PART 11: PARTICIPANTS DECLARATION AND CONSENT FORM
The study above has been explained to me. I have understood its purpose and my rights as a
participant in the study. I have been given a chance to ask questions and have been assured that if
in future, I have any concerns about the study or my rights as a subject, and I can ask the
invigilator. I understand that I can withdraw from the study at any time .I voluntarily agree to
participate in the study.
Signature of participant Date
APPENDIX 2a: QUESTIONNAIRE
UNIQUE PARTICIPANTS ID_________________________. DATE_________________
A QUESTIONAIRE TO DETERMINE KNOWLEDGE AND PREVENTION PRACTICE
OF HOSPITAL ACQUIRED INFECTION AMONG NURSES IN NAROK COUNTY
REFERRAL HOSPITAL.
This questionnaire is to collect data for purely academic purposes. The study seeks to find out
the knowledge and prevention practice of hospital acuired infections among Nurses in Narok
county referral Hospital. Do not put any name or identification on this questionnaire. Answer all
questions as indicated by either filling in the blank or ticking the option that applies.
PART 1: KNOWLEDGE
1. Are you aware of HAIs in you ward?
(a) yes (b) no
2. Which of the following HAIs are commonly seen in your ward?
(a) Wound infections (b) sepsis infections (c) respiratory tract infections (d) blood stream
infections (e) skin infections (f) others
3. Which population is the most susceptible to HAIs in your ward?
(a) In patients (b)out patients (c)doctors (d)nurses (e)visitors/care givers (f)support staff
4. Do you know about Infection prevention practices?
(a) yes (b) no
If yes highlight some of them
5. Where should infectious waste from patients be disposed off?
(a) yellow bin (b) black bin (c) red bin (d) no idea
6. The usage of PPEs protects from getting cross infection.
(a) patients/ health care workers/visitors
(b) patients/health care workers
(c) all the above
8. Please Answer all the Questions and Tick () for each Question.
Statement True False
Infection Prevention practices must be applied to all patients at all times.
Appropriate handwashing can minimize cross infection with micro-organisms.
Using tap water is only enough for handwashing.
Use of PPEs does not provide physical barrier between micro-organisms.
Sharps must be appropriately disposed and/or destroyed as per National Standard or
guidelines.
9. Please Answer all the Questions and Tick () for each Question
WHO recommends handwashing in the following moments;
Statement Yes No
Before touching patients
Before clean/aseptic procedure
After body fluids exposure
Before talking to patients
After touching patients
After touching patients surrounding.
PART 2: PRACTICE
1. How do often clean your medical equipment?
(a)daily (b) weekly (c)monthly (d)never (d)after examining each patient
2.. When do you wear your medical utility (non-sterile) gloves?
(a) Using the computer desk or patient care equipment
(b) Administering drugs
(c) Performing physical examination on patients
(d) None of the above
3. Have you ever been splashed by patients’ blood, vomit or other body fluids?
(a) yes (b) no
If yes specify
If yes what action did you take immediately?
(a) washed hands with disinfectant
(b) washed hands with runn8ing water
(c) changed gown/ scrub
(d) continued with the procedure.
4. Please Answer all the Questions and Tick () for each Question
Statement Yes No
Do you practice handwashing using antiseptic alcohol based hand wash before and
after examination of the patient?
Do you wash your hands after handling body fluids, blood, secretions or
contaminated items?
Do you wash your hands immediately after removing gloves?
Do you wear gloves while touching blood, body fluids, sections, excretions and
mucous membrane?
Do you change gloves between tasks on the same patient?
Do you wear masks during any procedures?
Do you recap bend used needles?
Do you dispose used syringes and needles in sharp bins?
Do you wear protective gears during any procedure?
5. Please Answer all the Questions and Tick () for each Question
Statement Yes No
I keep my nails short, clean and polished free.
I avoid wearing wrist watches and jewellery while on duty.
Any cut and abrasions are covered with water proof dressing.
I remove my wrist watch and any bracelets and roll up long sleeved while
handwashing.
I dry my hands properly to prevent recontamination.
We are supplied with disposable paper hand towels.
I change gloves before going to another patient