx lbgsf] nflu pko'Qm
7fpFdf ;Íng ug'{kb{5 . To;kl5 o;nfO{ la;h{g ug{ ;lsG5 . hals ;fngfn, /ut tyf /ut;Fu
;DalGwt kmf]x/ j:t'nfO{ ;s];Dd l56f] la;h{g ug'{k5{ .

;fngfnsf] la;h{g ug{sf] nflu Joj:yfkg

;+sng
!= :jf:Yo s]Gb|df b"lift kmf]x/nfO{ 5'§f5'§} efF8f]df ;Íng ug'{kb{5 .
@= o:tf efF8f]x? gr'lxPsf], 9sgL / n]an ePsf] x'g'kb{5 . ;fngfn ;Íng ug]{ JolQmn] b'a} xftdf
k~hf nufpg' kb{5 / o:tf ;fngfnnfO{ Psbd xf]l;of/Lsf;fy ;Íng ug'{kb{5 tfls o;af6
hldgsf] jl/kl/ slx+ klg /ut r'lxg gkfcf];\ .

;fngfnnfO{ ;+sng If]qaf6 la;h{g If]qdf cf];fg]{ tl/sf

;fngfn, /ut tyf /uthGo j:t' ePsf] kmf]x/nfO{ !÷# efu eg]{ ljlQs} la;h{g ug'{k5{ / olb
@–# 306fdf el/Pg eg] klg To;nfO{ la;h{g ug]{ If]qdf cf];fg'{kb{5 . kmf]x/ cf];fg]{ sfd la/fdL
tyf la/fdL e]6\g] dflg;x?sf] cf]xf]/ bf]x/ sd x'g] ;dodf ug'{ kb{5 . vf;u/L laxfg cyjf a]n'sf
ca]/ ubf{ ;lhnf] x'G5 . kmf]x/ ;Íng ug]{ JolQmn] ;fngfn cf];fg]{ ;dodf k~hf, Pk|f]g / a'6
nufpg'kb{5 .

12–14 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:ts !)–15
 ;fngfn la;h{g ug]{ If]qsf] Joj:yfkg
s]lx ;d'bfodf aRrf hGd]kl5 ;fngfn lng] rng 5 / o;nfO{ cfˆg} tl/sfn] la;h{g ug]{ ;fF:s[lts
k/Dk/f x'G5g\ . t}klg o;nfO{ l7s tl/sfn] la;h{g ug]{ / hgfj/n] o;nfO{ nu]/ rf/}lt/ lkmhfP/
;+qmd0f Nofpg ;Sg] s'/f ;d'bfonfO{ l;sfpg'k5{ . ;fngfnnfO{ k~hf nufP/ xft nufpg], /utnfO{
s'g} klg 7fpFdf gr'xfpg] tyf o;nfO{ hldgeGbf slDtdf ! dL6/ tn la;h{g ug'{ kb{5 .
;fngfnnfO{ OlG;g]/]zg ljlwaf6 la;h{g ug'{ ;aeGbf /fd|f] tl/sf xf] . OlG;g]/]zgkl5 ;fngfnsf]
kl/df0f tyf o;sf ;"Id hLjf0f'x? gi6 x'G5g\ . OlG;g]/]zgsf] nflu g]kfn ;/sf/sf] dfGotf k|fKt
OlG;g]/]6/ cfjZos k5{ . o:tf kmf]x/ j:t'x? hnfpg OlG;g]/]6/ leq pRr tfkqmd cfjZos k5{ .
OlG;g]/]6/ gePsf] 7fpFdf o:tf j:t'x? df6f]leq la;h{g ug'{ jfx]s csf]{ ljsNk x'b}g .
xfn ;fngfn tyf dfgac+u lj;{hgsf] nflu Uof; Knf06sf] k|ljlw ljsf; eO/x]sf] 5 . o;n]
jftfj/0fnfO gsf/fTds k|efj gkf{g'sf ;fy} Uof; pTkfbgn] phf{ pknAw klg x'G5 .
;fngfnnfO ;:tf] / lskmfoltlrq !)=@M
t/Lsfn] lj;{h;fngfn
g ug{ lgDgla;h{ g ug]vfN8f]
adf]lhdsf] { vfN8f]
agfP/ klg la;h{g ug{
;lsG5 M

lrq !)=@M ;fngfn la;h{g ug]{ vfN8f]

 sl/a %–^ dL= ulx/fO{ / !=% dL= rf}8fO{sf] vfN8f] agfOPsf] 5 . o:tf] vfN8f] vfg]kfgL >f]teGbf
%) dL= 6f9f /xg'kb{5 .
 e"–Ifoaf6 arfpg vfN8f]sf] leQfdf l;d]G6]sf] kvf{n nufpg' kb{5 t/ vfN8f]sf] tn cfwf/nfO{
;+qmd0f /f]syfdv'tyf
Nnf :jf:Yo
5f]8\g;+'k:5{yfhGo
. kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:ts !)–1
 vfN8f]sf] dflyNnf] efu l;d]G6sf] 9sgLn] 5fKg'k5{ . o;tf] 9Ssg ;fngfn xfNgsf] nflu !=% b]lv
@ lkm6;Ddsf] v'Nnf x'g'kb{5 . o:tf v'Nnf Kjfndf lasf]{ x'g'k5{ tfls rflxPsf] a]nfdf ;lhn}
vf]Ng / aGb ug{ ;lsof];\ .

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 12–15
 vfN8f]af6 lg:sg] b"lift UofF;nfO{ lgsfNg #–$ O~r kfOk /fvL EoflG6n]zgdf hfnL /fVg] t/
lem+ufaf6 arfpg vfN8f]nfO{ aGb ug'{k5{ .

P]lG6;]lK6s b"if0f lgjf/0f h:tf /;folgs 3f]nx? tyf Knfl:6s j:t'x? vfN8f]leq /fVg' x'b}g
 ha vfN8f] el/G5 o;nfO{ 5f]Kg] / ;'/lIft ?kdf 9'+uf tyf df6f]n] eg]{ . gofF vfN8f] cGo 7fpFdf
agfpg'kb{5 .
 7"nf] c:ktfn tyf w]/} la/fdLsf] ef/ kg]{ k|fylds :jf:Yo s]Gb|x?df @ j6f vfN8f] agfpg
l;kmfl/; ul/G5 . lsgeg] ha Pp6f vfN8f] el/G5, csf]{ vfN8f] k|of]u ug{ ;lsG5 . bf]>f] vfN8f]
eg]{ a]nf;Dd klxnf] vfN8f] ;l8;s]sf] x'G5 / k'gM k|of]u ug{ ;lsG5 .
 ;fngfn la;h{gsf] nflu c:yfO{ vfN8f] vGg ;lsG5 / ha of] el/G5 o;nfO{ df6f]n] k'g{ ;lsG5
/ csf]{ vfN8f] vGg ;lsG5 .
5= ;]lK6s s+lqm6 eN6 -Septic concrete vault_
 of] ljlwdf k|of]u ePsf l;of] / l;l/Ghx? lj;{hg ug{ ;lsG5 . of] ljlwdf lgDg t/Lsf ckgfpg'
kb{5M
 hldg d'lgsf] kfgLsf] ;tx g5'g] u/L s]xL ;do;Dd hDdf ePsf] l;of] tyf l;l/Ghx?nfO
lj;{hg ug{ ;lsg] u/L ! ld6/ x ! ld6/ x !=* ld6/ ulx/fO sf] vf8n vGg] .
 pSt vf8ndf s+lqm6sf] kvf{n agfpg] . l;of] tyf l;l/GhnfO hDdf ug{ dflg; vf8ndf l5g{
;lsg] u/L s+lqm6sf] :Nofa agfpg] . dflg; l5g]{ s+lqm6 /fVbf hldg eGbf s]xL ;]G6Lld6/ dfly
p7fPsf] x'g' kb{5 h;n] ubf{ hldgsf] kfgL vf8n leq gl5/f];\ .
 l;of] tyf l;l/Gh ePsf] ;]K6L aS; pSt vf8ndf hDdf ug]{ .
 of] If]qdf tf/jf/ nufpg] .

h= hnfpg] -Incineration_
 OlG;g]/]zg Pp6f pRr tfkqmd ljlwaf6 kmf]x/ j:t'sf] cfotg / ef/nfO{ sd ug]{ tl/sf xf] . of]
tl/sf k|foh;f] k'gM k|zf]wg gx'g], k'gM k|of]u gx'g] jf ;]lg6/L NofG8kmLn cyf{t 8lDkË ;fO6df
kmfNg g;lsg] kmf]x/ j:t'nfO{ la;h{g ug{sf] nflu 5gf}6 ul/G5 . t/ g]kfn ;/sf/sf] dfGotf
k|fKt OlG;g/]6/ dfq k|of]usf] nflu l;kmfl/; ul/Psf] 5 .

em= lglZqmo jgfpg] -Inertization_

 of] k|s[of cf}iflwhGo kmf]x/ / heavy metal h:tf kmf]x/x? / v/fgLnfO lj;{hg ug{sf] nflu a9L
k|of]udf NofOG5 -WHO 1999_ . of] k|s[ofdf ^% % :jf:Yo ;+:yfhGo km]fx/, !%% l;d]G6, !%
% nfOd / %% kfgLdf ld;fP/ ld>0f agfOG5 . pSt ld>0fnfO ;]6 u/fO pko'St lj;{hgsf]
nflu nluG5 . ld>0fnfO /fd|/L ;]6 x'g lbg kmf]x/x?nfO dl;gf] u/L lkGg' /fd|f] x'G5 -grind_ .
o;f] u/]df o;sf] t/n cj:yfdf g} Nof8lkmdf ;'/lIft tj/n] vGofpg ;lsG5 . of] k|s[ofn]
b'lift kmf]x/x?sf] b'if0f sd ub{5 / hldgsf] ;tx d'lg b'lift x'gjf6 arfpg'sf] ;fy} kmf]x/jf6
;fdfgx? vf]Hg] -scavenging_ sfdjf6 klg arfpg ;lsG5 .

12–16 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
 :jf:Yo ;+:yfhGo kmf]x/x?sf] Joj:yfkg
PHCORC lglh tyf
k|f lSnlgs / kmfd]{;L /
:jf:Yo ;+:yfjf6 lg:sg] :jf:Yo lhNnf vf]k s]Gb| ;/sf/L
Joj:yfkg ug]{ t/Lsf :jf k|of]uzfnf d]l8sn
kmf]x/x?sf] lsl;d rf}sL c:ktfn PHCORC/ lzIf0f
s] lSnlgs :6f]/
v]fk s]Gb| c:ktfn
Hff]lvd gePsf] kmf]x/
hf]vLd gePsf h}ljs o:tf kmf]x/x?nfO dn vfb / jfof]Uof;       
t/Lsfn] uNg] kmf]x/x? jgfpg ;lsG5 .
-s'lxg]+, dn agfpg of]Uo_
k'g{rlqmo of]Uo hf]vLd o:tf kmf]x/x?nfO k'g{rqm ug{ jf       
gePsf kmf]x/x? k'g{k|of]u ug{ ;lsG5 .

cGo Hff]lvd gePsf] kmf]x/ o:tf kmf]x/x?nfO k'g{rqm jf k'g{k|of]u       

ug{ g;Sg] ePsf]n] :yflgo Joj:yfkg
;+u ;Dks{ u/]/ lj;{hg ug{ ;lsG5 .

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
ljz]if Wofg k'¥ofpg' kg]{ :jf:Yo ;+:yfhGo kmf]x/x?

Dffgj cË / c+ux?, ;fngfn Knf;]G6f lk6df lj;{hg ug]{ jf ;'/lIft    X   X

tl/sfn] vf8n jf :t/Lo tl/sfn]
;+rflnt OlG;g/]6/

12–17
 PHCORC lglh tyf

12–18
k|f lSnlgs / kmfd]{;L /
:jf:Yo ;+:yfjf6 lg:sg] :jf:Yo lhNnf vf]k s]Gb| ;/sf/L
Joj:yfkg ug]{ t/Lsf :jf k|of]uzfnf d]l8sn
kmf]x/x?sf] lsl;d rf}sL c:ktfn PHCORC/ lzIf0f
s] lSnlgs :6f]/
v]fk s]Gb| c:ktfn
Wffl/nf tyf ltvf j:t'x? l;of] / l;l/Ghsf] 6'Kkf]nfO sfd gnfUg       
h:t} l;of] / Jn]8x? u/L sf6\g] To;kl5 lgd{lns/0f u/]/
dfq lj;{hg ug]{
jf
)=%% Snf]l/g 3f]n k|of]u u/L
b'if0flgjf/0f ug]{ / ulx/f] vf8n jf
;'/lIft vfN8f] -vault_ df lj;{hg ug]{
.
Dofb gf3]sf cf}iflwx?, b'lift o:tf cf}iflwx?nfO kmsf{pg] lglt    X   
/ sfd gnfUg] cf}iflwx? lng]M :6f]/df kmsf{pg] / :6]f/jf6 klg
cfk"lt{stf{ -supplier_ nfO g} kmsf{pg]
jf
OGSofk;'n];g-encapsulation_ u/]/
Nof08lkmn8df lj;{hg ug]{
;fO6f]6lS;s kmf]x/x? o:tf cf}iflwx?nfO kmsf{pg] lglt lng]M X X X X   
OGSofk;'n];g -encapsulation_
u/]/ :oflg6/L Nof08lkmndf lj;{hg ug]{
;+qmldt / Hofb} g} ;+qmldt
kmf]x/x?

