Kap Staff Questionnaire

Staff Survey
Number___________
Date ___________
TB Infection Control at the Church of Scotland Hospital

This questionnaire is part of an effort to assess TB infection control knowledge, attitudes and
practices of staff at the Church of Scotland Hospital. It is not a test. No one is evaluating you.
Before we begin to implement a TB infection control plan, we want to see what staff at the hospital
already know, think and do in relation to infection control in order to properly monitor and evaluate
progress in the plan when it is implemented.
Confidentiality and anonymity

This questionnaire is COMPLETELY CONFIDENTIAL AND ANONYMOUS. You will not
put your name on this questionnaire. You will make up your own ID number to put on the survey.
No one will know the secret code except you. Please make sure you remember this code, as you will
have to write it again in a few months when we take another survey. Use a number you will never
forget, and consider storing the number on your cell phone. No one will keep track of what you
wrote individually. When you are finished with the questionnaire, you can drop it in the box at the
front of the room so no one will see which one is yours.
Your answers will not be shared with anyone else from this hospital, the Department of Health
or elsewhere—neither your peers nor any of your superiors. Nothing you write in this survey
will have any impact on your employment at COSH or anywhere else.
Honesty
There are no right or wrong answers. We only want the truth. We want to know what you
actually think, feel and do in relation to TB infection control—not what you are supposed to
think, feel and do! Being dishonest will only waste everyone’s time and money and lead to a poor
TB infection control policy. This is bad for patients and for staff, as it puts everyone at risk of
catching TB in the hospital.
Please do not give answers that you think we want to hear. Please only tell us the truth. No one
in the world will know what you say on this survey and it will have no impact on your
employment at COSH or elsewhere.
Questions
We have used some technical terms in this form. Please feel free to ask about anything you don’t
understand. If you have any questions, you can contact Zahir Kanjee or Sister Kathryn Catterick.
We ask for your complete attention when you fill out this confidential questionnaire.
Please fill it out honestly. No one will know what you wrote. Your results will not be
shared with anyone and they will have no impact on your employment at COSH or
elsewhere.
Thank you for improving TB infection control at COSH by completing this survey!
Your colleagues and patients thank you.
-1-
Demographics
None of this data will be used to identify you personally. Please be honest when
you answer these questions.
D1. Which department do you work in most of the time? (Circle only one.)
OPD [a]
Male TB [b]
Female TB [c]
MDR-TB [d]
ARV clinic [e]
Radiology [f]
Mortuary [g]
Dentistry [h]
Gateway [i]
Male Medical [j]
Female Medical [k]
Trauma [l]
D2. What is your job title? (Circle only one.)

Professional Nurse [a]
Enrolled Nurse [b]
Enrolled Nursing Assistant [c]
Ward clerk [d]
DOTS tracer [e]
D3. How long have you been a nurse/nurse assistant/clerk/tracer (not just at COSH, but anywhere)? (Circle
only one.)
Less than 6 months [a]
Greater than 6 months-1 year [b]
Greater than 1 year- 5 years [c]
Greater than 5 years- 10 years [d]
Greater than 10 years- 20 years [e]
Greater than 20 years [f]
D4. Gender:
Male [a]
Female [b]
-2-
Staff Survey
Number___________
Date ___________
Knowledge/Information
The following questions are about TB. If you don’t know an answer, please do not guess. Instead,
choose the “I don’t know” option.
Please answer honestly. Remember that your answers are COMPLETELY CONFIDENTIAL
AND ANONYMOUS. No one will know what you wrote, and your answers will have no
impact on your employment at COSH or elsewhere.
K1. Are the following symptoms of TB? (For each symptom, check only one—either “yes”,
“no”, or “I don’t know”.)
Symptom Yes, a symptom No, not a symptom I don’t

of TB [a] of TB [b] know [c]
Blurry vision [1]
Coughing for longer than 2 [2]
weeks
Coughing up blood [3]
Dizziness [4]
Ear pain [5]
Fever [6]
Headache [7]
Many bacterial infections [8]
Memory loss [9]
Night sweats [10]
Pain with urination [11]
Tiredness/ malaise [12]
Watery eyes [13]
Weight loss [14]
K2. Are the following statements true or false? (For each option, check only one—either “true”,
“false”, or “I don’t know”)
Statement True False I don’t

[a] [b] know [c]
TB is often spread from person to person through sex [1]
TB is often spread from person to person through the air [2]
TB is often spread from person to person through blood [3]
HIV-positive patients are more vulnerable to catching TB [4]
than HIV-negative patients
-3-

