essential medical supplies and equipments

8/3/2019 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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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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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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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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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 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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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.

essential medical supplies and equipments

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