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
 PHCORC lglh tyf
k|f lSnlgs / kmfd]{;L /
:jf:Yo ;+:yfjf6 lg:sg] :jf:Yo lhNnf vf]k s]Gb| ;/sf/L
Joj:yfkg ug]{ t/Lsf :jf k|of]uzfnf d]l8sn
kmf]x/x?sf] lsl;d rf}sL c:ktfn PHCORC/ lzIf0f
s] lSnlgs :6f]/
v]fk s]Gb| c:ktfn
;+qmldt kmf]x/x? h:t} c6f]Sn]e -Jffliko lgd{lns/0f_ u/]/    X   X
/utsf Jofux?, k+hfx?, ;'/lIft lj;{hg ug]{
l;l/Ghx? lj;{hg/ k"g{rlqmodf k7fpg cl3
lgd{lns/0f kZrft Jofu, k+hf cflb
sf6\g' kb{5 . jf
/utsf Jofux?, k+hfx?, l;l/Ghx?nfO{
lj;{hg ug{ eGbf klxn] sfd gnfUg]
u/L sf6]/ Snf]l/g )=% % 3f]ndf
b'if0flgjf/0f u/]/ lj;{hg ug]{- ulx/f]
vfN8f]df uf8\g]_
;qmldt kmf]x/x? h:t} c6f]Sn]e -Jffliko lgd{lns/0f _ u/]/       X
Jof08]h, skf;x? ;'/lIft lj;{hg ug]{ jf

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
o:tf kmf]x/x?nfO{)=%% Snf]l/g 3f]ndf
b'if0flgjf/0f u/]/ -vfN8f]df
uf8\g]{+_, :oflg6/L Nof08lkmN8df lj;{hg
ug]{

12–19
 PHCORC lglh tyf

12–20
k|f lSnlgs / kmfd]{;L /
:jf:Yo ;+:yfjf6 lg:sg] :jf:Yo lhNnf vf]k s]Gb| ;/sf/L
Joj:yfkg ug]{ t/Lsf :jf k|of]uzfnf d]l8sn
kmf]x/x?sf] lsl;d rf}sL c:ktfn PHCORC/ lzIf0f
s] lSnlgs :6f]/
v]fk s]Gb| c:ktfn
/]l8of]PlS6e kmf]x/x? o:tf cf}iflwx?nfO{ kmsf{pg] lglt lng]M X X X X X  X
aGb ul/Psf /]l8of]PlS6e cf}iflw vl/b ug]{ k|s[ofdf g} kmsf{pg]
t/n tyf Uof;o'St jf/] ;xdlt ePsf] x'g' kb{5 jf
cf}iflwx?4f/f b'lift sfuhsf] /]l8of]PlS6e cf}iflwx?nfO{ k'0f{ ?kdf
skx?, l;of] l;l/Ghx?, 6]i66\ ;8\g] u/L hDdf u/L, Kofs u/L
o"jx? h:tf kmf]x/x? pko'St ;do;Dd ;'/lIft tl/sfn] /fVg'
kb{5 . olb ;+qmldt / /]l8of]PlS6e
kmf]x/ ld;fOPsf] v08df /]l8of]PlS6e
kmf]x/nfO{ klxn] To;kl5 dfq b'lift
kmf]x/x?sf] pkrf/ ug'{ kb{5 .
cGo xflgsf/s kmf]x/x?
Kff/f h:tf x]led]6n o:tf kmf]x/x?nfO{ kfgL ;+u ld;fO    X   
l;;fsf] jf]tndf /fVg] / o;sf] /fd|/L
n]an u/L ;'/lIft 7fpFdf /fVg]
/;folgs kmf]x/x?M k|;:t kfgL k|of]u u/L 9ndf lj;{hg    X   
b'if0flgjf/0fsf] lgldQ k|of]u ug]{
ePsf], ls/fx? dfg]{ cf}iflwx?
-Insecticide_
-Ref: Health Care Waste Mangement Guideline 2014 , MOH,DOHS_

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
 :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkg
;'b[l9s/0f
STRENGTHENING HEALTH CARE WASTE
MANAGEMENT
!#
ljifoj:t'
 :jf:Yo ;+:yfhGo kmf]x/ d}nf Joj:yfkgsf] ;'b[l9s/0f ug]{ k|s[of cjnDag ug]{
 sfo{ ;Dkfbg ;'wf/sf] nflu ckgfpg' kg{] r/0fx?sf] cEof; ug]{
 ljleGg u'0f:t/ ;'wf/sf 6'nx?sf] k|of]usf] cEof; ug]{
 sfo{ ;Dkfbgdf leGgtf kQf nufpg]
 sfo{of]hgf tof/ ug]{
 :jf:Yo ;+:yf hGo kmf]x/d}nf Joj:yfkgsf] u'0f:t/ ;'lglZrtfsf] nflu u'0f:t/ ;'wf/ ;ldlt
u7g ug]{ .

e"ldsf
u'0f:t/Lo :jf:Yo ;]jfsf] nflu :jf:Yo ;+:yfhGo kmf]xf]/d}nf Joj:yfkgsf] pkfox?sf] plrt
Joj:yfkg Psbd} dxTjk"0f{ x'G5 . o;f] gePdf ljleGg lsl;dsf] kmf]x/x?n] jftfj/0f b'lift x'g] /
;d'bfodf ;+qmd0f ;g{ ;Sg] vt/fx?sf] af/]df lj:t[t ?kdf j0f{g ul/;lsPsf] 5 . oL hfgsf/LnfO{
sfo{If]qdf ptfg{' clt cfjZos 5 . o;sf] nflu Joj:yfkg kIfn] Hofb} dxTjk"0f{ e"ldsf v]Ng'kg]{
x'G5 . :jf:Yo ;+:yfhGo kmf]x/d}nfsf] Joj:yfkgsf] dxTjk"0f{ e"ldsf ePtfklg w]/}h;f] :jf:Yo ;]jfdf
;+nUg JolQmx¿n] dfkb08 cg';f/ plrt lsl;dn] Joj:yfkg u/]sf] kfO{{b}g . o;sf sf/0fx¿ ljleGg
x'g ;S5g\ . :jf:Yo ;+:yfhGo kmf]x/ d}nfsf] Joj:yfkg ;DaGwL tfnLd/ uf]i7Laf6 hfgsf/L lnPkl5
o;sf] Joj:yfkg ug{ lgDg s'/fx¿ ug{ cfjZos x'G5 M
!= :jf:Yo ;+:yfhGo kmf]x/d}nfsf] Joj:yfkg ;DaGwL sfo{ ug{ :jf:Yo ;+:yfnfO{ tof/L cj:yfdf
/fVg] .
@= :jf:y ;]jf k|bfg ul/;s]kl5, ;]jf k|bfg ubf{ lg:s]sf kmf]x/d}nfsf] plrt Joj:yfkg ug]{ .

:jf:Yo ;+:yfhGo kmf]x/d}nfsf] Joj:yfkg ;DaGwL sfo{ ug{ :jf:Yo ;+:yfnfO{ tof/L cj:yfdf
/fVg] . u'0f:t/ ;'wf/ 6'nx? kl/lzi6 A df x]g'{xf];\ .
tfnLdkl5 :jf:Yo ;+:yfhGo kmf]x/d}nfsf] Joj:yfkg ;DaGwL sfo{ ug{ lgDg s'/fx¿ ug'{k5{M
!. xftsf] ;/;kmfOsf] nflu cfjZos kfgLsf] Joj:yf ug]{ .
@. cfjZos cf}hf/ tyf pks/0fsf] Joj:yf ug]{ .
#. cfjZos ;fdfu|L tyf supplies -h:t} ;+qmd0f lgjf/s 3f]n_ sf] Joj:yf ug]{ .

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 13–1
$. :jf:Yo ;+:yfhGo kmf]x/ d}nf Joj:yfkgsf] nflu cfjZos k"jf{wf/ tof/ ug]{ .
%. :jf:Yo ;+:yfhGo kmf]x/ d}nf Joj:yfkg ;DalGw dfkb08sf] Joj:yf ug]{ .
^. :jf:Yo ;+:yfhGo kmf]x/ d}nf Joj:yfkgsf] cg'udg / clen]v /fVg] (record keeping)] Joj:yf
ug]{ .
&= plrt tl/sfn] xftsf] ;/;kmfO{ ug]{ .
*. kmf]x/d}nf ubf{ pko'St ;'/Iff ;fdu|Lx?sf] k|of]u ug]{ .
(. kmf]x/ ;+sng / cf];f/k;f/ ul/Psf ;fdfgx?sf] ;/;kmfO{sf] nflu Snf]/Lg 3f]nsf] k|of]u ug]{

:jf:y ;]jf k|bfg ul/;s]kl5, ;]jf k|bfg ubf{ lg:s]sf :jf:Yo ;+:yfhGo kmf]x/d}nfsf] plrt
;+sng tyf lj;h{g ug]{ .
!= kmf]x/sf] dfqfnfO{ Go"lgs/0f ug]{
@= kmf]x/x?sf] k|s[lt cg';f/ o;sf] pTkfbg ePsf] 7fpFb]lv cnu cnu hDdf ug]{ .
#= wfl/nf] ;fdfgnfO{ afSnf] g5]l8g] efF8fdf (Puncture Proof Container) /fVg] .
$= b"lift ;fdfgnfO{ 7Ls tl/sfn] cf];f/ k;f/ ug]{ .
%= b"lift kmf]x/nfO{ plrt tl/sfn] ;+sng, e08f/0f tyf lj;h{g ug]{ .
o;sf] nflu tfnLd/uf]i7Lsf] cjlwleq g} 6'nx?sf] k|of]u u/]/ :jf:Yo ;+:yfhGo kmf]x/d}nfsf] n]vfhf]vf
u/]/ Joj:yfkgsf] cEof; ug'{k5{ . o;sf] k|of]usf] af/]df lj:t[t hfgsf/L kfgf g+= !!–% df lbOPsf]
5.
:jf:Yo ;+:yfdf dfly pNn]v ul/P adf]lhd ;a} kIfsf] Joj:yfkg ePdf dfq ;]jfsf] u'0f:t/
;'lglZrt ePsf] dfGg ;lsG5 . :jf:YosdL{x?n] tflnd/uf]i7L cjlwdf oL ;a}sf] af/]df 1fg, l;k /
Jojxf/df ptfg{' kg]{af/] hfgsf/L kfO;s]sf x'G5g\ . t/ o;sf] Jojxfl/s kIfnfO{ lg/Gt/ ;'b[l9s/0f
ub}{ n}hfg'k5{ .
:jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf] ;'lglZrt ug{ ;'b[l9s/0fsf] nflu tfnLd dfq lnP/ kof{Kt
gx'g] s'/f w]/} jif{sf] cg'ejn] b]vfO;s]sf] 5 . tfnLd ;+rfng ubf{ ljleGg k|sf/n] ug{ ;lsG5 h:t}M
:jf:YosdL{nfO{ jf ;xfos sd{rf/Lx?nfO{ :jf:Yo ;+:yfeGbf aflx/ lgDtf] u/]/ jf tfnLd 6f]nL g}
;DalGwt :jf:Yo ;+:yfdf uP/ :jf:YosdL{ nufot cGo ;Dk"0f{ sd{rf/Lx?nfO{ ;d]6]/ (Onsite whole
site approach_ tfnLd/uf]i7L ;+rfng ul/G5 . Onsite whole site approach ckgfpFbf Joj:yfkg kIf
;d]t ;+nUg x'g] xF'bf :jf:Yo ;+:yfhGo kmf]x/d}nfsf] dxTj /fd|/L a'em\g] xF'bf tfnLd/uf]i7L kZrft
k|efjsf/L ?ddf Joj:yfkg ug{ ;xh xg] / k|efjsf/L 9+un] kmf]x/d}nf ug{ ;lsG5 . of] tl/sf
ckgfpFbf ;+:yfsf] oyfl:yltsf] cWoog u/]/ To;sf] ;'wf/sf] nflu ;+:yfut cEof;x? ul/g] x'gfn]
w]/} dxTjk"0f{ x'g cfpF5 . Onsite whole site approach df :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf]
nflu lgoldt ?kdf :jf:Yo ;+:yfsf ;a}n] nuftf/ k|of; ul//xg' kg]{ cEof;df hf]8 lbg] ePsf]n]
o;nfO{ a9fjf lbg' cfjZos b]lvPsf]5 .
:jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkg ;+:yfut ?kdf g} ;'b[9 ug'{ Onsite whole site approach
k|efjsf/L ePsf] s]xL ;+:yfx?sf] pbfx/0fx? 5g\ . To;}n] of] tl/sfnfO{ :jf:Yo ;+:yfdf lj:t[t ?kdf
13–2 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
nfu" ug{;s]df o;sf] qmlds ;'wf/sf] cEof; ul//x]df o;nfO{ lgoldt sfo{qmdsf] ?kdf n}hfg
;s]df :jf:Yo ;+:yfsf] d'xf/ km]g{ Ps gofF km8\sf] dfg{ ;lsg] lyof] . of] t/Lsf ;DjlGwt ;+:yfsf
;Dk'0f{ sd{rf/Ln] o;sf] ;'wf/sf] af/]df lrGtg dgg u/]/ u'0f:t/ ;'wf/sf] sfo{of]hgf agfpg]
ePsf]n] klg of] tl/sf k|efjsf/L x'G5 . sfo{of]hgfnfO{ sfof{Gjog ug{ lg/Gt/ ?kdf d"Nof+sg
ug]{ k|s[of ckgfOG5 . o;f] u/]df pSt sfo{ ;Dkfbgsf ;'wf/sf] sfo{of]hgf ;Dk"0f{ sd{rf/Lx?n]
cfkm}n] agfPsf] x'gfn] cfkm\gf]kgsf] cfefif x'G5 / o;n] ult lnG5 . xf]Og eg] tfnLd lng] JolQm
dfqn] ;Dk"0f{ ;+:yfsf] kmf]x/d}nf Joj:yfkg h:tf] hl6n sfo{ ;DkGg ug{ ;Dej x'b}g . o;sf nflu
lgDgfg';f/sf] r/0fx? ckgfP/ sfo{ ;Dkfbgdf ;'wf/ u/L u'0f:t/ ;'lglZrt ug{ ;lsG5 . of] k|s[of
Ps lg/Gt/ ul/g' kg]{ cEof; xf] .