[a] [b] know [c]
Usually, only people with active TB disease in the lungs or throat [1]
are infectious
Patients with active TB disease can infect people by coughing [2]
Patients with active TB disease can infect people by sharing food or [3]
drinks
Patients with active TB disease can infect people by spitting [4]
Patients with active TB disease can infect people by sharing bed [5]
linens or toilet seats
Patients with active TB disease can infect people by talking [6]
Patients with active TB disease are more likely to infect others if [7]
they have a cough that produces a lot of sputum
Very young children (less than 5 years of age) with active TB disease [8]
are usually infectious
K4. Is this an N95 or a surgical mask?
N95 [a]
Surgical mask [b]
I don’t know [c]
K5. Is this an N95 or a surgical mask?
N95 [a]
Surgical mask [b]
I don’t know [c]
-4-
Staff Survey
Number___________
Date ___________

[a] [b] know [c]
N95s protect healthcare workers and visitors by stopping TB [1]
particles from being breathed in
N95s must be thrown away after each day’s use [2]
A wet or dirty N95 can still be used [3]
An N95 should be stored in a plastic bag when it is not being [4]
used
Healthcare workers should write their names and dates on an [5]
N95 when they get it so they know which one is theirs
Surgical masks protect healthcare workers and visitors by [6]
stopping TB particles from being breathed in
It is alright to wear a beard (amadevu) or facial hair with an [7]
N95
Surgical masks keep TB patients from coughing TB particles [8]
into the air
If mixing/extractor fans and ventilators are on in a room, it is [9]
NOT necessary to keep doors and windows open in order to
prevent the spread of TB
K7. How often should you check if your N95 is airtight and doesn’t allow any air to pass/leak?
(Check only one option.)
Never [a]
Every time you put on an N95 [b]
Once a week [c]
Once a month [d]
Once a year [e]
I don’t know [f]
K8. Where do most MDR-TB and XDR-TB patients catch MDR and XDR disease? (Check only
one option.)
Inside the hospital [a]
In the community (outside of the hospital) [b]
I don’t know [c]
-5-
The following questions are about infection control practices. Think about the answers for a little
while and write an answer if you can. The answer should be about 2 to 5 lines long. If you cannot
think of anything at all, you may leave the question blank.
Remember that your answers are COMPLETELY CONFIDENTIAL AND ANONYMOUS.
No one will know what you wrote, and your answers will have no impact on your employment
at COSH or elsewhere.
K9. What should you tell a coughing patient to do in order to prevent the spread of TB and other
respiratory infections?
K10. What item should you give to TB suspects or cases to prevent the spread of TB?
K11. Imagine you are in a room with TB patients. What item could you put on yourself to prevent
TB infection?
K12. Imagine you are in a room with TB patients. What could you do to the room to prevent the
spread of TB?
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Staff Survey
Number___________
Date ___________
STOP- END OF SECTION
-7-
-8-
Staff Survey
Number___________
Date ___________
Attitude/Motivation
The following questions ask about your feelings about TB infection control practices. Please
answer honestly, indicating how strongly you agree or disagree with the following statements.
Please circle only one answer option per question.
These next questions ask how comfortable you are with some practices. Being comfortable means
that you feel safe and not bothered to do it. You have no problem doing that activity for any
reason. Please circle only one option per question.
impact on your employment at COSH or elsewhere. Please tell us how you really feel—not
how you are supposed to feel!
A1. .
A2. I feel comfortable asking every patient I see if they have any signs or symptoms of TB.
Strongly agree [a]
Agree [b]
Neutral [c]
Disagree [d]
Strongly disagree [e]
A3. .
A4. I feel comfortable offering TB tests to all patients who have TB signs or symptoms.
Strongly agree [a]
Agree [b]
Neutral [c]
Disagree [d]
A5. I feel comfortable leaving doors open to prevent the spread of TB.
Strongly agree [a]
Agree [b]
Neutral [c]
Disagree [d]
A6. I feel comfortable leaving windows open to prevent the spread of TB.
Strongly agree [a]
Agree [b]
Neutral [c]
Disagree [d]
-9-
A7. If I were to develop symptoms of TB, I would feel comfortable requesting TB diagnosis
from COSH.
Strongly agree [a]
Agree [b]
Neutral [c]
Disagree [d]
A8. If I were to develop symptoms of TB, I would feel comfortable requesting TB diagnosis
from another facility.
Strongly agree [a]
Agree [b]
Neutral [c]
Disagree [d]
A9. If I were to develop symptoms of TB, I would hide them for as long as I could instead of
getting a diagnosis.
Strongly agree [a]
Agree [b]
Neutral [c]
Disagree [d]
A10. If I were HIV-positive and working in a high-risk TB area, I would feel comfortable asking
my supervisor to be relocated.
Strongly agree [a]
Agree [b]
Neutral [c]
Disagree [d]
A11. I would feel comfortable accepting confidential VCT from the COSH occupational health
officer or an EAP sister.
Strongly agree [a]
Agree [b]
Neutral [c]
Disagree [d]
A12. If COSH organized confidential VCT at another facility where no one knew me, I would feel
comfortable testing my HIV status this way.
Strongly agree [a]
Agree [b]
Neutral [c]
Disagree [d]
- 10 -
Staff Survey
Number___________
Date ___________
A13. If COSH provided home HIV testing kits for me to use at my house, I would feel
comfortable accepting and using this kit to test my HIV status.
Strongly agree [a]
Agree [b]
Neutral [c]
Disagree [d]
A14. .
A15. If COSH brought a mobile VCT unit to the hospital, and no one in the mobile unit knew me,
I would feel comfortable getting an HIV test there.
Strongly agree [a]
Agree [b]
Neutral [c]
Disagree [d]
A16. I feel comfortable telling coughing patients to follow cough hygiene procedures (like giving
surgical masks or tissues, or telling them to cover their mouths with their arms when they
cough or sneeze).
Strongly agree [a]
Agree [b]
Neutral [c]
Disagree [d]
A17. I feel comfortable advising every patient to accept VCT.

