# Presentation: 902597

## Module 4:  Managing Supplies for Sputum Smear Microscopy 

## Learning Objectives

- At the end of this module, you will be able to
- List all supplies required for performance of smear microscopy.
- Explain use and importance of the stock book in maintaining adequate inventory.
- Calculate supplies based on smears examined during a specific period.
- Explain storage of supplies and shelf life requirements of stains.

## Content Overview

- Supply list for smear microscopy
- Recordkeeping:  Stock book use and importance
- Calculation of supplies to order
- Receipt of supplies
- Storage and shelf life of supplies

## Supply Management Means...

**Properly maintaining adequate supplies to ensure uninterrupted service**

## NTP Specific Customization

- Customize this slide according to NTP specific on
- the carbol fuchsin stain concentration
- device (loop or stick) used for smearing
- use of frosted or unfrosted slides
- method of waste decontamination

## Ordering and Distribution of Supplies

- What to order?
- From where?
- How much?
- How often?
- How to assess correctness of order?
- What is the lead time/reserve quantity?

## Basic Supplies Required for AFB Smear Microscopy

**Prepared stains or components **
**Basic Fuchsin**
**Phenol**
**Alcohol**
**Decolorizing agent**
**Methylene blue**
**Distilled water**
**Immersion oil**
**Lens/tissue paper**
**Small equipment**
**Disinfectant**

**Soap **
**Disposable sticks or loop**
**Slides and storage boxes**
**Slide marking device**
**Spirit torch**
**Sputum collection containers**
**Request & report form**
**AFB-microscopy register**

## Supply Management Involves... 

- Performing a “stock count”
- Maintaining proper inventory records
- Determining how much to order
- Placing orders properly
- Inspecting and verifying supplies received
- Ensuring proper storage of stock

## Stock Book

**Stock Book**

| Physical count (Units) | Date physical count performed | Quantity (units) Requested | Date
Requested | Quantity
Received | Date
Received | Total stock in hand |
| --- | --- | --- | --- | --- | --- | --- |
|  |  |  |  |  |  |  |
|  |  |  |  |  |  |  |
|  |  |  |  |  |  |  |
|  |  |  |  |  |  |  |

**Item Name:_______________                    Unit__________________**

## Perform a Stock Count

| What is it? | Physically counting each item in the stock |
| --- | --- |
| When is it done? | Recommended at the end of each quarter |
| Who does it? | A designated person |

**All items must be accounted for. Everything that **
**comes in and goes out must be recorded.**

## AFB Laboratory Performance and Stock Form

**AFB Laboratory Performance and Stock Form**

## Methods for Calculating Supplies

- Method 1:  10% Positive case rate
- Not developed here
- Refer to reference manuals (WHO/IUATLD)
- Method 2:  Laboratory Quarterly Report - Smears examined and stock on hand

## Calculated Quarterly Requirements for Peripheral Microscopy Center

## Total Slides Examined Previous Quarter (A)

**  ****The value (A) equals the number of sputum examinations performed during the previous quarter**

## Examples of Items Required

**Items**
**Sputum containers****	**
**Slides ****	**
**Carbol fuchsin****	**
**Destaining reagent****	**
**Methylene blue****	**
**Immersion oil****	**
**Burning spirit****	**
**   ****Each of the consumables used for AFB microscopy and the unit of use**

## The Quantity Required for One Sputum Examination Is?

- Sputum containers
- Slides
- Carbol fuchsin
- Destaining reagent
- Methylene blue
- Immersion oil
- Burning spirit

## The Quantity Required for One Sputum Examination (B) Is

| Item Name | Quantity |
| --- | --- |
| Sputum containers | 	1 piece |
| Slides | 	1 piece |
| Carbol fuchsin | 	3 ml |
| Decolourising solution | 	5 ml |
| Immersion oil | 	0.05 ml	 |
| Burning spirit | 	1 ml |
| Methylene blue | 	3 ml |

**Notes:**
NOTE: -  NEED TO MAKE UNITS AND ORDER OF ITEM SAME AS WHAT IS ON SLIDE

## Calculation for One Quarter of  Supply of an Item (C)

- The value (C) equals the quantity of an item required for one quarter
- Calculate (C) by multiplying the number of slides examined during a quarter (A) by the amount of the item needed for one examination (B), therefore:
- 				**A x B = C**

## Example to Calculate One Quarter of Supply of Carbol Fuchsin (C)

- In the last quarter, you examined 400 sputum specimens (A).
- You need 3 ml of carbol fuchsin per examination (B), so how much carbol fuchsin will you need for the next quarter (C)?
- A x B = C
- 400 slides x 3 ml/slide = 1200 ml

## Reserve Quantity (D)

- The value (D) equals a one quarter consumption quantity of an item that must be kept as a reserve
- The value (D) is equal to (C), the quantity of an item calculated for one quarter:
- 				**(C) = D**

## Stock on Hand (E)

- The value (E) equals the stock on hand
- Determine (E) by the an actual physical count of existing stock (inventory)

## Calculated Quantity (F)

- The value (F) equals the quantity required for one quarter (C) plus the quantity required for one quarter reserve (D) less the stock on hand (E)
- Calculate (F) as follows:
**	****	****	****	****(F)= C+D-E**

## Quantities Requested/ Issued

- Round up the calculated quantity to a quantity consistent with the unit of issue
- Example 1, if the calculated quantity of carbol fuchsin is 1824 ml, round up to 2 liters
- Example 2, if the calculated quantity of slides is 700, round up to 720 since the unit of issue is 72 slides per box (i.e., request 10 boxes)