:jf:Yo ;+:yfhGo kmf]xf]/ d}nf Joj:yfkgsf] sfo{;Dkfbgdf ;'wf/ ug{ ckgfpg' kg{] r/0fx?
(steps to improve performance in infection prevention and health care waste
management)
x/]s :jf:Yo ;+:yfn] u'0f:tl/o ;]jf k|bfg ug{ ;d'bfosf] cfjZostf, cfˆgf] Ifdtf / pknAw ;'ljwf
cg';f/ nIo lgwf{/0f u/]sf] x'G5 . ;dosf] kl/jt{g / ;d'bfosf] dfu ;+u;+u} nIfdf klg kl/jt{g x'b}
hfG5 . ;f]xL nIfnfO{ k"/f ug{ x/]s :jf:Yo ;+:yfx¿n] ljleGg ;]jfx¿ k|bfg ub}{ cfPsf x'G5g\ . o;/L
:jf:Yo ;]jf lbg] qmddf :jf:Yo sfo{stf{x¿n] jf cGo sd{rf/Lx?n] :jf:Yo ;+:yfsf] nIo k"/f ug{
s] s:tf sfo{x? ug'{kg]{ xf] < xfn s] eO/x]sf] 5 < To;nfO{ lg/Gt/ ?kdf d'Nof+sg u/L cem s;/L
;'wf/ ug{] eg]/ Jojl:yt tl/sfn] sfd ug'{k5{ .
sfo{ ;Dkfbgdf ;'wf/ ug{ ljleGg r/0fx? ckgfpFbf sfo{x? Jojl:yt / ;/n tl/sfn] ug{ d2t k'U5 .
;fy} ;d:ofsf] jf:tljs sf/0f jf d'Vo h/f -h8_ ;Dd k'Ug d2t u5{ . sfo{ ;Dkfbgdf ;'wf/ ug]{
af6f]n] :jf:Yo ;+:yfsf] cfjZostf k'/f ug{ d2t k'¥ofpF5 .

sfo{ ;Dkfbg ;'wf/ ug]{ k|lqmof M

sfo{ ;Dkfbg ;'wf/ ug{ ;lhnf]sf] nflu ljleGg r/0fx? ljsl;t u/LPsf] 5 . sfo{ ;Dkfbg ;'wf/
ug{] af6f]sf] 9f+rf kfgf g+= !!–% df x]g'{xf];\ . oL r/0fx?sf] cfwf/ lnP/ sfo{ ubf{ sfo{ ;Dkfbgdf
Jojl:yt tl/sfn] ;'wf/ ug{ ;lhnf] x'G5 . sfo{ ;Dkfbg ;'wf/sf r/0fx? lgDg cg';f/ 5g\ M

!. ck]lIft sfo{ ;Dkfbg (Desired Performance):

ck]lIft sfo{ ;Dkfbg eGgfn] ;+:yfn] xfl;n ug{ rfx]sf] u'0f:t/Lo ;]jfx? x'g\ . oL s'/fx¿ /fli6«o
tyf cGt/f{li6«o dfkb08n] lgwf{/0f ul/lbPsf] x'G5 . ck]lIft sfo{ ;Dkfbgsf] dfkb08, dfkb08 jf
lgb]{lzsf cg';f/ x'g'k5{ . :jf:Yo ;+:yfsf] ck]lIft sfo{sf] k|efjsf/L ;Dkfbg ug{ sd{rf/Lx¿n] cf–
cfkmgf] lhDd]jf/Lx¿af/] :ki6 ¿kdf a'´\g clt cfjZos 5 . ;+qmd0f /f]syfdsf] /fli6«o dfkb08 g}
o;sf ck]lIft sfo{ ;Dkfbg cfwf/ xf] . To;}u/L :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkg lgb]{lzsf
-:jf:Yo dGqfno /:jf:Yo ljefu /Joj:yfkg dxfzfvf_ g} :jf:y ;+:yfsf] ck]lIft sfo{ ;Dkfbgsf]
cfwf/ xf] .

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 13–3
@= sfo{ ;Dkfbgsf] n]vfhf]vf
:jf:Yo ;+:yfn] dfkb08 cg';f/ ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/ d}nf Joj:yfkgsf]
pkfox¿ k|bfg ul//x]sf] 5 ls 5}g egL a]nf a]nfdf n]vfhf]vf ug'{k5{ . o;/L n]vfhf]vf ubf{ pQm
:jf:Yo ;+:yfaf6 lbOPsf ;+qmd0f /f]syfd tyf To;jf6 lg:s]sf kmf]x/sf] Joj:yfkgsf] ;Gbe{df
u|fxs jf lj/fdL ;Gt'i6 5÷5}g < lSnlgsn ;]jf lbg] k|lqmof dfkb08 cg';f/ eO{/x]sf] 5÷5}g <
;+qmd0f /f]syfd tyf jftfj/0fLo ;/;kmfO{ dfkb08 cg';f/ eO/x]sf] 5÷5}g < /]s8{ /fd|f]÷7Lsl;t
/flvPsf] 5÷5}g cflb x]l/G5 . o:tf] n]vfhf]vf # b]lv $ dlxgfsf] cGt/fndf ug'{k5{ .
sfo{ ljj/0f tyf lgb]{lzsfsf] cfwf/df tof/ ul/Psf] u'0f:t/ ;'wf/ 6'nx? k|of]u u/]/ :jf:Yo
;+:yfsf] ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf] n]vfhf]vf ug{ ;lsG5 .
o:tf] n]vfhf]vf cfkm}n] -self assessment_, ;fyLx?af6 -peer assessment_ tyf ;+:yfdf sfo{ ug]{eGbf
aflx/sf ;DalGwt JolQm jf lgsfoaf6 ug{ ;lsG5 .
o; tflnddf ;+nUg gul/Psf] ePklg, lj/fdL÷:ofxf/stf{ u|fxs;+usf] cGt/jftf{ tyf ;d'bfosf]
ljrf/÷wf/0ffnfO{ lnP/ n]vfhf]vf ug'{ /fd|f] x'G5 .

13–4 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
 sfo{ ;Dkfbg ;'wf/sf] nflu ckgfpg' kg{] r/0fx?

;xof]uL ;+:yf / AolQmx¿sf] ;xdtL lng] / sfod /fVg]

r/0f !
ck]lIft sfo{ ;Dkfbg

r/0f # r/0f $ r/0f % s r/0f % v

leGgtf d'n sf/0fx¿ ;dfwfgsf pkfox¿ pkfox¿sf]
yfxf kfpg] kQf nufpg] sfof{Gjog ug]{
sfo{ ;Dkfbgdf sfo{ ;Dkfbgdf b]lvPsf]
leGgtf x'g'sf] sf/0f leGgtfnfO{ sd ug{ s]
r/0f @ s] xf] < ug{ ;lsG5 <
sfo{ ;Dkfbgsf]

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
n]vfhf]vf

r/0f ^ sfo{ ;Dkfbgsf] cg'udg / d'NofÍg

13–5
;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf] nflu ;Gbe{ k'l:tsf !!–5
#= leGgtf s] xf] kQf nufpg]M
;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/ d}nf Joj:yfkg ;DalGw ck]lIft sfo{ ;Dkfbgsf]
cfwf/df s'g} :jf:Yo ;+:yfsf] sfo{ ;Dkfbgsf] n]vfhf]vf ul/;s]kl5 d'Vo leGgtf s] s] xf] eg]/
kQf nufpg' kb{5 . oL leGgtfx¿ ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/ Joj:yfkgdf ;'wf/
ug{sf] nflu Ps df}sfsf] ¿kdf lng'k5{ . olb leGgtfx¿ w]/} b]lvPdf To;nfO{ k|fyldstfsf] cfwf/df
ldnfpg' k5{ . Ps k6sdf g} w]/} leGgtfx¿nfO{ ;dfwfg ug{'eGbf k|fyldstfsf] cfwf/df %–& j6f
hlt leGgtfx¿nfO{ lnP/ ;dfwfg ug{ k|of; ug'{k5{ .

$= ;d:ofsf] d"n sf/0f kQf nufpg] (Finding root cause)

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf ;Gbe{df ck]lIft sfo{ ;Dkfbg /
jf:tljs sfo{ ;Dkfbg aLr cGt/ ePdf ;d:of ePsf] dflgG5 . o;/L ck]lIft / jf:tljs sfo{
;Dkfbg lar cGt/ ePdf Tof] s] sf/0fn] ePsf] xf] eg]/ yfxf kfpg' k5{ t/ aflx/af6 df]6fdf]6L
tl/sfn] x]g]{ lalQs} ;d:ofsf] d"n sf/0f ;Dd k'Ug ;ls+b}g . ck]lIft sfo{ ;Dkfbg (Desired
Performance) / jf:tljs sfo{ ;Dkfbg (Actual Performance) aLrdf leGgtf b]lvPdf, pQm
leGgtfsf] d"n sf/0f kQf nufpg :jf:Yo ;+:yfsf ;a}hgf a;]/ n]vfhf]vf÷ljZn]if0f ug'{k5{ . olb
;d:ofsf] jf:tljs sf/0f;Dd k'Ug ;lsPg eg] ToxfF ul/Psf ;a} k|of;x¿ lg/y{s x'g ;S5g\ .
;d:ofsf] d"n sf/0fdf k'u]kl5 To;sf ;dfwfgsf ljleGg pkfox¿sf] vf]hL ug{ ;lsG5 .
;d:ofsf] d"n sf/0f kQf nufpg ælsg=====lsg=====<Æ cyf{t æs] sf/0fn] of] ;d:of ePsf] xf]nf <
egL r/0fa4 ?kdf d"n sf/0f kQf gnfu] ;Dd k|Zg ug]{ ug{'k5{ . k|foMh;f] o:t} kfFr kN6;Dd ubf{
d"nsf/0f;Dd k'Ug] ;Defjgf w]/} x'G5 .
;d:ofsf] d"n sf/0f :Jff:YosdL{n] sfo{ ug]{ jftfj/0f, ;+:yfsf] ;xof]u, ;/–;fdfu|Lsf] pknAwtf,
p;sf] 1fg / ;Lk tyf sfo{ ug]{ rfxgf h:tf s'/fdf e/kg]{ ePsf]n] ;f] tx;Dd k'u]/ d"n sf/0f
kQf nufpg'k5{ .

%= ;dfwfgsf pkfox?sf] 5gf}6 tyf sfof{Gjog (selecting and implementing interventions):

o;/L ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/ d}nf Joj:yfkgdf leGgtf cyf{t ;d:of x'g'sf]
d"n sf/0fx¿ kQf nfu]kl5 ;f]xL cg'?k pko'Qm ;dfwfgsf] pkfo vf]Hg' k5{ . o:tf ;dfwfgsf]
vf]hL tyf sfof{Gjog ;a} :jf:YosdL{ tyf cGo sd{rf/Lx¿sf] ;+o'Qm k|of;af6 :jf:y ;+:yf leq}af6
ul/g'k5{ . t/ sltko ;d:ofx¿sf] ;dfwfgsf] nflu :jf:Yo ;+:yf Joj:yfkg ;ldlt, lhNnf, If]q
tyf s]lGb|o tx;Ddsf] klg ;xof]u lng'kg]{ x'G5 .
s'g} klg lqmofsnfk ubf{ ;fwg tyf ;|f]tx¿, ;DefJotf, ;fGble{stf tyf sd{rf/Lsf] ;xdtLdf
k|fyldstfsf] cfwf/df ug'{k5{ . s'g} ;d:ofsf] ;dfwfg cfkm\gf] IfdtfeGbf aflx/sf] ePdf bL3{sflng
of]hgf agfO{ afx\Ø ;xof]usf] nflu k|of; ug'{k5{ .
lqmofsnfkx¿nfO{ ;DkGg ug{ :jf:Yo ;+:yfsf sd{rf/Lx? / :jf:Yo ;+:yf Joj:yfkg ;ldltsf
;b:ox?sf] cfk;L 5nkmnaf6 sfo{ of]hgf tof/ ug{'k5{ . sfo{ of]hgfsf] gd'gf kl/lzi6 v df
lbOPsf] 5 .

13–6 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
sfo{of]hgf tof/ ug]{
klxrfg ul/Psf lqmofsnfkx?nfO{ Jojl:yt 9Ëaf6 tyf ;dod} sfof{Gjog ug{sf nflu o;sf]
lj:t[t sfo{of]hgf tof/ ug'{k5{ . sfo{of]hgfdf lqmofsnfkx?nfO{ k|fyldstfsf cfwf/df qmda4?kdf
pNn]v ug'{k5{ / s'g sfd slxn] / s;n] ;DkGg ug]{ eGg] klg :ki6 ?kdf pNn]v ug'{k5{ . ;fdfGotof
o:tf] sfo{of]hgf Ps cfly{s jif{sf nflu tof/ ug'{k5{, t/ k|To]s dlxgf jf k|To]s rf}dfl;s cjlwdf
;DkGg ug'{kg]{ lqmofsnfkx? sfo{of]hgfdf :ki6 pNn]v x'g'k5{ . ;+qmd0f /f]syfd tyf :jf:Yo ;+:yf
hGo kmf]x/ d}nf Joj:yfkgdf ;'wf/ ;DaGwL sfo{sf] dfl;s÷rf}dfl;s÷jflif{s ;dLIffsf] cfwf/df
sfo{of]hgfdf klg cfjZostf cg';f/ ;+zf]wg ub{} hfg'k5{ . cu|Ld ?kdf tof/ ul/Psf] jflif{s
sfo{of]hgfdf ;dfj]z ul/Pafx]s dfl;s ;dLIffaf6 k|fKt lgisif{sf cfwf/df cGo sltko ultljlwx?
klg ;~rfng ug'{kg]{ x'g;S5 . To;}n] o:tf ultljlwx?nfO{ ;dfj]z u/]/ x/]s dlxgfsf] lj:t[t
sfo{of]hgf ;d]t tof/ ug'{k5{ . sfo{ of]hgfsf] gd'gf kl/lzi7 …vÚ df lbOPsf] 5 .

^= sfo{ ;Dkfbgsf] cg'udg tyf d"NoF°g (monitoring and evaluating performance):

:jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkg ;DaGwL ;d:of ;dfwfg ug{ ul/Psf lqmofsnfkx¿af6 s]
slt ;'wf/ eof] eGg] s'/fsf], ;+:yfsf k|d'v jf :jf:Yo sfo{stf{x? jf dflyNnf] txsf ;'kl/j]Ifsx?af6
a]nf a]nfdf cg'udg eO/xg'k5{ . olb sf/0fjz cfzf ul/P cg'?k ;'wf/ Nofpg ;lsPg eg] k'gM
lsg To:tf] ePsf] xf] sf/0f kQf nufO{ ;dfwfgsf] plrt pkfo vf]Hg'k5{ .

:jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgdf u'0f:t/ ;'wf/

:jf:Yo ;]jfsf] u'0f:t/ ;'wf/sf ultljlwsf] klxrfg tyf ;~rfng r/0fa4?kdf ug'{kg]{ x'G5 / o:tf
ultljlw Ps k6s dfq ;DkGg u/]/ ;w}Fe/L u'0f:t/Lo ;]jf k|jfx ug{ ;Dej x'Fb}g . of] s'/f :jf:Yo
;+:yfhGo kmf]x/d}nf Joj:yfkgsf] u'0f:t/ ;'wf/df klg nfu" x'G5 . æu'0f:t/ ;'wf/Æ Pp6f lg/Gt/
rln/xg] k|lqmof xf] cyf{t\ u'0f:t/ ;'wf/sf ultljlwx? lg/Gt/ ?kdf ;w}Fe/L ;~rfng ug'{kg]{ x'G5 .
tn lbOPsf] lrqdf u'0f:t/ ;'wf/ rqm cyf{t u'0f:t/ ;'wf/sf r/0fx? / k|To]s r/0fcGtu{t ;Dkfbg
ug'{kg]{ sfdx?af/] hfgsf/L lbOPsf] 5 M
Dffkb08sf cfwf/df
jt{dfg l:yltsf] n]vf
hf]vf / cfjZostf
klxrfg

k|ult cg'udg tyf ultljlw klxrfg

d"NofÍg Uf'0f:t/Lo
tyf sfo{ of]hgf
:jf:Yo ;]jf lgdf{0f

sfo{ of]hgfcg';f/
ultljlw ;~rfng

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 13–7
:jf:Yo ;+:yfdf u'0f:t/ ;'wf/ 6f]nL lgdf{0f
:jf:Yo ;+:yfsf] sfo{of]hgf cg';f/ u'0f:t/ ;'wf/sf sfo{x? ;DkGg ug]{ / u'0f:t/Lo :jf:Yo ;]jf
k|bfg ug]{ sfo{df :jf:Yo ;+:yfsf ;Dk"0f{ sd{rf/Lsf] ;dfg e"ldsf / lhDd]jf/L x'G5 . :jf:y ;]jf
lbg] qmddf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkg Ps clt g} dxTjk"0f{ u'0f:t/ ;'wf/sf] sfo{ xf] .
;+qmd0f /f]syfd nufot cGo u'0f:t/ ;'wf/sf] sfo{ ug{ :jf:Yo ;+:yfsf sd{rf/L / :jf:Yo ;+:yf
Joj:yfkg ;ldltsf ;b:ox? dWo]af6 Pp6f ;fgf] 6f]nL u7g u/]/ u'0f:t/ ;'wf/sf ;Dk"0f{ ultljlwsf]
/]vb]v ug]{ lhDd]jf/L lbg pko'Qm x'G5 . o;} 6f]nLn] cfˆgf] :jf:Yo ;+:yfaf6 lg/Gt/ ?kdf u'0f:t/Lo
:jf:Yo ;]jf k|bfg eO/x]sf] 5 eGg] ;'lgZrt ug'{k5{ .
Joj:yfkg dxfzfvfn] u'0f:t/ ;'wf/ ;DaGwL lgb]{lzsfdf ljleGg txsf :jf:Yo ;+:yfx?n] lgDgfg';f/
u'0f:t/ ;'wf/ 6f]nL u7g ug'{k5{ eg]/ pNn]v u/]sf] 5 .

u'0f:t/ ;'wf/ 6f]nLsf] u7g

:jf:Yo ;+:yf u'0f:t/ ;'wf/ 6f]nL ;+Vof
:jf:Yo rf}sL :jf:Yo rf}sL k|d'v ! hgf
c=g=dL=÷c=x]=a= ! hgf
:jf:Yo rf}sL Joj:yfkg ;ldltaf6 ! hgf
dlxnf :jf:Yo :jo+;]ljsfdWo]af6 ! hgf
pkef]Qmf jf ;]jfu|fxLaf6 ! hgf
hDdf M % hgf
k|fylds :jf:Yo s]Gb| k|fylds :jf:Yo s]Gb| k|d'v ! hgf
x]Ny cl;:6]06÷c=x]=a= ! hgf
:6fkm g;{÷c=g=dL= ! hgf
k|fylds :jf:Yo s]Gb| Aoj:yfkg ;ldltaf6 @ hgf
dlxnf :jf:Yo :jo+;]ljsf dWo]af6 ! hgf
pkef]Qmf jf ;]jfu|fxLaf6 ! hgf

13–8 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
 kl/lzi6 s

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf 13–9
13–10 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
 :jf:Yo ;]jf ;'b[9Ls/0fsf nflu u'0f:t/ ;'wf/ 6'n (QI tool)
GN 02 : Infection prevention and Health Care Waste Management
A. Infection Prevention

! :jf:Yo ;+:yfsf]]
(gfd, 7]ufgf, HF sf]8_ M
@ cjnf]sg u/]sf] rf}dfl;s klxnf] -!_ bf]>f] -@_ t]>f] -#_
cjlw
# cjnf]sg u/]sf] ldlt
-ut]÷dlxgf÷;fn_
$ cjnf]sgstf{sf] gfd
% cjnf]sgtf{sf] kb M
Scoring Key: Y=Yes, N=No, NA=Not Applicable

sfo{ ;Dkfbgsf rf}dfl;s

k|dfl0fs/0fsf cfwf/x?
dfkb08 ! @ #
:jf:Yo ;+:yfdf kfgLsf] Joj:yf eP gePsf] cjnf]sg
!= :jf:Yo;+:yfdf ug'{xf];\ M -xft w'g] l;+s jf wf/fjfnf afN6Lg _
cfjZos kfgLsf]  hfFRg] sf]7fx?df
Joj:yf 5 .  ;]jf lbg] sIf -;'Ts]/L u/fpg] sf]7fdf, 8«]l;Ë
sf]7fdf, minor/major OT)
 Recovery area/room
 Jff8{df (if it provides in-patient services)
 k|of]uzfnfdf
 zf}rfnodf
Score: All "Yes"=1 point; Any "No"=0 points
cjnf]sg ug]
 ;+:yf jl/kl/
@= :jf:Yo;+:yf ;kmf
 k|ltIff ug]{ sf]7f / :yfg
/flvPsf] 5 .
 la/fdL hfFRg] sf]7fx?
 kl/If0f÷sfo{sIf (e.g. ;'Ts]/L sIf, minor/major OT)
 Recovery area/room
 ;fdfu|L k|;f]wg ug]{ 7fpF
 e08f/ sIf
 zf}rfno
Score: All "Yes"=1 point; Any "No"=0 points

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf s–1
 sfo{ ;Dkfbgsf rf}dfl;s
k|dfl0fs/0fsf cfwf/x?
dfkb08 ! @ #
#=:jf:Yo ;+:yfdf lgDg s'/fx?sf] lg/LIf0f ug'{xf];\
;+s|d0f /f]syfdsf  lgd{nLs/0fsf ug]{ ;fdfu|Lx?
nflu lglZrt  ltvf, wfl/nf j:t' hDdf ug]{ efFF8f]
dfkb08sf ;fdfu|Lx?  Disinfectant - Snf]l/g (Chlorine)
pknAw 5  Psrf]l6 k|of]udf Nofpg] l;l/Ghx?
Single use – standard disposable syringes
 ;fa'g
 xft ;kmf ug]{ PlG6;]lK6s 3f]n -alcohol +
glycerin)
 Latex gloves (Surgical gloves)
 Dff:s
 r:df
 Knfl:6ssf] Pk|f]g
 sfd ubf{ k|of]u ug]{ k+hf–df]6f] k+hf (Utility
gloves)
 IP Guideline - ;+s|d0f /f]syfd tyf :jf:Yo
;+:yf hGo kmf]xf]/ d}nf Joj:yfkg ;Gbe{ k'l:tsf
Score: All "Yes"=1 point; Any "No"=0 points
$= :jf:Yo ;+:yf hGo cjnf]sg ug]{
kmf]xf]/ d}nf ;+sngsf  :jf:Yo ;+:yfn] ltvf wfl/nf cf}hf/x? ;+sngsf
nflu pko'Qm Joj:yf nfuL kGr/ k|'km efF+8f jf needle cutter k|of]u u/]sf]
5.  :jf:Yo ;+:yfaf6 lg:sg] cGo kmf]xf]/ 5'§f 5'§}
ljleGg /+usf] 8:6ljgdf hDdf u/]sf] (as per
HCWM guideline by MD/ MoHP)
kmf]xf]/ d}nf ;+sngsf nflu pko'St ef+8fx? lgDg
sIfx?df pknAw 5g\
 lj/fdL hfFRg] sIf
 ;]jf lbg] sIf (e.g. ;'Ts]/L sIf, minor/major OT)
 ue{jtL kl/If0f sIf
 k|of]uzfnf
 Jff8{
Score: All "Yes"=1 point; Any "No"=0 points
%= sd{rf/Ln] k|To]s l;l/Gh / lgl8nx?
sIfdf ltvf / wf/Lnf  k'gM aGb (Re-cap) gu/L t'?Gt Sharp container
cf}hf/x? pko'St df /flvPsf] jf needle cutter df gi6 ul/Psf]
tl/sfn] lj;h{g  kmf]xf]/ / k|of]u ul/;s]sf ;fdfg /flvPsf] ef+F8f]
ub{5g\ . tLg rf}yfO{ el/Pkl5 aGb u/]/ t'?Gt lj;h{g
u/]sf] (3/4 full).
Score: All "Yes"=1 point; Any "No"=0 points

s–2 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
 rf}dfl;s
sfo{ ;Dkfbgsf dfkb08 k|dfl0fs/0fsf cfwf/x?
! @ #
^=:jf:Yo ;+:yfn] cjnf]sg ug]{
Antiseptic solutions x?  PG6L;]K6Lsx? 3fd gnfUg], lr;f] cFWof/f]
pko'Qm tl/sfn] tof/ sf]7fdf :6f]/ u/L /flvPsf]
u/L k|of]u ub{5g\ /  PG6L;]K6Ls 3f]n -Antiseptic solution) xfjf
plrt tl/sfn] e08f/0f ghfg] ef+F8f]df /flvPsf]
ub{5g\ .  Antiseptic nfO{ b}lgs k|of]u ug{ ldNg] u/L ;fgf]
aGb / k'gM k|of]u ug{ ldNg] ef+F8f]df /flvPsf]
 Dffkb08 cg';f/ pko'Qm antiseptic solution
k|of]u ul/Psf]
 PG6L;]K6Ls 3f]n -Antiseptic solution) uh
glrl/Psf] jf 3fp gePsf] 5fnfdf dfq k|of]u
u/]sf]
 uh / skf; antiseptics lagfsf] efF8fdf e08f/
u/]sf]
 Spirit swab k||To]s lbg tof/ u/]/ k|of]u u/]sf]
 k'gM k|of]udf cfpg] efF8fx?df PlG6;]lK6s
(Antiseptics) /fVg' cl3 efF8fx?nfO{ ;fa'g
kfgLn] wf]P/ ;'Vvf agfPsf]
 c? cf}hf/x? h:t} ydf]{ld6/, k|f]jx? / cGo
;fdu|Lx?sf] e08f/0f PlG6;]K6Ls emf]nsf]
ld>0fdf g/flvsg} ;'Vvf efF8f]df /fv]sf]
Score: All "Yes"=1 point; Any "No"=0 points
&= :jf:Yo ;+:yfn] cjnf]sg ug'{xf];\:
;+qmd0f /f]syfd  lgb]{lzsf cg';f/ )=%% Snf]l/g ;f]n';g tof/
lgb]{lzsf cg'?k b'if0f u/]sf]
lgjf/0f k|s[of ug]{  )=%% Snf]l/g ;f]n';g ePsf] ef+F8f ;]jf lbg]
ul/Psf] 5 . sIfx?df /fv]sf]
 k|of]u ul/Psf cf}hf/x? !) ldg]6 dfq Snf]l/g
3f]ndf 8'afpg] u/]sf
 To;kl5 ;fdfgx? ;kmf ug{ ;fa'gkfgL ePsf]
efF+8f]df /fVg] u/]sf]
 ;]jf lbg] sf]7f Snf]l/g 3f]nn] k'5\g] u/]sf]
 Snf]l/g kfp8/nfO{ xfjf gl5g]{ efF8fdf ;'/lIft
tl/sfn] e08f/ u/]sf]
Score: All "Yes"=1 point; Any "No"=0 points

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf s–3
 sfo{ ;Dkfbgsf rf}dfl;s
k|dfl0fs/0fsf cfwf/x?
dfkb08 ! @ #
*= @. :jf:Yo ;+:yfsf ;kmf ul//x]sf] ;dodf lgDg s'/fx? cjnf]sg
;xfos sd{rf/Ln] ug'{xf];\ M
cf}hf/ tyf ;fdfgx?  JolStut ;'/Iffsf ;fdfu|L k|of]u u/]sf] 5
7Ls tl/sfn] ;kmf
ub{5g\ . o Dff:s
o Knfli6s r:df
o Knfl:6ssf] Pk|f]g
o a'6
o sfd ubf{ k|of]u ug]{ k+hf (Utility
gloves)
 cf}hf/ tyf ;fdfgx? ;kmf ug{ ;kmf kfgL,
g/d a|; / ;fa'g kfgL, jf ;fa'g kfgLsf] 3f]n
k|of]u u/]sf]
 w]/} efux? ePsf cf}hf/ tyf ;fdfgx? vf]n]/
5'§\ofPsf]
 ;fj'g guP;Dd ;kmf kfgLn] kvfn]sf]
 ;kmf ?dfnn] k'5]/ ;'Vvf agfPsf] jf xfjfdf
;'sfPsf]
Score: All "Yes"=1 point; Any "No"=0 points
(= :jf:Yo ;+:yfdf cjnf]sg ug'{xf]; :
;+qmd0f /f]syfdsf]  cf}hf/x? / ;/;fdfgx? /fd|/L ;kmf u/L
lgb]{lzsf cg';f/ ;s]kl5 dfq lgd{lns[t ug{ 8«ddf ldnfP/ /fVg]
cf}hf/x? lgd{lns/0f ul/G5 (chettle forceps / jar klg)
ug]{ ul/Psf] 5 .  cf}hf/x? 8«ddf /fVbf To;sf bfFtx? v'Nnf u/]/
jf kf]sf] kf/]/ /fVg] u/]sf]]
 8«dsf ;j} Kjfnx? v'Nnf u/]/ c6f]Sn]edf
/fv]sf]
 kf]sf] kf/]sf cf}hf/x? c6f]Sn]edf #) ldg]6
!@! l8=;]= / !)^ ls=kf (15 lb/in2) pressure df
lgd{lns/0f ug]{ u/]sf]
 kf]sf] gkf/]sf] cf}hf/ cyjf v'NNff /fv]sf]
cf}hf/ c6f]Sn]edf @) ldg]6 !@! l8=;]=
tfkqmd / !)^ ls=kf= (15 lb/in2) pressure df
lgd{lns/0f ug]{ u/]sf]
 8«dsf ;a} Kjfnx? c6f]Sn]eaf6 lgsfNgf ;fy
aGb ug]{ u/]sf] / Ps xKtf leqdf k||of]u u/]]sf]
jf k]ml/ lgd{lns/0f ug]{ u/]sf]
Score: All "Yes"=1 point; Any "No"=0 points