Strongly agree [a]
Agree [b]
Neutral [c]
Disagree [d]
A18. .
A19. I feel comfortable making TB suspects and cases wear surgical masks when in the hospital.
Strongly agree [a]
Agree [b]
Neutral [c]
Disagree [d]
- 11 -
A20. I feel comfortable making visitors of TB patients wear surgical masks.
Strongly agree [a]
Agree [b]
Neutral [c]
Disagree [d]
A21. I feel comfortable making visitors of TB patients wear N95s.

Strongly agree [a]
Agree [b]
Neutral [c]
Disagree [d]
A22. If I were performing an autopsy/post-mortem, I would feel comfortable wearing an N95

every time.
Strongly agree [a]
Agree [b]
Neutral [c]
Disagree [d]
A23. It is very distressing to me that female MDR-TB and XDR-TB patients are admitted into the
general female TB ward because there is no female isolation ward.
Strongly agree [a]
Agree [b]
Neutral [c]
Disagree [d]
A24. Because COSH does not use ultraviolet (UV) lights, I feel that the hospital is putting
healthcare workers at higher risk of catching TB. (Note: If you do not know what UV lights
are, please choose option “a”.)
I do not know what UV lights are [a]
Strongly agree [b]
Agree [c]
Neutral [d]
Disagree [e]
Strongly disagree [f]
- 12 -
Staff Survey
Number___________
Date ___________
A25. Because COSH does not have mixing/extractor fans in my department, I feel that the
hospital is unnecessarily putting healthcare workers in my department at higher risk of
catching TB. (Note: If you work in a department with mixing/extractor fans or don’t know
what they are, please choose option “a”.)
Not applicable—I work in a department with mixing/extractor fans or I don’t know what these are
[a]
Strongly agree [b]
Agree [c]
Neutral [d]
Disagree [e]
Strongly disagree [f]
A26. Because COSH does not have an official TB infection control policy, following TB infection
control procedures must be unimportant.
Strongly agree [a]
Agree [b]
Neutral [c]
Disagree [d]
A27. Because COSH does not have an official TB infection control policy, staff are more
likely to ignore directions about TB infection control practices and procedures.
Strongly agree [a]
Agree [b]
Neutral [c]
Disagree [d]
A28. The confirmed TB/MDR-TB/XDR-TB deaths amongst staff make me less willing to work
in high-risk TB areas of the hospital.
Strongly agree [a]
Agree [b]
Neutral [c]
Disagree [d]
A29. The confirmed TB/MDR-TB/XDR-TB deaths amongst staff make me want to stop
working as a healthcare worker.
Strongly agree [a]
Agree [b]
Neutral [c]
Disagree [d]
- 13 -
A30. COSH administration cares about me and is trying hard to make sure I don’t catch
TB/MDR-TB/XDR-TB.
Strongly agree [a]
Agree [b]
Neutral [c]
Disagree [d]
A31. It would be fair to periodically rotate staff around departments so that the same healthcare
workers are not always working in high-risk areas.
Strongly agree [a]
Agree [b]
Neutral [c]
Disagree [d]
A32. It is very important to prevent the spread of TB in the hospital.

