Pharmaceutical Agents and other Clinical Consumables

1. Pharmaceutical Agents and other Clinical Consumables

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* 1. Facility Name:

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* 2. Which of the following general pharmaceuticals and other agents are available at your facility? Please select all that apply.

Intravenous Fluids

Oxygen

General anesthetics

Local anesthetics

Sedation for short-term procedures (e.g. midazolam, propofol, fentanyl, etc.)

Disinfectants and antiseptics (e.g. alcohol, iodine, etc.)

Oral rehydration

Antacids and other antiulcer medicines

Thyroid hormones and antithyroid medicines

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* 3. Which of the following antimicrobials are available at your facility? Please select all that apply.

Anthelminthics (e.g. antischistosomals)

Antibacterials (e.g. penicillin)

Antituberculosis medicines (e.g. Isoniazid)

Systemic antifungal medicines (e.g. Fluconazole)

Antiretrovirals (HIV)

Antimalarial medicines (e.g. Mefloquin)

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* 4. Which of the following cardiovascular and pulmonary medications are available at your facility? Please select all that apply.

Antianginal medicines (e.g. nitroglycerin)

Antiarrhythmic medicines (e.g. amiodarone)

Antihypertensive medicines

Lipid-lowering agents (e.g. statins)

Diuretics

Antiasthmatics and medicines for chronic obstructive pulmonary disease

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* 5. Which of the following anti-inflammatory agents are available at your facility? Please select all that apply.

NSAIDs

Corticosteroids

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* 6. Which of the following vaccines are available at your facility? Please select all that apply.

Hepatitis B vaccine

Hepatitis A vaccine

Diphtheria, Tetanus, Pertussis vaccine

Haemophilus influenza type B vaccine

Pneumococcal vaccine

Inactivated Polio vaccine

Live Polio vaccine

Influenza vaccine

Measles, Mumps, Rubella vaccine

Varicella vaccine

Meningococcal vaccine

Rotavirus vaccine

Human Papilloma Virus vaccine

Rabies vaccine

Yellow Fever vaccine

Typhoid vaccine

Dengue vaccine

Japanese Encephalitis vaccine

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* 7. What method(s) do you use to sterilize and disinfect re-usable surgical equipment? Please select all that apply.

Steam and high pressure (e.g. autoclave)

Dry heat (e.g. oven)

Chemical gas sterilization (e.g. ethylene oxide, ozone)

Chlorine bleach

Aledhydes (e.g. formaldehyde, Ortho-phthalaldehyde, gultaraldehyde)

Hydrogen peroxide

Acid (e.g. peracetic acid)

Ionizing radiation

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