## Exercise #1:  Calculate Quarterly Requirements for your Microscopy Center

- Use worksheet labeled exercise #1
- Work individually
- Use sample data provided on flipchart
- Use calculators provided
- Time allowed: 30 minutes

## Exercise #1:  Calculate Quarterly Requirements for your Microscopy Center

**Exercise #1:  Calculate Quarterly Requirements for your Microscopy Center**

## Exercise #1 AnswerCalculated Quarterly Requirements for Your Microscopy Center

## Calculated Quarterly Requirements for Peripheral Microscopy Center

**Calculated Quarterly Requirements for Peripheral Microscopy Center**

## Total Slides Examined Previous Quarter (A)

-   The value (A) equals the number of sputum examinations performed during the previous quarter

## Examples of Items Required

**Items**
**Sputum containers****	**
**Slides ****	**
**Carbol fuchsin****	**
**Destaining reagent****	**
**Methylene blue****	**
**Immersion oil****	**
**Burning spirit****	**
**   ****Each of the consumables used for AFB microscopy and the unit of use**

## The Quantity Required for One Sputum Examination Is?

- Sputum containers
- Slides
- Carbol fuchsin
- Destaining reagent
- Methylene blue
- Immersion oil
- Burning spirit

## The Quantity Required for One Sputum Examination (B) Is

| Item Name | Quantity |
| --- | --- |
| Sputum containers | 	1 piece |
| Slides | 	1 piece |
| Carbol fuchsin | 	0.003 liters |
| Destaining reagent | 	0.005 liters |
| Methylene blue | 	0.003 liters |
| Immersion oil | 	0.00005 liters |
| Burning spirit | 	0.001 liters |

**Notes:**
NOTE: -  NEED TO MAKE UNITS AND ORDER OF ITEM SAME AS WHAT IS ON SLIDE

## The Reagent Quantity per Liter (C) Is

| Reagent | Quantity per Liter |
| --- | --- |
| Basic Fuchsin | 	3 grams |
| Phenol | 	50 grams |
| Sulfuric acid | 	250 liters |
| Methylene Blue | 	3 grams |
| Denatured alcohol | 	0.1 liters |

**Notes:**
NOTE: -  NEED TO MAKE UNITS AND ORDER OF ITEM SAME AS WHAT IS ON SLIDE

## Calculation for One Quarter of  Supply of an Item (D)

- The value (D) equals the quantity of an item required for one quarter
- Calculate (D) by multiplying the number of slides examined during a quarter (A) by the amount of the item needed for one examination (B) and by the reagent quantity per liter, therefore:
- 				**A x B x C = D**

## Example to Calculate One Quarter of Supply of Basic Fuchsin (D)

- In the last quarter, you examined 400 sputum specimens (A).
- You need 0.003 liters of carbol fuchsin per examination (B), and your concentration of basic fuchsin in the carbol fuchsin is 3 grams per liter (C), so how much basic fuchsin will you need for the next quarter (D)?
- A x B x C = D
- 400 slides x 0.003 liters/slide x 3 grams/liter= 3.6 grams

## Reserve Quantity (E)

- The value (E) equals a one quarter consumption quantity of an item that must be kept as a reserve
- The value (E) is equal to (D), the quantity of an item calculated for one quarter
- 				**(D) = E**

## Stock on Hand (F)

- The value (F) equals the stock on hand
- Determine (F) by the an actual physical count of existing stock (inventory)

## Calculated Request (G)

- The value (G) equals the quantity required for one quarter (D) plus the quantity required for one quarter reserve (E) less the stock on hand (F)
- Calculate (G) as follows:
- 			    **(G)= D+E-F**

## Quantities Requested/ Issued

- Round up the calculated quantity to a quantity consistent with the unit of issue
- Example 1, if the calculated quantity of basic fuchsin is 14 grams, round up to 1 bottle of 25 grams
- Example 2, if the calculated quantity of slides is 2300, round up to 2 boxes since the unit of issue is 1728 slides per box

## Exercise #2:  Calculate Quarterly Requirements for your Microscopy Center

- Use worksheet labeled exercise #2
- Work individually
- Use sample data provided on flipchart
- Use calculators provided
- Time allowed: 30 minutes

## Exercise #2:  Calculate Quarterly Requirements for your Microscopy Center

**Exercise #2:  Calculate Quarterly Requirements for your Microscopy Center**

## Exercise #2 AnswerCalculated Quarterly Requirements for Your Microscopy Center

## Place Orders Properly 

- Describe ordering system that is in place
- Provide specific instructions for placing orders
- Describe contingency plan when supplies are not available
- National contingency plan
- Site contingency plan
- What information should be fed back to central procurement or stores, e.g., updated consumption rates during scale up

## Inspect & Verify the Delivery of Orders 

- Upon receipt:
- Verify contents of order received with requisition
- Check integrity of received supplies
- Date each item received
- Store new shipment behind existing shipment
- Create or update records

## Ensure Proper Storage of Inventory

- Keep in a clean, dry, well-ventilated, and organized storage area
- Store according to supplier’s instructions
- Place items on shelves
- Store away from direct sunlight
- Organize existing and new shipments by date received or prepared

## Summary

**What is supply management?**
**Why is a physical stock count necessary?**
**Why is it important to maintain inventory  records?**
**How do you calculate supplies required?**
**Why must orders be inspected and verified?**
**Why must supplies be stored properly? **