Strongly agree [a]
Agree [b]
Neutral [c]
Disagree [d]
These next questions ask how important you think some practices are for preventing the spread of
TB. On a scale of 1 to 5, with 1 being “not at all important” and 5 being “extremely important”,
circle how important you think each of the following activities are to the effort to prevent the spread
of TB. Please circle only one option per question.
impact on your employment at COSH or elsewhere. Tell us how you really feel—not how you
are supposed to feel!
A33. Asking every patient if they have signs or symptoms of TB.
1 2 3 4 5
Not at all Only a little Somewhat Important Extremely
important important important important
A34. Offering HIV tests to all patients.
1 2 3 4 5
- 14 -
Staff Survey
Number___________
Date ___________
A35. Offering TB tests to all patients who have TB signs or symptoms.
1 2 3 4 5
A36. Wearing an N95 all the time whenever I am around TB suspects or cases.
1 2 3 4 5
A37. Wearing an N95 whenever performing an autopsy/post-mortem.
1 2 3 4 5
A38. Leaving doors open in areas with TB patients.
1 2 3 4 5
A39. Leaving windows open in areas with TB patients.
1 2 3 4 5
A40. Going soon for diagnosis if I develop signs/symptoms of TB.
1 2 3 4 5
A41. Knowing my HIV status.
1 2 3 4 5
- 15 -
A42. Getting relocated to a low-risk TB area if I were HIV-positive and working in a high-risk TB
area.
1 2 3 4 5
A43. Following cough hygiene procedures (like giving surgical masks or tissues to patients who
are coughing, or telling them to cover their mouths with their arms when they cough or
sneeze).
1 2 3 4 5
A44. Advising every patient to accept VCT.
1 2 3 4 5
A45. Making TB suspects and cases wear surgical masks when in the hospital.
1 2 3 4 5
A46. Making visitors of TB patients wear surgical masks when in the hospital.
1 2 3 4 5
A47. Making visitors of TB patients wear N95s when in the hospital.
1 2 3 4 5
- 16 -
Staff Survey
Number___________
Date ___________
For the next section, check all the reasons that prevent healthcare workers at COSH from doing the
following practices. Circle as many answers as apply. If you have additional answers that do not
appear on this list, please write them in under “Other”. If you do not know, circle “I don’t know”.
impact on your employment at COSH or elsewhere. Tell us what you really feel—not how you
A48. What prevents healthcare workers at COSH from recommending VCT to all patients?
(Circle all that apply.)
Healthcare workers don’t know they are supposed to [a]
This is new and difficult for healthcare workers [b]
Healthcare workers think this does not work to find patients with HIV [c]
Healthcare workers are not good at doing it [d]
Healthcare workers think it is not important to find patients with HIV [e]
No one has given healthcare workers good training on this [f]
Patients won’t listen [g]
Healthcare workers are too lazy [h]
This takes too much time [i]
It is embarrassing for staff to talk about HIV and offer VCT [j]
It is embarrassing for patients to talk about HIV and offer VCT [k]
This is someone else’s job [l]
Peer pressure from other staff in the hospital not to do it [m]
It is very stressful for patients to get VCT, especially if they have other diseases like TB [n]
Others don’t do it, so healthcare workers think it is not important to do it [o]
I don’t know [y]
________________________________ Other [z]
________________________________ Other [z]
- 17 -
A49. What prevents healthcare workers at COSH from always wearing an N95 around TB
patients? (Circle all that apply.)
Healthcare workers think N95s do not protect against TB [c]
Healthcare workers are not good at wearing them [d]
It is hard to change from old practices [e]
It is rude or embarrassing for patients [g]
Healthcare workers think N95s cost too much [h]
It takes too much time to put on an N95 [i]
N95s are uncomfortable [j]
N95s look silly [k]
Peer pressure from other healthcare workers to not wear it [l]
Healthcare workers are lazy [m]
Healthcare workers prefer to wear surgical masks instead of N95s [n]
Sometimes there are not enough N95s [o]
Others don’t do it, so healthcare workers think it is not important to do it [p]
Healthcare workers are confused about how long they should wear N95s, so they don’t wear them
[q]
N95s destroy healthcare workers hairstyles [r]
I don’t know [y]
________________________________ Other [z]
________________________________ Other [z]
A50. What prevents healthcare workers at COSH from keeping doors and windows open in high-
risk TB areas? (Circle all that apply.)
Healthcare workers think this does not prevent TB [c]
Healthcare workers are not good at doing it [d]
It is hard to change from old practices [e]
It is sometimes too cold [g]
This takes too much time [h]
No one is in charge of this, so no one makes sure it gets done [i]
It is hard to keep patient confidentiality with open doors and windows [j]
Patients complain when doors and windows are open [k]
Peer pressure from other staff in the hospital to keep doors and windows closed [l]
This is someone else’s job [m]
Others don’t do it, so healthcare workers think it is not important to do it [n]
I don’t know [y]
________________________________ Other [z]
________________________________ Other [z]
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Staff Survey
Number___________
Date ___________
A51. What prevents healthcare workers at COSH from approaching staff doctors if they have
symptoms or signs of TB? (Circle all that apply.)
Healthcare workers think this doesn’t work to diagnose TB [c]
Healthcare workers do not recognize TB symptoms [d]
No one has given healthcare workers good training on this [e]
Healthcare workers think it is shameful to admit they might have TB [f]
This takes too much time [g]
Healthcare workers fear potential rejection and stigma from staff if they have TB [h]
Healthcare workers fear missing work if they have TB [i]
Healthcare workers do not trust the health services to take care of them if they have TB [j]
Healthcare workers worry that other staff will think they have HIV if they have TB [k]
Healthcare workers do not trust the doctors to maintain confidentiality [l]
Other staff members will think they are just pretending to be sick to get away from work [m]
This costs too much [n]
It is frightening to test for TB [o]
