Hospital for Children, Eye, ENT and Rehabilitation Services (CHEERS) is committed in providing clinical and rehabilitation services since December 2012. COVID 19 (pandemic) was first reported in Nepal on 24th January 2020. Since then, every well-prepared hospital in Nepal has been faced with complex challenges in health service provision. This rapidly advancing outbreak requires all hospitals to ensure safe environments for both their health workers who work on front line as well as their valued patients. CHEERS has been a forerunner in planning, developing guidelines, initiating and implementing measures to ensure safety of its staffs, patients and its community against COVID-19. Visitors are guided from the moment they step into the premises of the hospital. Safety procedures 

1. Entrance and parking Separate way of entrance and exit, for patients and hospital staffs have been developed. Only one visitor is allowed to enter with patient for minimizing the crowd. Vehicle parking is managed outside the hospital premises for patients and visitors. 

2. Wearing mask A protective mask covering the face is mandatory for all staffs, patients and visitors before entering the hospital. Masks with vents are discouraged and not recommended by us. 

3. Hand washing Maintaining Social distance, patients and visitors, on entering the hospital are directed to hand wash for washing their hands, as soon as they enter the hospital. Foot paddles are used for minimizing cross infection. 

4. Screening for all patients We screen every staff, patients and visitors for fever with a non-contact infrared thermometer on the entrance in every arrival. Temperature are scanned from wrist which is more reliable rather than forehead. Because recent studies have suggested that forehead scans cannot be trusted during a pandemic as it is less reliable during the time of stress, physical activity, medicines, use of helmets and masks, or even when the person has been smoking. We also take detail history of recent travel (national and international) and COVID related symptoms and record them. If patient has fever, we refer patient to fever clinic of our hospital, and if needed then refer to COVID designated hospitals. Token number is given for patients with optimum temperature on entrance, so there is no need to be in line for registration. 

 5. Hand Sanitizer and spirit Hand sanitizer and spirit are available at the entrance and other numerous locations of the hospital for sanitizing their hands before entering. 

6. Registration areas All the patients are seated in the waiting areas of registration with maintaining appropriate social distancing. Each patient is called according to the token number in registration areas. We have added glass barriers to reduce the contact. Also we have provision of eSewa appointment system so that those unwilling to queue can do so. 

 7. Spacing in waiting areas We have placed a cross for spacing out chairs in every next seat to assure social distancing. Limited numbers of patients are seated in the waiting areas of outpatient departments (OPD). One way direction is created through OPDs wherever possible. 

 8. Safety wear by staffs Doffing and Donning area are designated to specific places to protect from possible contamination. Hand sanitizer and alcohol rub are placed at those designated place. All medical staff wear personal protective equipment (PPE) appropriately with surgical masks, gloves and face shields, before entering OPD. Flexible distances are maintained during the examination of patients in both Eye and ENT department. Plastic barrier shields are placed on the slit lamp bio-microscope for safety purposes. All staff sanitizes their hand, after each examination of patient. All staff carry out safety measures at OPD, pharmacy, optical and lab. 

 9. Fumigation We fumigate the OPD at the end of the OPD hour, and is made ready for the next day. 

10. At OT and IPD All the patient reports are carefully checked at the Operation Theatres (OT) entrance and then the patient is sent for the OT. Patient entering to OT are asked to wear a new surgical face mask. For patients with aerosol generating procedures, ENT procedures and few retina ones, COVID PCR test is made mandatory. Operations are carried out only if RT PCR of the patient is negative, and hospital stay period is minimized as far as possible. After operation, patients are given the bed with maintaining distance. Admission in the ward is limited only for the needy ones and the post-operative cases. Operated patients who are not needy for admission are given cell number of operating consultants, so that if they have some problems, it can be solved through telemedicine, thus minimizing frequency of hospital visits. 

11. COVID-19 Testing Regarding CHEERS staffs, COVID RT PCR were done twice for all medical and non-medical staffs with negative reports. Periodic monitoring by COVID response team is done to assess implementation of safety measures.