Nepal

CLIENT EXAMINATION ROOM
AT THIS POINT ASK TO BE SHOWN THE ROOM OR AREA IN THE GENERAL OUTPATIENT AREA WHERE MOST CLIENT
SERVICES ARE OFFERED. OBSERVE THE CONDITION UNDER WHICH MOST CLIENT EXAMINATION TAKE PLACE.
INDICATE IF THE FOLLOWING ITEMS ARE AVAILABLE IN THE ROOM OR AREA. ASK TO BE SHOWN ITEMS THAT
YOU DO NOT SEE.
710* INFECTION CONTROL AND CONDITIONS FOR
CLIENT EXAMINATION
OBSERVED
REPORTED,
NOT SEEN
NOT
AVAILABLE
01 RUNNING WATER (PIPED, BUCKET WITH TAP OR POUR PITCHER) 1 2 3
02 HAND-WASHING SOAP (MAY BE LIQUID SOAP) 1 2 3
03 ALCOHOL-BASED HAND RUB 1 2 3
04 WASTE RECEPTACLE (PEDAL BIN) WITH LID AND COLOR CODED 1 2 3
PLASTIC BIN LINER / LABELED BIN (RED, GREEN, YELLOW AND BLUE) 06
05 OTHER WASTE RECEPTACLE 1 2 3
06 SHARPS CONTAINER ("SAFETY BOX") 1 2 3
07 DISPOSABLE LATEX GLOVES 1 2 3
08 DISINFECTANT/ANTISEPTICS [E.G., CHLORINE, HIBITANE, ALCOHOL] 1 2 3
09 SINGLE-USE STANDARD DISPOSABLE SYRINGES WITH NEEDLES OR 1 2 3
AUTO-DISABLE SYRINGES WITH NEEDLES
10 MEDICAL MASKS 1 2 3
11 GOWNS 1 2 3
12 EYE PROTECTION [GOGGLES OR FACE PROTECTION] 1 2 3
13 INJECTION SAFETY PRECAUTION GUIDELINES FOR STANDARD PRECAUTIONS 1 2 3
(Surakchhit sui ko niti)
14* NEEDLE DESTROYER 1 2 3
15* METHYLATED SPIRIT AND GLYCIRINE 70:30 1 2 3
711 DESCRIBE THE SETTING OF THE ROOM OR PRIVATE ROOM. . . . . . . . . . . . . . . . . . . . . . 1
SERVICE AREA
OTHER ROOM WITH
AUDITORY AND VISUAL PRIVACY. . . . . 2
VISUAL PRIVACY ONLY. . . . . . . . . . . . . . . . 3
NO PRIVACY. . . . . . . . . . . . . . . . . . . . . . . . 4
720 Is there a waiting area for clients where they YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
are protected from the sun and rain? NO PROTECTED CLIENT WAITING AREA . . . . . . . . . . . 2
ASK TO SEE THE CLIENT WAITING AREA.
MUST BE THE WAITINGAREA IN THE MAIN
OUTPATIENT SERVICE AREA.
CLIENT WAITING AREA
DISASTER PREPAREDNESS
720A*
720B*
720C*
Does this facility have a disaster preparedness contingency YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
plan/manual? NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 720C
May I see the disaster preparedness contingency OBSERVED. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
plan/manual REPORTED NOT SEEN. . . . . . . . . . . . . . . . . . . . . . . . . . .2
Does this facility conducted "Drill down" exercises YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
as part of disaster prepareness training? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
246 • Appendix C