I don’t know [y]
________________________________ Other [z]
________________________________ Other [z]
A52. What prevents HIV-positive healthcare workers at COSH from requesting to move from a
high-risk TB area to a low-risk TB area in order to not catch TB? (Circle all that apply.)
Healthcare workers do not want to admit to their supervisors that they are HIV-positive [b]
If healthcare workers tell their supervisors, then their co-workers will find out they are HIV-positive
[c]
Healthcare workers think this does not prevent HIV-positive workers from catching TB [d]
Peer pressure from other staff in the hospital to stay in the same department [f]
Other staff members will think they are just pretending to be sick to get away from work [h]
I don’t know [y]
________________________________ Other [z]
________________________________ Other [z]
- 19 -
A53. What prevents healthcare workers at COSH from accepting confidential VCT from EAP
sisters and the occupational health manager at COSH? (Circle all that apply.)
It is frightening to get tested for HIV [a]
No one has told healthcare workers it is important to know their status [b]
This costs too much [c]
Healthcare workers think people who get tested for HIV are promiscuous or dirty [d]
Healthcare workers would not trust the results of an HIV test performed at COSH [e]
Healthcare workers think EAP sisters/occupational health manager would not maintain
confidentiality [f]
Healthcare workers think other staff members would stigmatize them for getting a test [g]
Healthcare workers do not want to know their status [h]
I don’t know [y]
________________________________ Other [z]
________________________________ Other [z]
A54. What prevents healthcare workers at COSH from accepting confidential VCT from other
facilities where no one knows them? (Circle all that apply.)
It is frightening to get tested for HIV [a]
No one has told healthcare workers it is important to know their status [b]
This costs too much [c]
Healthcare workers think people who get tested for HIV are promiscuous or dirty [d]
Healthcare workers think VCT counsellors at other facilities will tell people at COSH the results [e]
Healthcare workers think other staff members at COSH would stigmatize them for getting a test [f]
Healthcare workers do not want to know their status [g]
Healthcare workers do not trust the results that come from other facilities [h]
I don’t know [y]
________________________________ Other [z]
________________________________ Other [z]
- 20 -
Staff Survey
Number___________
Date ___________
A55. What prevents healthcare workers at COSH from educating all patients on signs/symptoms
of TB? (Circle all that apply.)
Healthcare workers don’t know good education techniques [c]
Healthcare workers don’t know the signs/symptoms of TB [d]
Patients won’t listen [f]
Peer pressure from other staff in the hospital to not educate patients [h]
This is someone else’s job [i]
Others don’t do it, so healthcare workers think it is not important to do it [j]
I don’t know [y]
________________________________ Other [z]
________________________________ Other [z]
A56. What prevents healthcare workers at COSH from instructing coughing patients on cough
hygiene? (Circle all that apply.)
Healthcare workers think this does not prevent TB [c]
Healthcare workers don’t know what to tell patients about cough hygiene [d]
Patients won’t listen [e]
This takes too much time [f]
Healthcare workers do not see patients coughing [g]
It is embarrassing for staff [h]
It is embarrassing for patients [i]
Tissues and surgical masks are not available to give to patients [j]
Peer pressure from staff to not teach patients about cough hygiene [k]
This is someone else’s job [l]
Healthcare workers think patients have too much to worry about and don’t want to bother them [m]
Others don’t do it, so healthcare workers think it is not important to do it [n]
I don’t know [y]
________________________________ Other [z]
________________________________ Other [z]
- 21 -
A57. What prevents healthcare workers at COSH from making TB cases/suspects wear surgical
masks to stop them from spreading germs? (Circle all that apply.)
Healthcare workers think this does not prevent TB [b]
Patients won’t listen [c]
This takes too much time [d]
It is embarrassing for staff [e]
It is embarrassing for patients [f]
Surgical masks are not available to give to patients [g]
Peer pressure from staff in the hospital to not make TB cases/suspects wear surgical masks [h]
Making patients wear surgical masks is someone else’s job [i]
Others don’t do it, so healthcare workers think it is not important to do it [j]
I don’t know [y]
________________________________ Other [z]
________________________________ Other [z]
A58. What prevents healthcare workers at COSH from making visitors to TB cases/suspects wear
N95s to protect them from TB? (Circle all that apply.)
Healthcare workers think this does not prevent TB [b]
Visitors won’t listen [c]
N95s are too expensive [d]
N95s are uncomfortable [e]
N95s look silly [f]
Peer pressure from staff in the hospital to not make visitors wear N95s [g]
Healthcare workers prefer to offer surgical masks instead of N95s to visitors [h]
Making visitors wear N95s is someone else’s job [i]
Visitors are there only for a short time, so healthcare workers think visitors don’t need N95s [j]
Others don’t do it, so healthcare workers think it is not important to do it [k]
I don’t know [y]
________________________________ Other [z]
________________________________ Other [z]
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Staff Survey
Number___________
Date ___________
STOP- END OF SECTION
- 23 -
- 24 -
Staff Survey
Number___________
Date ___________
Practice/Behaviour
Please circle only one option per question.
impact on your employment at COSH or elsewhere. Tell us how you really feel—not how you
P1. We are NOT asking you to disclose your status. We are only asking: Do you know your
HIV status?
Yes [a]
No [b]
This section asks about your personal infection control practices. Please circle only one option per
question.
impact on your employment at COSH or elsewhere. Tell us what really happens—not what is
supposed to happen!
The following questions are about N95s. This is an N95.
P2. Do you know how to wear an N95 properly?

