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1851 INFECTION CONTROL AND CONDITIONS FOR OBSERVED REPORTED, NOT<br />

CLIENT EXAMINATION NOT SEEN AVAILABLE<br />

01 RUNNING WATER (PIPED, BUCKET WITH TAP OR POUR PITCHER) 1 2 3<br />

02 HAND-WASHING SOAP (MAY BE LIQUID SOAP) 1 2 3<br />

03 ALCOHOL-BASED HAND RUB 1 2 3<br />

04 WASTE RECEPTACLE (PEDAL BIN) WITH LID AND COLOR CODED 1 2 3<br />

PLASTIC BIN LINER / LABELED BIN (RED, GREEN, YELLOW AND BLUE) 06<br />

05 OTHER WASTE RECEPTACLE 1 2 3<br />

06 SHARPS CONTAINER ("SAFETY BOX") 1 2 3<br />

07 DISPOSABLE LATEX GLOVES 1 2 3<br />

08 DISINFECTANT/ANTISEPTICS [E.G., CHLORINE, HIBITANE, ALCOHOL] 1 2 3<br />

09 SINGLE USE STANDARD DISPOSABLE SYRINGES AND NEEDLES OR 1 2 3<br />

AUTO-DISABLE SYRINGES WITH NEEDLES<br />

10 MEDICAL MASKS 1 2 3<br />

11 GOWNS 1 2 3<br />

12 EYE PROTECTION [GOGGLES OR FACE PROTECTION] 1 2 3<br />

13* INJECTION SAFETY PRECAUTION GUIDELINES FOR STANDARD PRECAUTIONS 1 2 3<br />

(Surakchhit sui ko niti)<br />

14* NEEDLE DESTROYER 1 2 3<br />

15* METHYLATED SPIRIT AND GLYCIRINE 70:30 1 2 3<br />

1852 DESCRIBE THE SETTING OF THE ROOM OR AREA PRIVATE ROOM. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1<br />

OTHER ROOM WITH<br />

AUDITORY AND VISUAL PRIVACY. . . . . . . . . . . . . . . . 2<br />

VISUAL PRIVACY ONLY. . . . . . . . . . . . . . . . . . . . . . . . . . . . 3<br />

NO PRIVACY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4<br />

THANK YOUR RESPONDENT AND MOVE TO YOUR NEXT DATA COLLECTION POINT IF DIFFERENT FROM<br />

CURRENT LOCATION.<br />

Appendix C • 297

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