Appendix. Questionnaire
Dear Sir/Madam,
This questionnaire is for a special research project. Please reply to each of the items below as sincerely as
you can. You do not need to disclose your name. All answers will be treated in strict confidence.
Please mark where appropriate or fill in otherwise as provided.
Serial no: ………
1. Age (years): ………
2. Sex:
1. Male ……… 2. Female ………
3. Occupation:
1. Doctor ……… 2. Nurse ……… 3. Lab. worker………
4. Possible accidents at work
Please circle the correct answer and state how many times such accidents occurred to you in the last 6
months.
If yes, state how many times
in the last 6 months
Scalpel cut Yes/no/don’t know
Injury from diatermy Yes/no/don’t know
Cuts from drug ampoules Yes/no/don’t know
Needle pricks Yes/no/don’t know
Blood splashes on face and other parts of the body Yes/no/don’t know
Accidents from falls Yes/no/don’t know
Electric shock Yes/no/don’t know
Contact with patient’s blood with ungloved hands Yes/no/don’t know
Assault by violent aggressive patient Yes/no/don’t know
Chemical splashes Yes/no/don’t know
Open wound contamination with patient blood Yes/no/don’t know
Fire accidents Yes/no/don’t know
Glove perforation during surgery Yes/no/don’t know
i. Others, please specify and state how many times in the last 6 months.
……………………………………………………………………
………………………………………………………………………
5. What is responsible for these accidents?
(Please circle the correct answer)
Long duration of procedure Yes No Don’t know
Fatigue Yes No Don’t know
Desire to speed up procedure Yes No Don’t know
Lack of co-ordination Yes No Don’t know
Type of procedure Yes No Don’t know
Amount of blood lost Yes No Don’t know
Lack of concentration Yes No Don’t know
Inadequate knowledge about the risk
of complications possible
from such an accident
Yes No Don’t know
Non-availability of protective measures Yes No Don’t know
Distraction by others Yes No Don’t know
Improper utilization of adequate protection Yes No Don’t know
Lack of time Yes No Don’t know
Use of inadequate/inappropriate equipment Yes No Don’t know
Others (Please specify) ………………………