Yes [a]
No [b]
P3. How often do you wear an N95 when you are in a room with TB patients or suspects?
I have never been in this situation [a]
Only if there is an MDR or XDR patient there [b]
Always [c]
Often [d]
Sometimes [e]
Infrequently [f]
Never [g]
I don’t know [h]
- 25 -
P4. How often do you wear an N95 when you are in a room while TB patients or suspects are
giving sputum samples?
Only if it is an MDR or XDR patient [b]
Always [c]
Often [d]
Sometimes [e]
Infrequently [f]
Never [g]
I don’t know [h]
P5. How often do you wear an N95 when you are transporting TB patients from one part of
the hospital to another part of the hospital?
Always [c]
Often [d]
Sometimes [e]
Infrequently [f]
Never [g]
I don’t know [h]
P6. How often do you wear an N95 when you are transporting TB patients from this hospital to
a different hospital?
Always [c]
Often [d]
Sometimes [e]
Infrequently [f]
Never [g]
I don’t know [h]
P7. When you wear an N95, how often do you check if it has made a tight seal around your
face?
I have never worn an N95 [a]
I don’t know how to check if it has made a tight seal around my face [b]
Only if there is an MDR or XDR patient there [c]
Always [d]
Often [e]
Sometimes [f]
Infrequently [g]
Never [h]
I don’t know [i]
- 26 -
Staff Survey
Number___________
Date ___________
P8. How often do you use an N95 when a post-mortem/autopsy is being performed?
Only if it is on an MDR or XDR patient [b]
Always [c]
Often [d]
Sometimes [e]
Infrequently [f]
Never [g]
I don’t know [h]
Please answer the following questions honestly. Remember that your answers are
COMPLETELY CONFIDENTIAL AND ANONYMOUS. No one will know what you wrote,
and your answers will have no impact on your employment at COSH or elsewhere. Tell us
what really happens—not what is supposed to happen!
Please circle only one option per question.

