Hospital Infection Prevention Survey
Please complete this survey to help us assess and improve infection-prevention practices in our hospital. Your responses are anonymous and valuable.
Which department are you currently working in?
*
Please Select
Emergency
ICU
Surgery
Pediatrics
Internal Medicine
Other
How frequently do you perform hand hygiene (hand washing or sanitizing) before and after patient contact?
*
Always
Often
Sometimes
Rarely
Never
Which personal protective equipment (PPE) do you use during patient care? (Select all that apply)
*
Gloves
Masks
Gowns
Face Shields/Goggles
Other
How would you rate the availability of hand hygiene supplies (soap, sanitizer, paper towels) in your work area?
*
1
2
3
4
5
How often are high-touch surfaces (e.g., bed rails, doorknobs) cleaned and disinfected in your area?
*
Multiple times a day
Once daily
A few times a week
Rarely
Not sure
Have you observed any lapses in infection prevention practices in the past month? (Select all that apply)
*
Hand hygiene missed
Improper PPE use
Cleaning/disinfection missed
Improper waste disposal
No lapses observed
Other
Please indicate your level of agreement with the following statements:
*
Rows
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Staff receive regular infection prevention training
1
2
3
4
5
There is clear communication about infection prevention policies
6
7
8
9
10
Supplies for infection prevention are readily available
11
12
13
14
15
Leadership supports infection prevention efforts
16
17
18
19
20
How confident do you feel about your knowledge of infection prevention protocols?
*
Not confident
1
2
3
4
Very confident
5
1 is Not confident, 5 is Very confident
Have you reported any infection prevention concerns or incidents in the past 6 months?
*
Yes
No
Prefer not to say
Please share any suggestions or comments to improve infection prevention in our hospital.
Submit Survey
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