s–4 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
 rf}dfl;s
sfo{ ;Dkfbgsf dfkb08 k|dfl0fs/0fsf cfwf/x?
! @ #
!)= :jf:Yo ;+:yfdf cjnf]sg ug'{xf]; :
;+qmd0f /f]syfdsf]  sDklgsf] lgb]{zg cg';f/ /f;folgs 3f]n tof/
lgb]{lzsf cg';f/ cf}hf/x? ul/G5 jf klxn]g} tof/ ul/Psf] 3f]n k|of]u ug]{
/f;folgs lgd{lns/0f ug]{ u/]sf]
ul/Psf] 5 .  /f;folgs 3f]n ;kmf / lasf]{ ePsf] efF8f]df /fVg]
u/]sf]
 3f]n ePsf] efF8fdf, 3f]n tof/ u/]sf] ldlt /
expiry x''g] ldlt n]lvPsf]
 b"if0f lgjf/0f u/]/, ;kmf ul/Psf cf}hf/ tyf
;fdfgx?nfO{ vf]n]/ / 5'§\ofP/ ;kmf / lasf]{
ePsf] efF8f]sf] /f;folgs 3f]ndf k"0f{ ?kdf
8'afpg] u/]sf]
 cf}hf/ tyf ;fdfgx?nfO{ gluteraldehyde df !)
3G6f 8'afpg] u/]sf]
 lgd{nLs/0f ul/Psf] lrD6fn] 3f]naf6 ;fdfgx?
lemSg] u/]sf]
 ;fdfgx?sf] ;a} efux? lgd{nLs/0f ul/Psf]
kfgLn] w'g] / xfjfdf ;'sfPsf]
 lems]sf ;fdfgx? t'?Gt k|of]udf NofPsf] / olb
k|of]u ul/+b}g eg] To;nfO{ sl:;Psf] lasf]{
;lxtsf] lgd{nLs[t efF8f]df e08f/ u/]sf] -xfjf
gl5g]{ efF8f]df_ / Ps xKtfleqdf k||of]u u/]]sf]
Score: All "Yes"=1 point; Any "No"=0 points
!!= :jf:Yo ;+:yfdf cjnf]sg ug'{xf];\ :
;+qmd0f /f]syfdsf] Boiler jf lasf]{ ePsf] 8]SrL k|of]u ubf{
lgb]{lzsf cg';f/ cf}hf/x?  vf]n]/ / 5'§\ofP/ ;kmf ul/Psf ;fdfu|Lx? kfgLdf
pRr:tl/o ;+qmd0f k'/} 8'Ag] u/L /fv]sf]]
lgjf/0f ug]{ ul/Psf] 5 .  lasf]{ aGb u/]sf]
 plDng ;'? u/]sf] @) ldg]6;Dd pdfn]sf]
Steamer k|of]u ubf{
 cf}hf/ 5'§f5'§} /fv]sf]
 afkm cfpg z'? ePkl5 @) ldg]6;Dd ksfpg]
u/]sf]
 ;'? ul/;s]kl5 yk ;fdfu|L /fVg] gu/]sf]

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf s–5
 rf}dfl;s
sfo{ ;Dkfbgsf dfkb08 k|dfl0fs/0fsf cfwf/x?
! @ #
 @) ldg]6kl5 ;dfu|Lx? pRr:tl/o ;+qmd0f
lgjf/0f u/]sf] lrD6fn] pRr:tl/o ;+qmd0f
lgjf/0f u/]sf] ;Vvf efF+8f]df e08f/ u/]sf]
Score: All "Yes"=1 point; Any "No"=0 points
!@= :Jff:Yo ;+:yfdf k|of]u cjnf]sg ug'{xf]; :
x'g] cf}hf/x? pko''St  lgd{lns/0f / pRr:tl/o ;+qmd0f lgjf/0f
tl/sfn] e08f/ ul/Psf] ul/Psf cf}hf/x?nfO{ lgd{lns/0f / pRr:tl/o
5.
;+qmd0f lgjf/0f ul/Psf] ef+F8f]df e08f/0f ul/Psf]
 Double wrap ul/Psf cf}hf/x? tyf
;fdfgx?nfO{ ;kmf b/fhdf e08f/0f ul/Psf]
 lgd{lns/0f ul/Psf cf}hf/x? tyf ;]6x?df
lgd{lns/0fsf] expiry ldlt n]lvPsf]
Score: All "Yes"=1 point; Any "No"=0 points
!#= :Jff:Yo ;:yfn] cjnf]sg ug'{xf];\ :
kmf]xf]/d}nf ;+sng ug]{  sd{rf/Lx?n] kmf]x/d}nf Joj:yfkg ubf{ sfd ubf{
sfo{ pko'St tl/sfn] nufpg] k+hf nufPsf]
ub{5 .
 pkrf/ ubf{ lg:s]sf tyf cGo kmf]x/d}nf ljleGg
/+usf] km/s km/s ef+8f]df /fVg] u/]sf]
 wfl/nf cf}hf/x?nfO{ Puncture proof ef+F8f]df
/fVg] u/]sf]
 lzzfsf 6'qmfx? 5'§} ef+F8f]df /fVg] u/]sf]
Score: All "Yes"=1 point; Any "No"=0 points
!$= :jf:Yo ;+:yfn] cjnf]sg ug'{xf]; :
;kmfOsf sfo{x?nfO{  :jf:Yo ;+:yfsf] jl/kl/sf] kmf]x/d}nfsf]
a9fjf lbg] u/]sf] 5 . Joj:yfkgsf nflu 7fpF7fpFdf dustbins /flvPsf]
5
 :jf:Yo ;+:yfsf] j/k/sf] jftfj/0f ;kmf /flvPsf]
5
Score: All "Yes"=1 point; Any "No"=0 points

s–6 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
;'´fjM------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------

GN 02/A: Infection Prevention

hDdf Dffkb08 !$ !$ !$ !$
dfkg ul/Psf Dffkb08
k"/f ul/Psf Dffkb08 (Standard met)
k|fKt k|ltzt % % % %

jfXo cjnf]sg
 cjnf]sgstf{sf] gfdM
 cjnf]sg u/]sf] ldlt M
 k|fKt k|ltztM

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf s–7
 :jf:Yo ;]jf ;'b[9Ls/0fsf nflu u'0f:t/ ;'wf/ 6'n (QI tool)
GN 02: Infection prevention and Health Care Waste Management
B. Health Care Waste Management

! :jf:Yo ;+:yfsf]]
-gfd, 7]ufgf, HF sf]8_M
@ cjnf]sg u/]sf] rf}dfl;s cjlw klxnf] -!_ bf]>f] -@_ t]>f] -#_
# cjnf]sg u/]sf] ldlt
ut]÷dlxgf÷;fn
$ cjnf]sgstf{sf] gfd
% cjnf]sgtf{sf] kb M
Scoring Key: Y=Yes, N=No, NA=Not Applicable

rf}dfl;s
sfo{ ;Dkfbgsf dfkb08 k|dfl0fs/0fsf cfwf/x?
! @ #
!= :jf:Yo ;+:yfdf cjnf]sn ug'{xf];
kmf]x/d}nf ;+sng tyf  6f]kL
lj;h{g sfo{ ug{+s|f] nflu  Dff:s (Masks)
sd{rf/Lx?nfO{ pko'St  r:df
;'/IffTds cj/f]wsx?  sfd ubf{ k|of]u ug]{ k+hf (Utility gloves)
(Protective barrier)
 Knfl:6ssf] h'Qf
pknAw 5g\ .
 Knfl:6ssf] Pk|f]g
Score: All "Yes"=1 point; Any "No"=0 points
@= :jf:Yo ;+:yfdf kmf]x/ cjnf]sn ug'{xf];
d}nf lj;h{g sfo{ ug{sf]  Knf:6Ls tyf 6Lgn] ag]sf g5]l8g] / gr'lxg]
nflu cfjZos ef}lts vfnsf] ef+8f (Pucture proof container)
k'jf{wf/x?, ;/;fdfgx? /  Needle cutter
cfk"lt{sf] JojZyf 5 .  ljleGg /+usf] 8:6ljg (as per HCWM
guideline by MD/ MoHP)
 Disinfectant (Chlorine compounds,
aldehyde and phenolic compounds )
 ;fa'g
 c6f]Sn]e (Autoclave)
 Sanitary landfill sites
 Vff8n
 ;fnsf] nflu Vff8n (Placenta pit)
 Incinerator (as per standard set by MOSTE)
 Health Care Waste Management Guideline
(MD, DoHS)
Score: All "Yes"=1 point; Any "No"=0 points

s–8 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
 rf}dfl;s
sfo{ ;Dkfbgsf dfkb08 k|dfl0fs/0fsf cfwf/x?
! @ #
#= :jf:Yo ;+:yfdf cjnf]sn ug'{xf];\
kmf]x/d}nf k[ylss/0fsf]  :jf:Yo ;+:yfdf ltvf wfl/nf cf}hf/x?
lgldQ pTkfbg >f]td} ;+sngsf nflu kGr/k|'km ef+F8f jf needle
pko'St JojZyf 5 . cutter ;]jf lbg] sIfx?df ePsf]
 :jf:Yo ;+:yfaf6 lg:sg] cGo kmf]xf]/ 5'§f5'§}
ljleGg /+usf] 8:6lagdf hDdf ug]{ u/]sf] (as
per HCWM guideline by MD/ MoHP)
– hf]vLd gePsf h}ljs t/Lsfn] uNg]
-s'lxg]_ kmf]x/x? xl/of]
– hf]vLd gePsf k'gr{lqmo of]Uo kmf]x/x?
– Uff9f lgnf]
– cGo hf]vLd gePsf kmf]x/x? – xNsf
lgnf]
– hf]vLdo'St, ;+qmldt tyf clt g} vt/gfs
;+qmldt kmf]x/x?, k|of]uzfnfaf6 lg:s]sf
vt/gfs kmf]x/x?, Hf]flvdo'St b'lift
wfl/nf kmf]x/x? / cf}iflwhGo kmf]x/x? –
/ftf]
– ;+qmldt / clt ;+qmldt kmf]x/x? – v}/f]]
– /]l8of]PlS6e kmf]x/x? – sfnf]
– cGo vt/gfs kmf]x/x? (Kff/f h:tf heavy
metals) – kx]+nf]
Score: All "Yes"=1 point; Any "No"=0
points
$= :jf:Yo ;+:yfsf cjnf]sg ug'{xf];\
sd{rf/Ln] ltvf / l;l/Gh / lgl8nx?M
wf/Lnf cf}hf/x? pko'St  k'gM aGb (Re-cap) gu/L t'?Gt puncture
tl/sfn] lj;h{g ub{5g\ . proof sharp container df /fv]sf]
 Needle cutter df gi6 ul/Psf]
 kmf]xf]/ / k|of]u ul/;s]sf ;fdfg /flvPsf]
efF8f] tLg rf}yfO{ el/Pkl5\ aGb u/]/ t'?Gt
lj;h{g u/]sf] (3/4 full).
Score: All "Yes"=1 point; Any "No"=0
points

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf s–9
 rf}dfl;s
sfo{ ;Dkfbgsf dfkb08 k|dfl0fs/0fsf cfwf/x?
! @ #
%= :jf:Yo ;+:yfdf cjnf]sg ug'{xf];
kmf]x/d}nf plrt  kmf]x/ d}nf ;s+ng tyf rnfpFbf / kl/jxg
tl/sfn] ;+sng tyf ubf{{ :jf:Yo ;+:yfsf sd{rf/Lx? pko'St
e08f/0f ub{5g\ . ;'/IffTds cj/f]wsx? (Protective barrier)
h:t} sfd ubf{ k|of]u ug]{ k+hf (Utility
gloves) / df:s k|of]u u/]sf]
 ltvf / wf/Lnf cf}hf/x? puncture proof
sharp container Dff ;s+ng u/]sf]
 :jf:Yo ;+:yfaf6 lg:sg] ljleGg kmf]xf]/x? 5'§f
5'§} ljleGg /+usf] 8:6lagdf hDdf ug]{ u/]sf]
 kmf]x/d}nf tf]lsPsf] 7fpF jf If]qdf plrt
vt/fsf] lrGx ;lxt e08f/0f u/]sf]
Score: All "Yes"=1 point; Any "No"=0
points
^= :jf:Yo ;+:yfsf cjnf]sg ug'{xf];\
sd{rf/Ln] ;+:yfleq -on-  :jf:Yo ;+:yfdf lgoldt jf cfjZoStf cg';f/
site_ / :jf:Yo ;+:yfaf6 kmf]x/ d}nf ;s++ng / s]lGb|o e08f/;Dd
aflx/ -off-site_ kmf]x/ kl/jxg ul/Psf]
d}nf cf];f/ k;f/ plrt  kmf]x/ d}nfsf] k[ylss/0f, kl/jxgsf] a]nfdf
tl/sfn] ub{5g\ . klg sfod} /fv]sf]
 kmf]x/ d}nf wheeled trolleys, containers åf/f
jf plrt tl/sfn] af]s]/ ;DalGwt 7fpFdf
k'/\ofOPsf]
 hf]vLdo'St, ;+qmldt / hf]vLd gePsf
kmf]x/x? leGbfleGb} trolley df kl/jxg
u/]sf]
 ;+:yfleq -on-site_ kmf]x/d}nf ;s+ng ug]{
jfxg ;w}F ;kmf / ls6f0f'/lxt u/]sf]
Score: All "Yes"=1 point; Any "No"=0
points

s–10 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
 rf}dfkls
sfo{ ;Dkfbgsf dfkb08 k|dfl0fs/0fsf cfwf/x?
! @ #
&= :jf:Yo ;+:yfdf cjnf]sn ug'{xf];
kmf]x/d}nfsf] plrt
pkrf/ / lj;h{g ug{]
JojZyf 5 .
 Hff]lvd gePsf] kmf]x/
– dn vfb / afof]UofF; jgfPsf]
– k'gr{qm ug{ jf k'gM k|of]u u/]sf]
– k'gr{qm jf k'g{k|of]u ug{ g;lsg] kmf]x/nfO
:yflgo Joj:yfkg;+u ;Dks{ u/]/ lj;{hg
u/]sf]
 Wffl/nf tyf ltvf j:t'x? h:t} l;of] / An]8x?
– l;of] / l;l/Ghsf] 6'Kkf]nfO{ sfd gnfUg
u/L sf6]sf] / To;kl5 lgd{lns/0f u/]/
dfq lj;{hg u/]sf]
– )=%% Snf]l/g 3f]n k|of]u u/L
b'if0flgjf/0f u/]sf] / ulx/f] vf8n jf
;'/lIft vfN8f] -vault_ df lj;{hg u/]sf]
 clt ;+qmldt kmf]x/x? h:t} /utsf Jofux?,
k+hfx?, l;l/Ghx?
– c6f]Sn]e (autoclave_ u/]/ lgd{lns/0f
kZrft sfd gnfUg] u/L sf6]/ ;'/lIft
lj;h{g u/]sf] jf k"g{rqm ug{ k7fPsf]
– )=%% Snf]l/g 3f]ndf b'if0flgjf/0f
u/]kZrft sfd gnfUg] u/L sf6]/ lj;h{g
u/]sf] -ulx/f] vfN8f]df uf8\g]_
 Knf;]G6f, DffgjtGt' tyf c+ux?
– Knf;]G6f lk6df (placenta pit) lj;{hg
u/]sf] jf ;'/lIft t/Lsfn] vf8ndf
lj;h{g u/]sf]
– dfkb08 cg';f/ agfPsf] :t/Lo t/Lsfn]
;+rflnt OlG;g/]6/df lj;h{g u/]sf]
 /f;folgs kmf]x/x?M -b'if0f lgjf/0fsf] lgldQ
k|of]u ePsf_], ls/fx? dfg]{ cf}iflwx? -
Insecticide