The following questions are about surgical masks. This is a surgical mask.
P9. How often do you offer surgical masks to visitors of TB patients?

I have never been in this situation (If you choose this option, skip the next question) [a]
Always [c]
Often [d]
Sometimes [e]
Infrequently [f]
Never (If you choose this option, skip the next question) [g]
I don’t know [h]
P10. How often do visitors actually use the surgical masks when you offer them?
Always [c]
Often [d]
Sometimes [e]
Infrequently [f]
Never [g]
I don’t know [h]
- 27 -
P11. How often do you offer surgical masks to TB patients when they are sitting in the
wards?
Always [c]
Often [d]
Sometimes [e]
Infrequently [f]
I don’t know [h]
P12. How often do TB patients actually use the surgical masks when you offer them
while they are sitting in the wards?
Always [c]
Often [d]
Sometimes [e]
Infrequently [f]
Never [g]
I don’t know [h]
P13. How often do you offer surgical masks to TB patients when you transport them
from one part of the hospital to another part of the hospital?
Always [c]
Often [d]
Sometimes [e]
Infrequently [f]
I don’t know [h]
while you transport them from one part of the hospital to another part of the hospital?
Always [c]
Often [d]
Sometimes [e]
Infrequently [f]
Never [g]
I don’t know [h]
- 28 -
Staff Survey
Number___________
Date ___________
P15. How often do you offer surgical masks to TB patients when you transport them
from this hospital to another hospital?
Always [c]
Often [d]
Sometimes [e]
Infrequently [f]
I don’t know [h]
while you transport them from this hospital to another hospital?
Always [c]
Often [d]
Sometimes [e]
Infrequently [f]
Never [g]
I don’t know [h]
The next question asks about cough hygiene. Cough hygiene means giving coughing patients a
tissue or surgical mask to prevent them from coughing or sneezing into the air. It can also mean
telling them to cover their mouths with the inside of their arm when they cough or sneeze.
supposed to happen!
P17. When you see patients cough, how often do you tell them about cough hygiene?
Always [c]
Often [d]
Sometimes [e]
Infrequently [f]
Never [g]
I don’t know [h]
P18. How often do the TB patients in your ward escape from isolation without
permission and go places they are not supposed to go to? (Note: If you do not work in an
isolation ward, please choose option “a”.)
I do not work in an isolation ward [a]
Always [b]
Often [c]
Sometimes [d]
Infrequently [e]
Never [f]
I don’t know [g]
- 29 -
P19. How often do you educate patients on the signs/symptoms of TB and to seek help
if they arise?
Always [b]
Often [c]
Sometimes [d]
Infrequently [e]
Never [f]
I don’t know [g]
P20. How often are doors open in your work area?

Only if there are MDR/XDR patients there [a]
Always [b]
Often [c]
Sometimes [d]
Infrequently [e]
Never [f]
I don’t know [g]
P21. How often are windows open in your work area?

