Appendices

QUESTIONNAIRE-INFECTION CONTROL PROTOCOLS

 Name of Surveyee:

 Name of the Hospital:

 Total duration worked at the hospital:

 Total work experience:

 Designation: Physician--------Nursing--------------Lab Tech----------------Others-----------

 Age : 20-35,36-50, ------------ more than 50---------------more than -----------

 Gender: Male----------Female-----------------

1) Are you aware of HCAIs in your hospital?

a. Yes
b. No

2) Have you received some form of training or orientation about infection prevention and
control?

a. Yes
b. No

3) Do you have infection control policies and guidelines in your hospital?

a. Yes
b. No
c. Don’t know

4) Do you think all staff in your hospital is following promptly infection control
policiesrules and guidelines?

a. Yes
b. No
c. Don’t know

5) Do you think your hospital is prepared for any infection outbreak?

a. Yes
b. No
c. Don’t know

6) In your opinion what could be the possible cause of outbreak?

a. Breaching infection control policies,rules and guidelines

b. No clear infection control policies,rules and guidelines
c. Carelessness of healthcare workers
d. Shortage of appropriate personnel protective equipments
e. Infection control infrastructure does not exist
f. No idea

7) Your working practice in hospital is based on:

a) Your own experience

b) The practice of your seniors

c) The hospital/national guidelines

8) How often do you clean your stethoscope with antiseptic ?

a. After examining each patient

b. Daily
c. Monthly
d. Never

9) Where Should infections waste from patients be disposed of?

a. Yellow Garbage bin

b. Green garbage bin
c. Red garbage bin
d. No idea

10) How often do you wash your while cost or uniform?

a. Daily
b. 3 times a week
c. Weekly
d. Monthly
e. Do not remember when last washed

11) How do you usually wash your hands while on duty?

a. Wash with running water

b. Wash with running water and her soap
c. Wash with running water and hand-washing liquid
d. Wash with running water and skin disinfectant
e. Wah with alcohol hand rub

12) The proper minimum spacing between beds in multi patient rooms should be:

a. 2feet
b. 3feet
c. 5feet
d. No idea

13) With regards to HCAIs, visitors may have negative impacts on patients by:

a. Disturbing patient’s rest

b. Transmitting infectious agents between patients
c. Serving as a carrier of multidrug-resistant pathogens from/to community
d. D.isturbing effective infection control measures
e. Smoking within the patient’s room

14) What infection are reported to MOH?

a. All healthcare associated infections

b. All infections(both hospital and community acquired
c. Don’t know

15) In your hospital, is there known turnaround time of laboratory results of the reportable
infectious agents?

a. Yes
b. No
c. Don’t know

16) Which is the single most effective method to prevent HCAIs?

a. Hand washing properly

b. Wearing caps and masks
c. Regular vaccination of healthcare workers
d. Isolation of infected patients
e. Prudent use of antibiotics
f. Educating healthcare workers,patients, and families.
g. Visitor management

17) Do you have a list of reportable infectious agnts available in your hospital and accessible
to al staff?

a. Yes
b. No
c. Don’t Know
18) Do You think that all staff can differentiate between different isolation protocol such as
droplet or contact?

a. Yes
b. No
c. Don’t know

19) At your hospital do you think there is active infection control team?

a. Yes
b. No
c. Don’t know