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf s–11
 rf}dfkls
sfo{ ;Dkfbgsf dfkb08 k|dfl0fs/0fsf cfwf/x?
! @ #
– /f;folgs pkrf/kl5 k|z:t kfgL k|of]u
u/L 9ndf lj;h{g u/]sf]
– k|z:t kfgL k|of]u u/L 5'§} ulx/f] vf8ndf
lj;h{g u/]sf]
Score: All "Yes"=1 point; Any "No"=0
points
cjnf]sg ug'{xf];
*=:jf:Yo ;+:yfdf  kmf]x/d}nf ;+sng / e08f/sf] nflu cfjZos
kmf]x/d}nfsf] plrt 7fpF jf If]q pknAw u/]sf]
lj;h{g ug{] sfo{nfO{  :jf:Yo ;+:yf j/k/ kmf]x/d}nf /fVgsf]nflu
a9fjf lbOPsf] 5 . dustbins /flvPsf]
 :jf:Yo ;+:yf j/k/ ;kmf /flvPsf]
 :jf:Yo ;+:yfn] kmf]x/d}nf Joj:yfkgsf] nflu
k'g{rqm jf k'gMk|of]u / kmf]x/d}nf sd ug]{
sfo{nfO a9fjf lbPsf]
Score: All "Yes"=1 point; Any "No"=0
points

;'´fjM-------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------

GN 02/B: Health Care Waste Management

hDdf Dffkb08 * * * *
dfkg ul/Psf Dffkb08
k"/f ul/Psf Dffkb08 (Standard met)
k|fKt k|ltzt % % % %

afXo cjnf]sg
 cjnf]sg stf{sf] gfdM
 cjnf]sg u/]sf] ldlt M
 k|fKt k|ltztM

s–12 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
 :jf:Yo ;]jf ;'b[9Ls/0fsf nflu u'0f:t/ ;'wf/ 6'n (QI tool)
GN 02: Infection Prevention and Health Care Waste Management
C. Hand Hygiene

! :jf:Yo ;+:yfsf]]
-gfd, 7]ufgf, HF sf]8_M
@ cjnf]sg u/]sf] rf}dfl;s
klxnf] -!_ bf]>f] -@_ t]>f] -#_
cjlw
# cjnf]sg u/]s]f ldlt
ut]÷dlxgf÷;fn
$ cjnf]sgstf{sf] gfd
% cjnf]sgstf{sf] kb M
Scoring Key: Y=Yes, N=No, NA=Not Applicable

rf}dfl;s
sfo{ ;Dkfbgsf dfkb08 k|dfl0fs/0fsf cfwf/x?
! @ #
!= ;]jfk|bfosn] xftsf] cjnf]sg ug'{xf];\ M
;/;kmfOsf] nflu tof/L  ;]jfk|bfossf g+ux? sfl6Psf]
ub{5g\ .  ;]jfk|bfosn] gSsnL g+ux? g/fv]sf]
 ;]jfk|bfossf g+ux?df kfln; gnufPsf]
 ;]jfk|bfosn] xftsf u/uxgf / 3l8 km'sfn]sf]
 xftsf] ;/;kmfOsf] nflu cfjZos ;/;fdfu|Lx?
olsg u/]sf] -;fa'g, ;fa'g /fVg] efF8f, aUb}
u/]sf] kfgL (Running water) / JolStut
?dfn jf Psrf]l6 k|of]u ug]{ ?dfn_
 xftsf afx'nf dfly ;f/]sf] .
Score All "Yes"=1 point; Any "No"=0 points
@= ;]jfk|bfosn] ^ ;fa'g, kfgLn] xftsf] ;kmfO ug]{M
r/0fdf ;fa'g kfgLn] ;]jfk|bfosn] ^ r/0fdf ;fa'g kfgLn] xft w'G5g\ –
xft w'G5g\ . cjnf]sg ug'{xf];\ M
-$)–^) ;]s]08_  aUb} u/]sf] ;kmf kfgLdf (Running water) xft
(Simple hand washing) lehfPsf] .
 xftdf ;fag' nufP/ b'O{ xft df]Ng] / /fd|/L
kmL+h lgsfNg] ;fy} xftsf] ;a} efudf df]n]sf]
olsg u/]sf]
 xftsf cf}+nfx? / a'9L cf}+nfsf] sfkdf, cufl8
k5fl8 / gË ;a}df /fd|f];Fu df]n]sf]] .
;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf s–13
 rf}dfl;s
sfo{ ;Dkfbgsf dfkb08 k|dfl0fs/0fsf cfwf/x?
! @ #
^ r/0f
 b'j} xftsf xTs]nf Ps cfk;df ldr]sf]
 bflxg] xTs]nfn] b]a|] xTs]nfsf] pN6f] k6\6L
ldr]sf]], To;} u/L b]a|] xTs]nfn] bflxg] xTs]nfsf]
pN6f] k6\6L ldr]sf]
 b'j} xftsf cf}+nfx? Ps csf{df l5/fO b'j}
xTs]nf Ps cfk;df ldr]sf]
 b'a} xftsf cf}nfx? cw{d'¶L agfO{ Ps csf{df
c8\sfP/ /u8]sf]
 Ps xftsf] a'9L cf}+nfnfO{ csf]{ xftsf] d'¶Lleq
3'dfpg], oxL lqmof csf]{ xftlt/ bf]xf]¥ofPsf]
 Ps xftsf cf}+nfx? csf]{ xftsf] xTs]nfdf
3'dfpg] / oxL k|s[of csf]{ xftlt/ bf]xf]¥ofPsf]
 aUb} u/]sf] ;kmf kfgLdf xftsf] ;fa'g guP;Dd
kvfn]sf]
 ;kmf ;'s]sf] ?dfnn] xft k'5]sf] jf xfjfdf
;'sfPsf]] -JolQmut ?dfn k|of]u u/]sf]_ .
Score: All "Yes"=1 point; Any "No"=0 points
#= ;]jfk|bfosn] olb xftdf b]lvg] u/L kmf]x/ gePdfM
cNsf]xn ld;fPsf] cjnf]sg ug'{xf];\ M
P]lG6;]lK6s emf]nn]  P]lG6;]lK6s emf]n k|z:t dfqfdf -Ps lrof
xftsf] ;kmfO u5{g\ . rDrf–% ld=ln= hlt_ lnP/ xftsf] ;a} efudf
-@)—#) ;]s]08, ^ / cf}+nfx?df nufPsf]
r/0fdf_ ^ r/0f
(Handrub with  b'j} xftsf xTs]nf Ps cfk;df ldr]sf]]
antiseptics)  bflxg] xTs]nfn] b]a|] xTs]nfsf] pN6f] k6\6L ldRg],
To;} u/L b]a|] xTs]nfn] bflxg] xTs]nfsf] pN6f]
k6\6L ldr]sf]
 b'j} xftsf cf}+nfx? Ps csf{df l5/fO{ b'j}
xTs]nf Pscfk;df ldr]sf]
 b'a} xftsf cf}nfx? cw{d'¶L agfO{ Pscsf{df
c8\sfP/ /u8]sf]
 Ps xftsf] a'9L cf}+nfnfO{ csf]{ xftsf] d'¶Lleq
3'dfpg], oxL s[of csf]{ xftlt/ bf]xf]¥ofPsf]

s–14 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
 rf}dfl;s
sfo{ ;Dkfbgsf dfkb08 k|dfl0fs/0fsf cfwf/x?
! @ #
 Ps xftsf cf}+nfx? csf]{ xftsf] xTs]nfdf
3'dfpg] / oxL k|s[of csf]{ xftlt/ bf]xf]¥ofPsf]
 b'a} xft g;'s];Dd /u8]sf]
Score: All "Yes"=1 point; Any "No"=0 points
$= ;]jfk|bfosn] cjnf]sg ug'{xf];\ M
zNolqmof ug'{ cufl8  xftsf u/uxgf / 3l8 km'sfn]sf]
xftsf] ;kmfO u5{g\ .  aUb} u/]sf] ;kmf kfgLdf xft lehfPsf] / gË
-#—% ldg]6;Dd, ^ ;kmf u/]sf]
r/0fdf_ (surgical hand  P]lG6;]lK6s emf]n jf emf]n ;fa'g kfgL xftdf
preparation) lnPsf]
 xftnfO s'lxgfeGbf dfly p7fPsf]] /
P]lG6;]lK6s 3f]n jf emf]n ;fa'g kfgL xftdf
lnO{ cf}+nfb]lv s'lxgf;Dd nufO{ uf]nfsf/
t/Lsfn] -circular motion_ dNb} uPsf]] . of]
lqmof csf]{ xftdf klg bf]xf]¥ofPsf] -# b]lv %
ldg]6_
 xftnfO s'lxgfeGbf dfly p7fP/ kfgLn]
cf}+nfsf] 6'Kkf]af6 ;'? u/]/ s'lxgf;Dd /fd|/L
kvfn]sf], of] qmd b'a} xftdf kfn};Fu u/]sf]
 xftnfO{ dfly p7fpFb} / hLpeGbf 6f9f
/fvL s'g}klg 7fpF jf j:t'nfO{ g5'g] / ;'Vvf
/ lgd{lns[t ?dfnn] cf}+nfb]lv k'5\b} s'lxgflt/
nu]sf]] / ;f]xL lgd{lns[t ?dfnsf] csf]{ 6'Kkf]n]
csf]{ xft klg ;f]xL lgodfg';f/ xft k'5]sf] /
olb ?dfn 5}g eg] xfjfdf ;'sfPsf]
 Ps rDrf 5 mL, @ b]lv $ k|ltztsf]
Chlorhexidine jf &=% b]lv !) k|ltztsf] kf]
le8g cfof]l8g slDtdf ^) ;]s]08;Dd ^
r/0fdf, xftdf /u8]sf]] .
 To;kl5 b'a} xftdf lgd{nLs[t k~hf nufPsf]
olb la/fdLsf] rfk a9L ePdf (in high-volume
settings)
 b'O{ zNols|ofsf] aLrdf 3–5 mL cNsf]xn
handrub solution n] g;'s'Gh]n;Dd b'a} xft
/u8]sf]

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf s–15
 rf}dfl;s
sfo{ ;Dkfbgsf dfkb08 k|dfl0fs/0fsf cfwf/x?
! @ #
 k|To]s ! 306fdf jf x/]s rf/hgfsf] zNols|of
kl5 -h'g klxnf x'G5_ ;fa'g kfgLn] surgical
scrub u/]sf]
Score: All "Yes"=1 point; Any "No"=0 points
% ;]jfk|bfosn] xftsf] tnsf cf7dWo] % If0fx?df cjnf]sg ug'{xf];\M
;kmfOsf If0fx? ;]jf  la/fdLsf] hfFr ug'{ cufl8 .
k|bfg ug]{ s|ddf sfod}  s'g} ;fdfGo sfo{ljlw ug{ k~hf nufpg' cufl8
u5{g\ .  Do"s; d]Da|]g, /ut tyf z/L/af6 lg:s]sf] cGo
emf]n kbfy{ 5f]Pkl5
 la/fdLsf hfFr ul/;s]kl5 .
 s'g} klg sfo{ ug'{eGbf cl3 jf ul/;s]kl5 .
 k~hf km'sfln;s]kl5
 kmf]x/d}nf Joj:yfkg u/]kl5
 s'g} klg sfo{ ug'{eGbf cl3 jf ul/;s]kl5
Score: All "Yes"=1 point; Any "No"=0 points

;'´fjM-------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------

GN 02/C: Hand Hygiene

hDdf Dffkb08 % % % %
dfkg ul/Psf Dffkb08
k"/f ul/Psf Dffkb08 (Standard met)
k|fKt k|ltzt % % % %

afXo cjnf]sg
 cjnf]sgstf{sf] gfdM
 cjnf]sg u/]sf] ldlt M
 k|fKt k|ltztM

s–16 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
 :jf:Yo ;]jf ;'b[9Ls/0fsf nflu u'0f:t/ ;'wf/ 6'n (QI tool)
GN 02 : Infection prevention and Health Care Waste Management
D: Housekeeping

! :jf:Yo ;+:yfsf]]
-Gffd, 7]ufgf, HF sf]8_ M
@ cjnf]sg u/]sf] rf}dfl;s
klxnf] -!_ bf]>f] -@_ t]>f] -#_
cjlw
# cjnf]sg u/]s]f ldlt
-ut]÷dlxgf÷;fn_
$ cjnf]sgstf{sf] gfd
% cjnf]sgtf{sf] kb M
Scoring Key: Y=Yes, N=No, NA=Not Applicable

rf}dfl;s
sfo{ ;Dkfbgsf dfkb08 k|dfl0fs/0fsf cfwf/x?
! @ #
!= :jf:Yo ;+:yfn] cjnf]sg ug'{xf];
cfKfmgf] jftfj/0f :jR5  xfp;lslkªsf] (Housekeeping) / ljleGg
sfod} /fVg ;kmfO{sf sfo{sIfx?sf] ;kmfOsf] tflnsf agfO{ ;kmf
nflu ;dotflnsf agfO{ u/]sf] / ;f]lxcg';f/ sfod} /fv]sf]
;f]lxcg';f/ sfd u/]sf]]  zNols|of sIf -ck/]zg sf]7f_ / c?
5. sfo{sIfsf] nflu 5'66} ;kmfOtflnsf agfO{
;f]lxcg';f/ sfod} /fv]sf]
 Housekeeping -xfp;lslkª_sf pks/0fx?
k|of]u ug'[{ cufl8 lgoldt ?kdf b'if0f lgjf/0f
u/]sf] / ;kmf u/L ;'sfPsf]
Score: All "Yes"=1 point; Any "No"=0 points
@= :jf:Yo ;+:yfn] cjnf]sg ug'{xf];
xfp;lslkªsf  6f]kL
(housekeeping) /  Dff:s
sk8f ;kmfO ug]{ k|ls||of  Knfli6s r:df
(linen processing
 Knfl:6ssf] Pk|f]g
tasks) df ;+nUg ;a}
 a'6
s{drf/Lx?sf nflu
JolStut ;'/Iffsf  sfd ubf{ k|of]u ug]{ k+hf
(Utility gloves)
Score: All "Yes"=1 point; Any "No"=0 points
;fdfu|Lx? pknAw
u/]sf] 5 .

