DATA COLLECTION TOOL

SEMI STRUCTURED QUESTIONNAIRE FOR ASSESSING

KNOWLEGDE REGRADING NEEDLE STICK INJURY

Instructions: Please read each statement and questions carefully and put tick Mark (✓) in the
appropriate response.

Participant code no: Date:

Section A: Demographic data

1. Age (In years)

a. 18 to 20
b. 20 to 22
c. 22 to 24
d. 24 to 26

2. Gender
a. Male
b. Female

3. Religion

a. Hindu
b. Muslim
c. Christian

4. Did you Receive training on safe injection practice?

a. Yes
b. No

5. Status of Hepatitis B Immunization

a. 3rd dose completed.

b. 2nd dose completed.

c. 1st dose completed.

d. Not immunized
 6. Have you ever administered injections in any form?

a. Yes

b. No

7. Did you ever have needle stick injury?

a. Yes

b. No
If yes, did you report the incident of needle stick injury to the healthcare department/
head of department?
a. Yes
b. No

Section B: Knowledge assessment questionnaire regarding Needle stick injury

1. What is Needle stick injury?

a. Wounds caused by needles.

b. Wounds caused by scalpels.

c. Wounds caused by suture threads.

2. Which is the most common clinical activity that can cause needle stick injury?
a. Suturing
b. Recapping Needle
c. Passing the instrument
3. What should you immediately after needle stick injury?
a. Squeeze the injured area till blood oozed out.
b. Lick the area with tongue and apply tape.
c. Wash the area with soap and running water.

4. Which of the following technique is safe while recapping used needles?

a. Single handed
b. Double handed.
c. None of the above
5. Which is the other name for the method of recapping the needle?
a. Inserting
b. Scooping
c. Devising
6. Which color code do you select for disposing the needles?
a. Yellow
b. Red
c. White
7. Which disease is transmitted by needle stick injury?
a. Hepatitis B
b. Hepatitis C
c. Both Hepatitis B and Hepatitis C
8. What is the schedule for Hepatitis B vaccination?
a. 0,1st month, 6th month, Booster dose after 1 year
b. 0, 3rd month, 6th month, Booster dose after 1 year
c. 0, 2nd month, 3rd month, Booster dose after 1 year
9. When the Hepatitis B booster dose should be taken?
a. After 1 year of complete vaccination
b. After 5 years of complete vaccination
c. After 10 years of complete vaccination
10. What is the protective level of hepatitis B titer value?
a. Less than 5mlU
b. 5 to 12 mlU
c. Greater than 12mlU

11. What is personal protective equipment (PPE)?

a. Equipment minimizes exposure to body fluid exposure.

b. Equipment minimizes exposure to blood exposure.

c. Equipment minimizes exposure to blood and body fluid exposure.

12. When do you empty the sharp container?

a. When it fills 2/3rd

b. When it fills ¾th

c. When it fills Completely

13. Which type of gloves do housekeeping staffs use for final segregation of needles?

a. Medical gloves

b. Surgical gloves

c. Heavy duty gloves

14.To which department do you report needle stick injury?

a. Radiology

b. Emergency department

c. Infection control department

15.When do you initiate management of needle stick injury?

a. Within 15 minutes

b. Within 30 minutes

c. Within 1 hour

16. Which blood borne disease that cannot be prevented by vaccination?

a. Hepatitis C

b. Hepatitis B

c. Hepatitis A

17. Which vaccine is not the part of treatment after experiencing needle stick injury?

a. Hepatitis B immunoglobulin

b. Hepatitis B booster

c. Tetanus Toxoid (TT)

18. Which intervention is needed to be implemented after needle stick injury?

a. Pre exposure prophylaxis

b. Post exposure prophylaxis

c. None of the above

19. What is universal precaution?

a. Methods designed to prevent communicable diseases.

b. Methods designed to prevent diseases from blood exposure.

c. Methods designed to prevent diseases from blood and body fluid exposure.

20. Which treatment should be taken after getting needle stick injury from HIV positive patient?

a. Anti-viral therapy

b. Antibacterial therapy

c. Antiretroviral therapy

21. Which hospital department is at high risk of having needle stick injury?

a. OPD

b. Casualty

c. Operation theatre

22. After needle stick injury, which of the following test is done?

a. HIV

b. HBV

c. Both

23. What is incident form?

a. A form that is to be filled after an unusual event.

b. A form that is to be filled after a usual event.

c. A form that is to be filled during emergency.

24. What are safety engineered needles?

a. Device that provides needle less injection

b. Device that used as alternative for injection

c. Device with needles that retract after injection.

25. What is the full form of OSHA?

a. Occupational Safety and Health Administration

b. Occupational Security and Health Administration

c. Occupational Sheltering and Health Administration

26. What is NSP act?

a. Needle Stick Safety and Prevention Act

b. Needle Stick Injury Safety and Protection Act

c. Needle Stick Infection Safety and Prevention Act

27. When did NSP act came into force?

a. October 2000

b. November 2000

c. December 2000

28. Which device account for 78% of all Needle stick Injuries?

a. Suture Needles

b. IV cannulation Stylets

c. Disposable syringes

29. What is the prevalence rate of Needle Stick Injury in India?

a. 78 to 80 %

b. 68 to 70 %

c. 58 to 60 %

30. Which group of hospital staff gets maximum needle stick injury?

a. Receptionist

b. Doctors

c. Nurses
31. Which part of needle causes Needle stick injury?

a. Bevel

b. Hub

c. Plunger