Download - Essential Medical Supplies and Equipments
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Essential Medical Supplies
and Equipment
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ln terms of selection and management, medical
supplies and equipment are rarely given as
much attention as drugs
For some reason they are regarded as lessimportant
Yet they are as essential to patient care as drugs
Their cost is considerable In most developing countries, the cost for
medical supplies can be as much as 30 to 40
percent of the amount spent on drugs
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Supplies
comprise mainly disposable items
(such as cotton, dressings,disposable syringes) or items with
relatively short life spans (such as
reusable syringes or catheters)
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Equipment
encompasses both capital equipment and
recurrent equipment,
the former being long-lasting, durable goods
such as autoclave's, and the latter including goods with shorter life spans
such as thermometers or sphygmomanometers.
The distinction between supplies and equipmentis not always clear, for example, thermometers
are pieces of equipment, but they are purchased
so frequently that they are sometimes referred to
as supplies.
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National Equipment and
Medical Supplies PolicyThree main problems associated with
medical supplies and equipment are
lack of policies
lack of standardization, and
lack of quality assurance
Consequence? wasteful and expensive over purchasing
and overstocking
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National Equipment and
Medical Supplies Policy..A sound national equipment policy with a list ofessential medical supplies can be effective in
simplifying supply issues
reducing costs, and promoting efficient provision of health care
The policy specifies what medical equipmentand supplies should be used in which types of
medical tests
interventions and
operations
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National Equipment and
Medical Supplies Policy Since different medical procedures are
carried out at different levels of health
care, the policy defines the sets of
supplies and equipment that will be
needed at each of these levels.
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Drawing Up the List
From this policy, lists of essential equipment and
supplies can be drawn up according to level of
care.
These lists are useful to define priority items and help ensure that the most
essential items are available where needed;
promote careful use of scarce financial resources;
promote standardization, which simplifies supply
management and reduces stock costs;
provide the basis for training of staff and maintenance
technicians.
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Managing the Medical Supplies and
Equipment List
The list of essential equipment andsupplies should contain a complete andclear description of each items including
stock number type
standard pack size, and the
most recent unit priceVEN categories are useful to identify thoseitems that should never be allowed to run
out of stock.
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Managing the Medical Supplies and
Equipment List.
Without effective limits, a list of medicalsupplies tends to be long
It is therefore important that the items be
standardized as much as possible There is usually pressure to include more
items on the list
Doctors who were trained overseas maywant to bring their treatment habits withthem, or even impose them other healthworkers
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Managing the Medical Supplies and
Equipment List.
It is not easy to resist such pressure but a
standardized list, drawn up by the
committee and with procedures for regular
updates, is probably the best solution.
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Minimum Specifications
In addition to a catalog or list of essential items, a
separate set of technical specifications for the items
must be developed.
These specifications must be prepared bytechnically qualified personnel and must be as
accurate and precise as possible.
They are essential to the procurement departmentor tender board to ensure the quality of the items.
They are also needed for any claim if poor quality
goods have been received.
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Sample Product Specifications
Minimum Quality Requirements forHydrophilic Absorbent Gauze Raw material: 100 percent cotton, bleached
Minimum number of warp and weft threadsper inch: 19 x 15
Total of warp and weft threads per cm: 13
Net weight per square meter: 17 g
Net weight per roll: 1,392 g
Products comply with BP88
Packing details: Per piece in white
polyethylene bag; 20 pieces in export carton
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Selecting Medical Supplies
Many supply items, such as syringes,
needles, and gloves, are available as
either disposable or reusable items.
The national policy on the use of
disposable or reusable items may differ
from one country to another.
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Disposable and Reusable Items
In countries with limited funds for medical
supplies, the main problem with using
disposable syringes and needles is that they are
expensive and sometimes out of stock; Because of this, they are often resterilized and
used again.
Two problems arise:
first, these disposables are not meant to be sterilized
(resulting in air leakage and inadequate closing);
second, the method of sterilizing is often inadequate
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Disposable and Reusable Items
Boiling only disinfects and does notsterilize
The same applies for soaking the disposables in
a disinfectant solution
Where stock outs are a problem, every healthfacility should probably keep a few reusable
syringes and needles in reserve.
