2010 - Modifications in the updated 301 to 500 Bedded District Hospitals document (Major changes have been highlighted

in yellow colour) A The revised IPHS [DH (301-500)] has considered the services, infrastructure, manpower, equipments and drugs in two categories of Essential (minimum assured services) and Desirable (the ideal level services which the states and UT shall try to achieve). B Services: Following were included under this heading i. Psychiatry ii. Geriatric services (10 bed ward) iii. Tobacco Cessation Services iv. Dialysis Services v. Physical Medicine and Rehabilitation services vi. DOT centre & Designated Microscopy centre vii. AYUSH services viii. Integrated Counselling and Testing Centre; STI Clinic; ART Centre ix. Blood Bank x. Disability Certification Services xi. Accident and Emergency Services Desirable i. De-addiction centre ii. Diagnostic and other para clinical services: NCV, EMG, VEP( visual evoked potential), Muscle Biopsy iii. MRI C .Guidelines on Patient Safety and infection control and Health Care workers Safety added. D .Provisions for proposed Bachelors of Rural Health Care (BRHC) course mentioned for inclusion whenever to be implemented. . E Infrastructure: following were added. i. Factors determining number of beds is listed ii. Hospital building , planning, lay out updated iii. Signage. iv. Disaster prevention measures (desirable for new upcoming facilities), v. Environmental friendly features vi. Barrier free access. vii. Provisions for quality assurance in clinics, laboratories, blood bank, ward unit, pharmacies, and accident & emergency services. viii. Housekeeping services, annual maintenance contract and record maintenance. F Separate provision for examination of victims of sexually assault added under Accident & Emergency Services G .Manpower: the new manpower proposed i. Additional requirements for existing specialities and support staff updated. ii. New man power 1. One assistant medical superintendant (desirable) 2. One Orthodontist (desirable) 3. One Radiotherapist (desirable) 4. One PMR specialist 5. Medical Physicist (desirable wherever there is a radiotherapy centres) 6. One Clinical psychologist (desirable) 7. One LHV 8. One health worker male 9. One Dental Technician 10. One dental Hygienist 11. Nine ANS

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12. Radio therapy technician (desirable) 13. One Dental Assistant 14. Therapist : one occupational and two rehabilitation (desirable) 15. One prosthetist and one orthotist (desirable) 16. One Multi Rehabilitation worker 17. One rehabilitation worker (desirable). 18. One Cold Chain & Vaccine Logistics Assistant 19. One Cold chain handler 20. One Instructor for young hearing impaired.(desirable under NPPCD) List of drugs and equipments updated; drugs and equipments for special care newborn unit added. Annexure added. i. National guidelines on hospital waste management. ii. Guidelines to reduce environmental pollution due to mercury waste. iii. Surgical safety checklist. iv. Special New born care unit. v. MIS format for monthly reporting. vi. List of statutory compliances. vii. Seismic safety guidelines. J. Annexure deleted i. Guidelines for schemes for financial support for hospital waste management (not included in 11th Five year Plan)

Immune System Components: Common Terms and Definitions

AntibodyA Y-shaped protein secreted by B cells in response to an antigen. An antibody binds specifically to the antigen that induced its production. Antibodies directed against antigens on the surface of infectious organisms help eliminate those organisms from the body. AntigenA substance (often a protein) that induces the formation of an antibody. Antigens are commonly found on the surface of infectious organisms, transfused blood cells, and organ transplants. Antigen presenting cells (APC)One of a variety of cells within the body that can process antigens and display them on their surface in a form recognizable by T cells. AutoantibodyAn antibody that reacts with antigens found on the cells and tissues of an individual's own body. Autoantibodies can cause autoimmune diseases. Autoimmune diseaseA condition that results from the formation of antibodies that attack the cells or tissues of an individual's own body. B cellsAlso known as B lymphocytes. Each B cell is capable of making one specific antibody. When stimulated by antigen and helper T cells, B cells mature into plasma cells that secrete large amounts of their specific antibody. Bone marrowThe soft, living tissue that fills most bone cavities and contains hematopoietic stem cells, from which all red and white blood cells evolve. The bone marrow also contains mesenchymal stem cells that a number of cell types come from, including chondrocytes, which produce cartilage. CytokinesA generic term for a large variety of regulatory proteins produced and secreted by cells and used to communicate with other cells. One class of cytokines is the interleukins, which act as intercellular mediators during the generation of an immune response. Immune system cellsWhite blood cells or leukocytes that originate from the bone marrow. They include antigen presenting cells, such as dendritic cells, T and B lymphocytes, and neutrophils, among many others. Lymphatic systemA network of lymph vessels and nodes that drain and filter antigens from tissue fluids before returning lymphocytes to the blood. Memory cellsA subset of antigen-specific T or B cells that "recall" prior exposure to an antigen and respond quickly without the need to be activated again by CD4 helper T cells. Major histocompatibility complex (MHC)A group of genes that code for cell-surface histocompatibility antigens. These antigens are the primary reason why organ and tissue transplants from incompatible donors fail. T cellsAlso known as T lymphocytes. There are two primary subsets of T cells. CD4 helper T cells (identified by the presence of the CD4 protein on their surfaces) are instrumental in initiating an immune response by supplying special cytokines. CD8 cytotoxic (killer) T cells (identified by the presence of the CD8 protein on their surfaces), after being activated by the CD4 helper cells, are capable of killing infected cells in the body. CD4 helper T cells are destroyed by the HIV virus in AIDS patients, resulting in an ineffective immune system. ThymusA lymphoid organ located in the upper chest cavity. Maturing T cells leave the bone marrow and go directly to the thymus, where they are educated to discriminate between self and nonself proteins. (See tolerance.) ToleranceA state of specific immunologic unresponsiveness. Individuals should normally be tolerant of the cells and tissues that make up our own bodies. Should tolerance fail, an autoimmune disease may result.