| Age: |
| 18–24 |
| 25–30 |
| 31–40 |
| 41–50 |
| 51–60 |
| >60 |
| Gender: |
| Male |
| Female |
| Medical Profession: |
| Physician |
| Nursing |
| Lab Tech |
| Others |
| I am working at: |
| Private hospital |
| Government hospital |
| Poly clinic (private sector) |
| Do you have infection control program at your institution? |
| Yes |
| No |
| Don’t know |
| Have you received some form of training or orientation about infection prevention and control? |
| Yes |
| No |
| Do you have infection control policies and guidelines in your unit? |
| Yes |
| No |
| Don’t know |
| Do you think that all staff in your unit are following promptly infection control policies, rules and guidelines? |
| Yes |
| No |
| Don’t know |
| Do you think your hospital is prepared for any infection outbreak? |
| Yes |
| No |
| Don’t know |
| In your opinion, what is the cause(s) of outbreaks? |
| Breaching infection control policies, rules, and guidelines |
| No clear infection control policies, rules, and guidelines |
| Carelessness of healthcare workers |
| Shortage of appropriate personnel protective equipment |
| Infection control infrastructures do not exist |
| Factors that contribute to the spread of infection in the hospital: |
| Hospital infrastructure and design |
| Lack and shortage of staff |
| No infection control training program |
| No resources to fulfill the infection control requirements and needs |
| No infection control on-call |
| At your institution, do you have active infection control team? |
| Yes |
| No |
| Don’t know |
| Do you think that all staff can differentiate between different isolation protocol such as droplet or contact? |
| Yes |
| No |
| Don’t know |
| Do you have a list of reportable infectious agents available in your unit and accessible to all staff: |
| Yes |
| No |
| Don’t know |
| Is your hospital is enrolled in national surveillance system: |
| Yes |
| No |
| Don’t know |
| Which infections are reported to MOH: |
| All healthcare associated infections |
| All infections (both hospital and community acquired) |
| Don’t know |
| In your institution, is there known turnaround time of laboratory results of the reportable infectious agents: |
| Yes |
| No |
| Don’t know |
| What is reporting system do you have at your hospitals: |
| Electronic surveillance system |
| Paper version |
| Telephone communication |
| In your opinion, what is the effective reporting system for reporting infectious agents: |
| Electronic surveillance system |
| Paper version |
| Telephone communication |
| Do you have an emerging infectious diseases task force (dealing with outbreaks) |
| Yes |
| No |
| Don’t know |
| Do you agree that surveillance tool used in your institution is effective to prevent or control infection |
| Yes |
| No |
| Don’t know |