This implies that a national policy for using onlydisposable oronlyreusable materials is not
always practical.
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Needles and Syringes
Injections are overused in many countries.
In view of their cost and the risk of transmissionof disease, this practice should be discouragedas much as possible.
Nevertheless, every health facility should keepon hand enough syringes and needles to providesterile items for each injection.
In most hospitals or districts, the range ofdifferent syringes and needles can be simplified.
It is not necessary to have all possible sizes
available.
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Sutures
At the primary care level, two kinds of sutures
are usually sufficient: a resorbable chromiccatgut suture with needle for deliveries, and anon resorbable monofilament or braided suturewith needle for wound suturing and minorsurgery.
In district and specialist hospitals, someadditional types of sutures are needed, but notthe wide range that is usually found in stock, atconsiderable cost.
There are round and cutting needles of differentsizes, with catgut, nylon, silk, or Dexon threadsin five to ten different thick-nesses;
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Gloves
Gloves are necessary for staff in dressing anddelivery rooms, operating rooms, andlaboratories where blood samples are handled.
Gloves are used to protect personnel from
infection by microorganisms from a patient'sbody fluids.
In surgery, they are also used to protect thepatient against infection with microorganisms
from the surgeon's hands. The risk of HIV transmission has increasedawareness and underscored the importance ofusing good-quality products with a low risk ofpinholes and cuts.
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Gloves..
There are many different types of gloves:
thick rubber gloves used by cleaners andmortuary workers;
thin, plastic non sterile disposable gloves tohandle infected materials (dressings);
plastic or rubber non sterile but reusable plasticgloves; sterile disposable surgeon's gloves;
and reusable rubber surgeon's gloves, whichcan be sterilized several times,
It important to match the correct gloves to thetask.
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Gloves..
Common errors are
cleaners using rubber surgeon's gloves
surgeons wearing resterilized disposable
gloves (often patched with small pieces ofrubber to repair the holes).
Latex rubber gloves are preferred overplastic for procedures in which contact with
a patient's body fluids is likely. Even wearing two or three layers of gloves
does not reduce the risk of needle stickinjury.
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ESSENTIAL MEDICAL SUPPLIES
AND EQUIPMENT
When I worked in theoperating room last yearI hated it. The equipment
never worked.
Nowadays the
equipment is
very reliablenly because the medical director finally put nurses
only because the medical director
finally put nurses on the selection
committee
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Selecting Instruments and
Equipment Around the world, there are at least four different
types of electrical plugs; two voltage systems, with
110 or 220 volts and 50 or 60 cycles per second;
three different weight and volume measure-mentsystems
The obvious strategy for tackling this problem is to
standardize equipment and instruments
When the standard types and brands have been
chosen, a list of standard equipment with
specifications should be prepared to serve as a
guideline for the procurement department.
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Donated Supplies and
EquipmentsResponsibilities of Recipients
Standardize equipment as much as
possible.
Involve technical departments in
formulating a request for support.
Clearly specify the items to accompanythe equipment.
Make a checklist of these three points
for submission to the donor.
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Responsibilities of Donors
Communicate with the recipient before donatingequipment.
Supply fully operational equipment. Supply all technical documents. Supply the requirements of consumables and
spare parts for two years. Ensure proper packaging and shipping. Offer technical assistance in the training of end-
users and maintenance staff. Understand and respect important laws and
regula-tions in the recipient country (for example,with regard to payment of customs duties).
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Management of Medical
SuppliesIn principle, managing medical supplies
and equipment is similar to managing drug
supply.
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Procurement
Procurement of medical supplies is notsubstantially different from drug
procurement.
There are a limited number of items thatare responsible for a large proportion of
the budget, and these can be identified by
ABC analysis
There will always be requests for the
procurement of items that are not on the
national list of essential supplies
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Procurement.
For such items, for new items that have not yet
beet included on the list, or for new items with an
expected low turnover, the following questions
should be asked before an order is placed: Is the item really necessary?
Can and will it be use in the place for which it is
being ordered?
Is there a local alternative?
Can spare parts or means of maintenance be
consistently obtained?