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf s–17
 rf}dfl;s
sfo{ ;Dkfbgsf dfkb08 k|dfl0fs/0fsf cfwf/x?
! @ #
#. :jf:Yo ;+:yfsf] sd cjnf]sg ug'{xf];\
hf]lvdsf If]qx? ;do ;fa'g kfgLsf] ‰mf]n jf l86/h]G6df lehfPsf]
tflnsf / sk8fn] k'5]s]f
sfo{lgb]{lZfsf cg';f/ ;kmf
 ‰ofn, ‰ofnsf] dfly / 9f]sfx?
ul/G5 .
 cfnf (Stethescope) / BP cuffs
 e'OFx?
 la/fdLsf sf]7fx? Patients room
b'if0f lgjf/0f ug]{ ‰mf]ndf lehfPsf] sk8fn] k'5]s]f
 s';L{x?, 6]anx?, alQx?, la/fdLsf a]8x?,
la/fdLsf 6]anx?, ;dfTg] railing x?, cflb
 sfo{sIfx? (Procedure rooms)
 hfFRg] sf]7fx?
 k|of]uZffnf
 kmf]x/ hDdf ug{] efF8fx?
b'if0f lgjf/0f ug]{ ‰mf]ndf lehfPsf] 5'§} sk8f jf
a|;n] k'5]s]f
 xft w'g] 7fpFF
 zf}rfno
Score: All "Yes"=1 point; Any "No"=0 points

$. :jf:Yo ;+:yfsf] cjnf]sg ug'{xf];

zNols|of sIf -ck/]zg  x/]s lbgsf] z'?df ;a} ;tx ;kmf / leh]sf]
sf]7f_ ;dotflnsf / sk8fn] ;kmf u/]sf]
sfo{lgb]{lZfsfsf dfkb08
 x/]s lbgsf] cGtdf e'OF k'5\g] / ;a} ;tx :s|a
cg';f/ ;kmf ul/G5 .
ug]{ -total cleaning jf terminal cleaning)
u/]sf]
 x/]s zNols|of sf] aLrdf, zNols|of ug]{ a]8
;fdfg /fVg] 6]an, zNols|of ug]{ a]8 jl/kl/
/ kf]lvPsf] /ut cflb b'if0f lgjf/0f ug]{ ‰mf]nn]
;kmf u/]sf]
Score: All "Yes"=1 point; Any "No"=0 points

s–18 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
 rf}dfl;s
sfo{ ;Dkfbgsf dfkb08 k|dfl0fs/0fsf cfwf/x?
! @ #
%= :jf:Yo ;+:yfdf sk8f cjnf]sg ug'{xf];
;kmfO ug{{ sfo{ ;Dkfbg  sk8f ;kmfO ug]{ sfddf ;+nUg ;a}
dfkb08 jf k|f]6f]sn 5g\ . s{drf/Lx?n] JolStut ;'/Iffsf ;fdfu|Lx?
h:t} sfd ubf{ k|of]u ug]{ k+hf (Utility
gloves), Dff:s, k|of]udf NofO;s]sf sk8fx?
hDdf ubf{, rnfpFbf, cf];f/ k;f/ ubf{, 5fGbf /
;kmf ubf{ k|of]u u/]sf]
 k|of]udf NofO;s]sf sk8fx?, Knfl:6ssf] jf
sk8fsf] ‰mf]nf jf lasf]{ ePsf] ef‘8fdf hDdf
u/]sf]
 hDdf ul/Psf k|of]udf NofO;s]sf sk8fx?,
;kmf ug]{ 7fp‘;Dd lbgx'F cf];f/k;f/ ubf{, aGb
ul/Psf gr'lxg] ‰mf]nf jf lasf]{ ePsf] ef‘8fdf
u/]sf]
 k|of]udf NofO;s]sf ;kmf / kmf]x/ sk8fx?
5'§f5'§} cf];f/k;f/ u/]sf]
 k|of]udf NofO;s]sf sk8fx? lbgx'F hDdf u/]/
d'Vo ;kmfO ug]{ 7fpFdf lgoldt ¿kdf
k'/\ofPsf]
Score: All "Yes"=1 point; Any "No"=0 points
^. :jf:Yo ;+:yfdf cjnf]sg ug'{xf];
k|of]udf NofO;s]sf sk8f  sk8f ;kmf ug]{ lglZrt 7fpF, c? 7fpFx?,
;kmfO ug{{ lglZrt 7fpF h:t} ;kmf sk8f e08f/ ug]{, la/fdLnfO{
pknAw u/]sf] 5 . ;]jf lbg] / vfgf tof/ ug]{ 7fpFx? eGbf 5'§}
ePsf]
 k|of]udf NofO;s]sf sk8f ;kmfO ug]{ 7fpF
xfjf nfUg] ePsf]
 ;kmf sk8f e08f/ ug]{ 7fpF / k|of]udf
NofO;s]sf sk8f ;kmfO ug]{ 7fpF ljefhg
u/]sf]
 k|of]udf NofO;s]sf ;a} sk8f klxnf b'if0f
lgjf/0f u/]sf] . (Decontamination)
 k|of]udf NofO;s]sf kmf]x/ sk8f / ;kmf
sk8f 5'§} wf]Psf]
Score: All "Yes"=1 point; Any "No"=0 points

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf s–19
 rf}dfl;s
sfo{ ;Dkfbgsf dfkb08 k|dfl0fs/0fsf cfwf/x?
! @ #
&. :jf:Yo ;+:yfdf ;kmf Observe
sk8f ;'sfpg], kl/If0f ug]{  Wff]Psf] sk8f xfjfdf ;'sfPsf] jf dlzgn]
/ k§\ofpg] plrt k|ls|of ;'sfPsf]
5.  sk8f ;'s]kl5 tL sk8fx?df Kjfn ePsf] jf
pw|]sf] 5 ls hfFr u/L dd{t u/]sf]
 ;kmf / ;'s]sf] sk8f cfjZostf cg';f/ :qL
u/L, k§ofP/ e08f/ u/]sf]
Score: All "Yes"=1 point; Any "No"=0 points

;'´fjM-------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------

GN 02/D: House Keeping

hDdf Dffkb08 & & & &
dfkg ul/Psf Dffkb08
k"/f ul/Psf Dffkb08 (Standard met)
k|fKt k|ltzt % % % %

afXo cjnf]sg
 cjnf]sgstf{sf] gfdM
 cjnf]sg u/]sf] ldlt M
 k|fKt k|ltztM

s–20 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
 :jf:Yo ;]jf ;'b[9Ls/0fsf nflu u'0f:t/ ;'wf/ 6'n (QI tool)
GN 02 : Infection prevention and Health Care Waste Management
E: Central Sterile Supply Department (CSSD)

! :jf:Yo ;+:yfsf]]
-gfd, 7]ufgf, HF sf]8_ M
@ cjnf]sg u/]sf] rf}dfl;s
klxnf] -!_ bf]>f] -@_ t]>f] -#_
cjwL
# canf]sg u/]s]f ldlt
-ut]÷dlxgf÷;fn_
$ cjnf]sgstf{sf] gfd
% cjnf]sgtf{sf] kb M
Scoring Key: Y=Yes, N=No, NA=Not Applicable

rf}dfl;s
sfo{ ;Dkfbgsf dfkb08 k|dfl0fs/0fsf cfwf/x?
! @ #
!. :jf:Yo ;+:yfdf cjnf]sg ug'{xf];
;+s|d0f /f]syfd sf]  k|of]udf NofO;s]sf ;kmf / kmf]x/ sk8fx?
nfuL CSSD sf] 5'§} tyf cf}hf/x? lng] 7fFp ePsf]
JojZyf 5 .  ;kmf ug]{ ;fdfgx? h:t} s'rf], k'5\g] sk8f,
aflN6g, ;kmfO ug]{ ;fwgx? e08f/ ug]{ 7fFp
ePsf]
 ;kmf ug]{ 7fFp ePsf]
 lgd{lns/0f ug{ cufl8 ;fdfg Kofs ug]{ 7fFp
ePsf]
 lgd{lns/0f ug]{ 7fFp ePsf]
 lgd{lns/0f jf pRr :t/Lo ;+qmd0f lgjf/0f
u/]sf ;fdfgx? e08f/ ug]{ 7fFp ePsf]
 lgd{lns/0f jf pRr :t/Lo ;+qmd0f lgjf/0f
u/]sf ;fdfgx? ljt/0f ug]{ 7fFp jf sfpG6/
ePsf]
Score: All "Yes"=1 point; Any "No"=0 points
@. :jf:Yo ;+:yfsf ;xfos sd{rf/Ln] cf}hf/ tyf ;fdfgx? ;kmf
;xfos sd{rf/Ln] ul//x]sf] ;dodf cjnf]sg ug'{xf];\
cf}hf/ tyf ;fdfgx?
7Ls tl/sfn] ;kmf
ub{5g\ .

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf s–21
 rf}dfl;s
sfo{ ;Dkfbgsf dfkb08 k|dfl0fs/0fsf cfwf/x?
! @ #
 cf}hf/ tyf ;fdfgx? ;kmf ug]{ a]nfdf
JolStut ;'/Iffsf ;fdfu|Lx? k|of]u u/]sf]
o 6f]kL
o Dff:s
o Knfli6s r:df
o Knfl:6ssf] Pk|f]g
o a'6
o sfd ubf{ k|of]u ug]{ k+hf (Utility
gloves)
 cf}hf/ tyf ;fdfgx? ;kmf ug{ ;kmf kfgL,
g/d a|; / ;fa'g kfgL, jf ;fa'g kfgLsf] 3f]n
k|of]u u/]sf]
 w]/} efux? ePsf cf}hf/ tyf ;fdfgx? vf]n]/
5'§\ofPsf]
 ;fa'g guP;Dd ;kmf kfgLn] kvfn]sf]
 ;kmf ?dfnn] k'5]/ ;'Vvf agfPsf] jf xfjfdf
;'Vg lbPsf]
Score: All "Yes"=1 point; Any "No"=0 points
#. :jf:Yo ;+:yfdf cjnf]sg ug'{xf];
;+qmd0f /f]syfdsf]  cf}hf/x? / ;/;fdfgx? /fd|/L ;kmf u/L
lgb]{lzsf cg';f/ ;s]kl5 dfq lgd{lns[t ug{ 8«ddf ldnfP/
cf}hf/x? lgd{lns/0f /fVg] u/]sf] (chettle forceps / jar klg)
ug]{ ul/Psf] 5 .  cf}hf/x? 8«ddf /fVbf To;sf bfFtx? v'Nnf
u/]/ jf kf]sf] kf/]/ /fVg] u/]sf]]
 8«dsf ;a} Kjfnx? v'Nnf u/]/ c6f]Sn]edf
/fv]sf]
 kf]sf] kf/]sf cf}hf/x? c6f]Sn]edf #) ldg]6
!@! l8=;]= / !)^ ls=kf (15 lb/in2) pressure
df lgd{lns/0f ug]{ u/]sf]
 kf]sf] gkf/]sf] cf}hf/ cyjf v'NNff /fv]sf]
cf}hf/ c6f]Sn]edf @) ldg]6 !@! l8=;]=
tfkqmd / !)^ ls=kf= (15 lb/in2) pressure
df lgd{lns/0f ug]{ u/]sf]
 8«dsf ;a} Kjfnx? c6f]Sn]eaf6 lgsfNgf;fy
aGb ug]{ u/]sf] / Ps xKtfleqdf k||of]u u/]]sf]
jf k]ml/ lgd{lns/0f ug]{ u/]sf]
Score: All "Yes"=1 point; Any "No"=0 points

s–22 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
 rf}dfl;s
sfo{ ;Dkfbgsf dfkb08 k|dfl0fs/0fsf cfwf/x?
! @ #
$= :jf:Yo ;+:yfdf cjnf]sg ug'{xf];\
;+qmd0f /f]syfdsf]  sDklgsf] lgb]{zg cg';f/ /f;folgs 3f]n
lgb]{lzsf cg';f/ tof/ ul/G5 jf klxn] g} tof/ ul/Psf] 3f]n
cf}hf/x? /;folgs k|of]u ug]{ u/]sf]
lgd{lns/0f ug]{ ul/Psf]  /f;folgs 3f]n ;kmf / lasf]{ ePsf] efF8f]df
/fVg] u/]sf]
5.
 3f]n ePsf] efF8fdf, 3f]n tof/ u/]sf] ldlt /
expiry x''g] ldlt n]lvPsf]
 b"if0f lgjf/0f u/]/, ;kmf ul/Psf cf}hf/ tyf
;fdfgx?nfO{ vf]n]/ / 5'§\ofP/ ;kmf / lasf]{
ePsf] efF8f]sf] /f;folgs 3f]ndf k"0f{ ?kdf
8'afpg] ul/Psf]
 cf}hf/ tyf ;fdfgx?nfO{ gluteraldehyde df
!) 3G6f 8'afpg] u/]sf]
 lgd{nLs/0f ul/Psf] lrD6fn] 3f]naf6
;fdfgx? lemSg] u/]sf]
 ;fdfgx?sf] ;a} efux? lgd{nLs/0f ul/Psf]
kfgLn] wf]Psf] / xfjfdf ;'sfPsf]
 lems]sf ;fdfgx? t'?Gt k|of]udf NofPsf]
/ olb k|of]u ul/+b}g eg] To;nfO{ sl:;Psf]
9sgL ;lxtsf] lgd{nLs[t efF8f]df e08f/
u/]sf] -xfjf gl5g]{ efF8f]df_ / Ps xKtfleqdf
k||of]u u/]]sf]
Score: All "Yes"=1 point; Any "No"=0 points
%= :jf:Yo ;+:yfdf cjnf]sg ug'{xf];
;+qmd0f /f]syfdsf] Boiler jf lasf]{ ePsf] 8]SrL k|of]u ubf{
lgb]{lzsf cg';f/  vf]n]/ / 5'§\ofP/ ;kmf ul/Psf ;dfu|Lx?
cf}hf/x? pRr:tl/o kfgLdf k'/} 8'Ag] u/L /fv]sf]
;+qmd0f lgjf/0f ug]{  lasf]{ aGb u/]sf]
ul/Psf] 5 .  plDng ;'? u/]sf] @) ldg]6;Dd pdfNg]
Steamer k|of]u ubf{
 cf}hf/ / k+hfx? 5'§f 5'§} /fv]sf]
 afkm cfpg z'? ePkl5 @) ldg]6;Dd ksfpg]
u/]sf]
 ;'? ul/;s]kl5 yk ;dfu|L /fVg] gu/]sf]
 @) ldg]6kl5 ;dfu|Lx? pRr:tl/o ;+qmd0f
lgjf/0f u/]sf] lrD6f jf k+hfn] pRr:tl/o ;+qmd0f
lgjf/0f u/]sf] ;Vvf efF+8f]df e08f/ u/]sf]
Score: All "Yes"=1 point; Any "No"=0 points