Only if there are MDR/XDR patients there [a]
Always [b]
Often [c]
Sometimes [d]
Infrequently [e]
Never [f]
I don’t know [g]
P22. How long do you usually use an N95 before you throw it away?
I never use an N95 [a]
One hour [b]
One day [c]
One week [d]
One month [e]
One year [f]
P23. How often do you throw an N95 away when it becomes dirty?
Always [b]
Often [c]
Sometimes [d]
Infrequently [e]
Never [f]
- 30 -
Staff Survey
Number___________
Date ___________
P24. How often do you throw an N95 away when it becomes wet?
Always [b]
Often [c]
Sometimes [d]
Infrequently [e]
Never [f]
The following questions ask about your abilities to perform certain infection control practices.
Please answer honestly, circling only one answer per question.
supposed to happen!
P25. If you work in an area with mechanical ventilation (like mixing/extractor fans and
ventilators, are you able to see if mechanical ventilation is on, and turn it on if it is off?
I do not work in an area with mechanical ventilation [a]
Yes [b]
No [c]
P26. Do you feel skilled enough to properly educate patients about diseases?
Yes [a]
No [b]
P27. Do you have enough knowledge to educate patients on the signs and symptoms of
TB?
Yes [a]
No [b]
P28. Do you know who to speak with for confidential TB diagnosis at COSH if you
were to develop TB signs/symptoms?
Yes [a]
No [b]
P29. Do you know who to speak with for confidential VCT at COSH?
Yes [a]
No [b]
- 31 -
For OPD Staff Only
THIS SECTION IS FOR OPD STAFF ONLY. IF YOU ARE NOT IN OPD, YOU MAY SKIP
THIS SECTION.
The following questions ask about the OPD TB screen. A TB screen means asking a patient if they
have been coughing. If they answer yes, it also means asking them for how long or if they are
currently being investigated for TB. It is done to find TB suspects or cases.
supposed to happen!
Think about the answers for a little while and write an answer if you can. The answer should be
about 2 to 5 lines long. If you cannot think of anything at all, you may leave the question blank.
S1. Imagine you found a TB suspect in the waiting room. What should you tell him/ do with him
before he goes for TB diagnosis?
S2. How often do patients get a TB screen immediately when they come into the OPD
(before they see the clinician)? (Circle only one.)
Always [a]
Often [b]
Sometimes [c]
Infrequently [d]
Never [e]
I don’t know [f]
S3. How often does every patient get a TB screen in the exam room by the clinician? (Circle
only one.)
Always [a]
Often [b]
Sometimes [c]
Infrequently [d]
Never [e]
I don’t know [f]
S4. When TB suspects are discovered in the waiting room, how often are they moved to the
front of the queue for service? (Circle only one.)
Always [a]
Often [b]
Sometimes [c]
Infrequently [d]
Never [e]
I don’t know [f]
- 32 -
Staff Survey
Number___________
Date ___________
S5. What prevents healthcare workers at COSH from screening all patients for TB? (Circle all
that apply.)
They don’t know they are supposed to [a]
This is new and difficult for them [b]
They think this does not work to find patients with TB [c]
They are not good at doing it [d]
They think it is not important to find patients with TB [e]
No one has given them good training on this [f]
Patients won’t listen [g]
They are too lazy [h]
It is embarrassing for patients [i]
Peer pressure from other staff in the hospital not to do it [k]
Other staff don’t do it, so healthcare workers think it is not important to do it [l]
I don’t know [y]
________________________________ Other [z]
________________________________ Other [z]
- 33 -
STOP- END OF QUESTIONNAIRE
Please ensure you have written your confidential code and today’s date on each and every
page.
Thank you for completing this questionnaire. If you would like, feel free to write any
confidential comments about the questionnaire or about TB infection control here. You may
also approach Zahir or Sister Kathy to give us comments or questions personally, if you
prefer.
- 34 -

Kap Staff Questionnaire

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Kap Staff Questionnaire

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Staff Survey

TB Infection Control at the Church of Scotland Hospital

Confidentiality and anonymity

D2. What is your job title? (Circle only one.)

Symptom Yes, a symptom No, not a symptom I don’t

Statement True False I don’t

Statement True False I don’t

K4. Is this an N95 or a surgical mask?

K5. Is this an N95 or a surgical mask?

Statement True False I don’t

STOP- END OF SECTION

A17. I feel comfortable advising every patient to accept VCT.

A21. I feel comfortable making visitors of TB patients wear N95s.

A22. If I were performing an autopsy/post-mortem, I would feel comfortable wearing an N95

A32. It is very important to prevent the spread of TB in the hospital.

A33. Asking every patient if they have signs or symptoms of TB.

A34. Offering HIV tests to all patients.

A35. Offering TB tests to all patients who have TB signs or symptoms.

A37. Wearing an N95 whenever performing an autopsy/post-mortem.

A38. Leaving doors open in areas with TB patients.

A39. Leaving windows open in areas with TB patients.

A40. Going soon for diagnosis if I develop signs/symptoms of TB.

A41. Knowing my HIV status.

A44. Advising every patient to accept VCT.

A47. Making visitors of TB patients wear N95s when in the hospital.

________________________________ Other [z]

________________________________ Other [z]

________________________________ Other [z]

________________________________ Other [z]

________________________________ Other [z]

________________________________ Other [z]

________________________________ Other [z]

________________________________ Other [z]

________________________________ Other [z]

________________________________ Other [z]

________________________________ Other [z]

________________________________ Other [z]

________________________________ Other [z]

________________________________ Other [z]

________________________________ Other [z]

________________________________ Other [z]

________________________________ Other [z]

________________________________ Other [z]

________________________________ Other [z]

________________________________ Other [z]

STOP- END OF SECTION

Please circle only one option per question.

The following questions are about N95s. This is an N95.

P2. Do you know how to wear an N95 properly?

Please circle only one option per question.

P9. How often do you offer surgical masks to visitors of TB patients?

P20. How often are doors open in your work area?

P21. How often are windows open in your work area?

________________________________ Other [z]

________________________________ Other [z]

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