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Storage
Although most medical and surgical supplies are
quite durable, some contain specific expiration
dates, and others are subject to spoilage if left
unused for too long Other items are sensitive to heat and humidity.
Many sterile products, even if properly packed
by the manufacture remain sterile only if stored
correctly.
Many have an expiry date and may lose sterility
under tropical conditions.
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Storage
Insufficient attention is frequently paid to thestorage requirements of medical supplies.
In some places, storage conditions are poor, withleaking roofs, dust, extreme heat, and rodents.
Under such circumstances, the financial wastedue to damaged supplies is considerable, andinvesting to upgrade the stores, particularly at thecentral and regional levels, is likely to be cost
effective. In selecting supplies and in defining thespecifications for them, one should consider theanticipated storage conditions.
Guidelines for storage should he prepared anddescribed in the list of essential supplies.
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Distribution
Preprinted standard requisition lists of medicalsupplies, organized by level of health facility, areuseful tools to simplify the distribution of suppliesand promote the rational use of limited
resources. Such lists indicate to the end user the range of
items that are available within the system, withtheir specifications, pack sizes, and stock
numbers. The lists can also include the current unit price. In addition, such lists facilitate checking
procedures for ensuring that only approveditems are ordered and supplied
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Distribution.
The lists should specify the maximumamounts of all critical items to be kept inthe health facility or hospital ward.
Many medical supplies (gloves, catheters,and sutures) come in various sizes andmaterials.
One of the most difficult aspects of stockmanagement of medical supplies is toensure that the specifications for the items(size, material, pack size) are all correct.
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Consumption Monitoring
Regular monitoring of the consumption of
medical supplies and equipment is useful
to plan for future requirements, allocate
supplies, and identify wards and facilitiesthat have higher-than-expected
consumption of particular items.
Such a simple system can be an importantdeterrent to the misuse of supplies.
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Consumption Monitoring
Consumption monitoring is not necessaryfor all items.
Initially, it can be limited to those items
that are most attractive, most prone tomisuse, or most valuable.
Monitoring reports can be produced
quarterly. Each ward or unit should be listedseparately.
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Consumption Monitoring
Over time, usage indicators can be developed
along the lines of those that already exist for
drugs.
An example of a usage indicator would be:number of rolls of cotton per month per 100
medical admissions.
Such an indicator becomes a useful tool for
comparing consumption among medical wards
and for planning future requirements.
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Supplies for Other Services
There are other medical services that
need a certain number of "instruments,
basic equipment, reagents, chemicals,
and spare parts.
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Laboratory Services
The extent of laboratory services may vary considerablyfrom one country to another, and this situation hasimplications for the supply system.
In most developing countries, laboratory services exist atthe district hospital, and sometimes in facilities at lowerlevels, for collecting specimens and performing simpleanalyses.
The selection of laboratory equipment, instruments, andsupplies should be need driven and based on the range oftests required at each level.
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Dental Services
The extent of dental services is oftenlimited in developing countries, due to alack of dentists and dental technicians.
Comprehensive services are availableonly in dental clinics in the major towns orat the regional hospitals.
The equipment and supplies needed foreach level of health care should be listedon the basis of the available services.
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Family Planning Services
Family planning services in many developingcountries are largely donor supported.
The donor provides contraceptive supplies andtrains local health workers.
Unfortunately, in many cases, the donor alsodecides which methods and brands are to beused.
Procurement and distribution of supplies areoften carried out separately from the regulargovernmental system.
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Immunization Services
Immunization services are also largelydonor supported in some countries.
UNICFEF is the main donor of both
equipment and services. The extent of cooperation between
UNICFEF and the ministry of health may
vary, and, as with family planning, theinvolvement of national staff on themanagerial level may be limited.
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There is no reason that supplies and equipment forLaboratory, dental, family planning, and immunizationservices should not be part of medical supplies ingeneral.
However, the responsibility for such supplies may liewith different departments in the ministry of health.
To ensure optima! management and a rational supplyprocess, these units should play a consultative role in
selecting items and estimating national needs In the same way that nurses and doctors are involved
in the selection of drugs and general medicalsupplies.