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf s–23
 rf}dfl;s
sfo{ ;Dkfbgsf dfkb08 k|dfl0fs/0fsf cfwf/x?
! @ #
^= :Jff:Yo ;+:yfdf cjnf]sg ug'{xf];
k|of]u x'g] lgd{lns/0f  lgd{lns/0f / pRr:tl/o ;+qmd0f lgjf/0f
jf pRr:tl/o ;+qmd0f
lgjf/0f ul/Psf ul/Psf cf}hf/x?nfO{ lgd{lns/0f /
cf}hf/x? pko''St pRr:tl/o ;+qmd0f lgjf/0f ul/Psf] ef+F8f]
tl/sfn] e08f/ ul/Psf] df e08f/0f ul/Psf] Stores the sterile/HLD
5. instruments in sterile/ HLD container
 Double wrap ul/Psf cf}hf/x? tyf
;fdfgx?nfO{ ;kmf b/fhdf e08f/0f u/]sf] /
Ps xKtfleq k|of]udf NofPsf]
 lgd{lns/0f ul/Psf cf}hf/x? tyf ;]6x?df
ltgsf] gfd / lgd{lns/0fsf] expiry ldlt
n]lvPsf]
Score: All "Yes"=1 point; Any "No"=0 points

;'´fjM-------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------

GN 02/E: CSSD
hDdf Dffkb08 & & & &
dfkg ul/Psf Dffkb08
k"/f ul/Psf Dffkb08 (Standard met)
k|fKt k|ltzt % % % %

afXo cjnf]sg
 cjnf]sgstf{sf] gfdM
 cjnf]sg u/]sf] ldlt M
 k|fKt k|ltztM

s–24 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
 kl/lzi6 v

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf s–25
s–26 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
 sfo{ ;Dkfbg dfkb08df b]lvPsf ;d:ofx? ;'wf/ ug{sf nflu k|of]u ug]{ sfo{ of]hgfsf] gd"gf

:jf:Yo ;+:yfsf] gfd M

lhDd]jf/ JolQm M
lhNnf M ldltM
lhDd]af/ slxn] k'/f
d'Vo ;d:of sf/0f ;dfwfgsf pkfox? sfo{qmdsf] cj:yf
JolQm ug]{

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
sfof{Gjog ;d"x !==============================================================@====================================================#=================================================

v–1
o; k':tsnfO{ kl/dfh{g ug]{ l;nl;nfdf ;xof]u ug{'x'g] ljz]if1x?k|lt wGojfb lbg rfxG5' M
klxnf] ;+:s/0f @)^# -@))%_
1= >LdtL b'uf{ u'?Ë, jl/i7 gl;{Ë clws[t /f=:jf=tf=s]=, dft[ tyflzz' :jf:Yo sfo{qmd .
2= 8f= lzn' cof{n, dft[ ;'/Iff ;+of]hs, kl/jf/ :jf:Yo dxfzfvf .
3= >L lb3{/fh >]i7, 6f]nL g]tf, u'0f:tl/o ;]jf sfo{qmd .
4= >LdtL ladnf lh=l;, sfo{qmd clws[t, g]kfn kl/jf/ :jf:Yo sfo{qmd .
5= 8f= /fh]Gb| eb|, 6f]nL g]tf, tfnLd, g]kfn kl/jf/ :jf:Yo sfo{qmd .
6= >LdtL laGb' ah|frfo{, jl/i7 sfo{qmd clws[t, g]kfn kl/jf/ :jf:Yo sfo{qmd .
7= >LdtL k|f0f]Zj/L >]i7, d]6«f]g lq=lj= lzIf0f c:ktfn, dxf/fhu+h .
8= >LdtL zflGt dNn, gl;{Ë clws[t, k|fljlws lzIff tyf Jofj;flos tfnLd kl/ifb\ .
9= >LdtL pdf zfx, g;{ 6«]g/, u'0f:tl/o ;]jf sfo{qmd .
10= >LdtL s[i0ff k|hfklt, lzIf0f c:ktfn .
11= >LdtL lji0f' >]i7,;L=Pkm=8An"=;L= .
12= >LdtL sljtf b]jsf]6f, lzIf0f c:ktfn .
13= >LdtL wd{ nIdL >]i7, lzIf0f c:ktfn .
14= >LdtL ;'wf a}B, aL/ c:ktfn .
15= >LdtL O{Zj/L vgfn, Pg=Pg=;L= .
16= >LdtL Gx"R5]dfof k|hfklt,
17= >LdtL ;'nf]rgf >]i7, dxf/fhu+h, gl;{Ë SofDk; .
18= >LdtL ;s'Gtnf zfSo, dxf/fhu+h gl;{Ë SofDk; .
19= >LdtL nLnf k|wfg, sflGt afn c:ktfn .
20= >LdtL ;'ldqf ;'Aaf, lzIf0f c:ktfn .

bf];|f] ;+:s/0f @)^^ -@)!)_

!= >L Clif/fd v8\sf, pk ;lrj, /fli6«o :jf:YotfnLd s]Gb|
@= 8f= /fd/fh kGyL, OlG6u|]6«]8 d]l8sn clkm;/, /fli6«o :jf:Yo tfnLd s]Gb|
#= >L x/L d}gfnL, /fli6«o :jf:Yo tfnLd s]Gb|
$= >L g/x/L zdf{, /fli6«o :jf:Yo tfnLd s]Gb|
%= >L vu]Gb| e08f/L, /fli6«o :jf:Yo tfnLd s]Gb|
^= >L eLd yfkf, /fli6«o :jf:Yo tflnd s]Gb|
^= >L ;fu/ bfxfn, jl/i7 hg :jf:Yo k|zf;s, kl/jf/ :jf:Yo dxfzfvf
&= >LdtL k'ikf If]qL, gl;{Ë clws[t, kl/jf/ :jf:Yo dxfzfvf
*= 8f= s'z'd yfkf, l;lgo/ sG;N6\ofG6, k/f]ksf/ k|;'tL tyf :qL /f]u c:ktfn

v–2 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
(= >LdtL ;fhgf /lGht, d]6«f]g, k/f]ksf/ k|;'tL tyf :qL /f]u c:ktfn
!)= 8f=hLjg e§/fO{, lgb]{zs, If]qkf6L kl/jf/ sNof0f s]Gb|
!!= >LdtL s[i0ffk|ef If]qL, g;{ 6«]g/, If]qkf6L kl/jf/ sNof0f s]Gb|
!@= >LdtL k|f0f]Zj/L >]i7, d]6«f]g, lq= lj= lzIf0f c:ktfn, dxf/fhu+h
!#= >LdtL nIdL /fhe08f/L, lq= lj= lzIf0f c:ktfn, dxf/fhu+h
!$= >LdtL dL7' rGb|, lq= lj= lzIf0f c:ktfn, dxf/fhu+h
!%= 8f= aLgf If]i7, 6«]g/, g]kfn kl/jf/ lgof]hg ;+3
!^= >LdtL /Ltf kf]v/]n, Pg=P;=cfO{=
!&= >LdtL ljBf >]i7, 6«]lgË, Dofg]h/, lk=P;=cfO{=
!*= 8f= /fHonIdL zdf{, 6«]lgË, Pd=P;=cfO{=
!(= >LdtL pdf zfx, sG;N6\ofG6
@)= >LdtL ;fljqL hf]zL, sG;N6\ofG6
@!= >LdtL t'D;f >]i7, sG;N6\ofG6
@@= >L lb3{/fh >]i7, 6Ld ln8/–k|hgg\ :jf:Yo, g]kfn kl/jf/ :jf:Yo sfo{qmd
@#= 8f= /fh]Gb| eb|, :k];lni6–sfo{ ;Dkfbgdf ;'wf/, g]kfn kl/jf/ :jf:Yo sfo{qmd
@$= >LdtL /fwf /fO{, l;lgo/ k|f]u|fd clkm;/, g]kfn kl/jf/ :jf:Yo sfo{qmd
@%= >LdtL ladnf lh=l;, sfo{qmd clws[t, g]kfn kl/jf/ :jf:Yo sfo{qmd

t];|f] ;+:s/0f @)&@ -@)!%_

!= >L dx]Gb| >]i7, lgb]{zs, /fli6«o :jf:Yo tflnd s]Gb|
@= >L cRo"t nfld5fg], lg= lgb]{zs, /fli6«o :jf:Yo tflnd s]Gb|
#= >L dw';'bg cdfTo, /fli6«o :jf:Yo tflnd s]Gb|
$= 8f= >L O{Zj/ k|;fb pkfWofo, l;= OlG6u|]6]8 d]l8sn clkm;/, sfo{qmd ;of]hs, /fli6«o :jf:Yo
tflnd s]Gb|
%= >L ;[hgf >]i7, jl/i7 hg :jf:Yo k|zf;s, Joj:yfkg dxfzfvf
^= >L ;'/]z bfxfn, lk=Pr=cfO{, /fli6«o :jf:Yo tflnd s]Gb|
&= >L r'8fd0fL e§/fO{, lk=Pr=cfO, /fli6«o :jf:Yo tflnd s]Gb|
*= >L /fdhL aflgofF, l;=lk=Pr=cf]= afn :jf:Yo dxfzfvf
(= 8f= >L hLjg e§/fO{, sG;N6]G6, l;=Pkm=8An"=l;=
!)= >Llji0f'b]jL >]i7, sG;N6\ofG6
!!= >L lb3{/fh >]i7, cfOkf;
!@= >L ladnf lh=l;= ;'cfxf/f
!#= 8f= >L /fh]Gb| eb|f, x]Ny km/ nfOkm
!$= 8f= >L zfGtL hf]zL, k/f]ksf/ k|z'lt tyf :qL /f]u c:ktfn

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf v–3
!%= 8f= >L dLgf ´f, k/f]ksf/ k|;'tL tyf :qL /f]u c:ktfn
!^= >L pdf zfx, sG;N6\ofG6
!&= >L t'd;f >]i7, sG;N6\ofG6
!*= >L /Ltf kf]v/]n, Pg=P;=cfO{=
!(= >L ljBf >]i7, sG;N6\ofG6, lk=P;=cfO{=
@)= >L bfgdfof yfkf, If]qkf6L kl/jf/ sNof0f s]Gb|
@!= 8f= >L ob' k|wfg, Pd=P;=cfO= g]kfn
@@= 8f= >L cf]d dxh{g, g]kfn kl/jf/ lgof]hg ;+3
@#= >L l;k|f hf]zL, g]kfn kl/jf/ lgof]hg ;+3
@$= >L x/Lb]aL dxh{g, k/f]ksf/ k|;'tL tyf :qL /f]u c:ktfn
@%= >L ;GWof Gof}kfg], /fli6«o :jf:Yo tflnd s]Gb|
@^= >L s?0ff zfSo, Pg=Pr=P;=P;=lk=
@&= >L cfzf /fO{, z'cfxf/f
@*= >L /rgf >]i7, kf6g c:ktfn
@(= >L ;'ldqf zfSo, kf6g c:ktfn
#)= >L cfzf nIdL k|hfklt, k/f]ksf/ k|;'tL tyf :qL /f]u c:ktfn
#!= >L O{Zj/L vgfn, lq= lj= lzIf0f c:ktfn, dxf/fhu+h
#@= >L sljtf b]jsf]6f, lq= lj= lzIf0f c:ktfn, dxf/fhu+h
##= >L ls/0f /fjn, Pk=mPr=cfO{= #^), g]kfn
#$= >L k|ef dNn, hkfOuf]
#%= >L dGhLnf zdf{, Pd=P;=cfO{= g]kfn
#^= >L sNof0fL >]i7, sG;N6\ofG6
#&= >L czf]s >]i7, /fli6««o of}g/f]u tyf P8\; lgoGq0f s]Gb|
#*= >L pd]z dxh{g, /fli6«o :jf:Yo tflnd s]Gb|
#(= >L eLdaxfb'/ yfkf, /fli6«o :jf:Yo tflnd s]Gb|
$)= 8f= >L sl/idf dNn a}B, k/f]ksf/ k|;'tL tyf :qL /f]u c:ktfn
$!= >L ;kgf hf]zL, Pg=P;=cfO{=
$@= >L uf]df lg/f}nf, aL/ c:ktfn, gl;{Ë lgb]{zs
$#= 8f= >L b'uf{ e08f/L, PkmPrcfO
$$= >L df]xg kf}8]n, kf6g c:ktfn, xfp; lsk/
$%= >L dLgf yfkf, o'lg;]km
$^= 8f= >L /fhs'df/ dxTj, PrkLPrPn
$&= >L ;hgf clwsf/L, g]kfn kl/jf/ lgof]hg ;+3
$*= >L a;'Gw/f zdf{, afn :jf:Yo dxfzfvf
$(= >L kjg 9'Ë]n, g]kfn kl/jf/ lgof]hg ;+3
v–4 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf
%)= >L xl/s[i0f 9'Ëfgf, /fli6«o :jf:Yo tflnd s]Gb|
%!= 8f= >L aLgf >]i7, x]Ny km/ nfOkm
%@= 8f= >L /f]zgL cdfTo, x]Ny km/ nfOkm
%#= 8f= cr{gf cdfTo, lq= lj= lzIf0f c:ktfn, dxf/fhu+h
%$= 8f= /fh]Gb| u'?Ë, Pg=Pr=P;=P;=kL=
%%= k"0f{b]aL >]i7, g]= 6«df ;]06/

;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf v–5
v–6 ;+qmd0f /f]syfd tyf :jf:Yo ;+:yfhGo kmf]x/d}nf Joj:yfkgsf nflu ;Gbe{ k'l:tsf