Nepal

1015A OBSERVE ICEPACKS CONDITIONING. ICEPACK CONDITIONING MAINTAINED . . . . . 1
NOT MAINTAINED . . . . . . . . . . . . . . . . . . . . . . . 2
1015B Does this facility have vaccine bundling system? (Syringe, Icepacks, YES. . . . . . . . . . . . . . . . . . . .. . . . . . . . . .. . . . . . 1
Diluent, Safety Boxes and Re-constitution Syringe) NO. . . . . . . . . . . . . . . . . . . .. . . . . . . . . .. . . . . . . 2 1015D
1015C May I see vaccine bundling commodities? OBSERVED. . . . . . . . . . . . . . . . . . . .. . . . . . . . . 1
OBSERVE IF COMMODITIES BUNDLING (MANAGED BY THE FACILITY ) REPORTED, NOT SEEN. . . . . . . . . . . . . . . . . . 2
IS ACCORDING TO THE DOSES OF VACCINES. NOT AVAILABLE (NOT VACCINATION DAY) . . 3
1015D Do you follow multi dose-vial policy (MDVP) ? YES. . . . . . . . . . . . . . . . . . . .. . . . . . . . . .. . . . . . 1
NO. . . . . . . . . . . . . . . . . . . .. . . . . . . . . .. . . . . . . 2
1015E Do you follow vaccine vial monitoring (VVM) ? YES. . . . . . . . . . . . . . . . . . . .. . . . . . . . . .. . . . . . 1
NO. . . . . . . . . . . . . . . . . . . .. . . . . . . . . .. . . . . . . 2
1015F Does this facility use the Adverse Effect Following Immunization (AEFI) YES. . . . . . . . . . . . . . . . . . . .. . . . . . . . . .. . . . . . 1
form to report vaccine-related adverse effects? NO. . . . . . . . . . . . . . . . . . . .. . . . . . . . . .. . . . . . . 2 1050
1015G May I see a copy of the form? OBSERVED. . . . . . . . . . . . . . . . . . . .. . . . . . . . . 1
REPORTED, NOT SEEN. . . . . . . . . . . . . . . . . . 2
NOT AVAILABLE . . . . . . . . . . . . . . . . . 3
INFECTION CONTROL
1050 ASSESS THE ROOM OR AREA FOR THE ITEMS LISTED GENERAL INFORMATION [Q710]. . . . . . . . . . . 11
BELOW. FOR ITEMS THAT YOU DO NOT SEE, CHILD CURATIVE CARE [Q1251]. . . . . . . . . . . 13
ASK YOUR RESPONDENT TO SHOW THEM TO YOU. FAMILY PLANNING [Q1351]. . . . . . . . . . . . . . . .14
ANTENATAL CARE [Q1451]. . . . . . . . . . . . . . . .15
IF THE SAME ROOM OR AREA HAS ALREADY BEEN PMTCT [Q1551]. . . . . . . . . . . . . . . . . . . . . . . . . 16
ASSESSED, INDICATE WHERE THE DATA ARE RECORDED DELIVERY [Q1651]. . . . . . . . . . . . . . . . . . . . . . . 17
STI SERVICES [Q1851] . . . . . . . . . . . . . . . . . . . 18
TUBERCULOSIS [Q1951]. . . . . . . . . . . . . . . . . . 19
HIV TESTING [Q2051]. . . . . . . . . . . . . . . . . . . . 21
NCD [Q2351]. . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
MINOR SURGERY [Q2451]. . . . . . . . . . . . . . . . 23
NOT PREVIOUSLY SEEN. . . . . . . . . . . . . 31
NEXT SECTION / SERVICE SITE
1051* INFECTION CONTROL AND CONDITIONS FOR OBSERVED REPORTED, NOT
CLIENT EXAMINATION NOT SEEN 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
1052 DESCRIBE THE SETTING OF THE CHILD VACCINATION PRIVATE ROOM. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
SERVICE DELIVERY ROOM OR AREA.
OTHER ROOM WITH
AUDITORY AND VISUAL PRIVACY. . . . . . . . . . . 2
VISUAL PRIVACY ONLY. . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
NO PRIVACY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
THANK YOUR RESPONDENT AND MOVE TO YOUR NEXT DATA COLLECTION POINT IF DIFFERENT FROM
CURRENT LOCATION.
270 • Appendix C