ESAC-Pr Surgical Instrument Questionnaire
1. Please state your country:
2. Please state the name of your country Association:
3. Please state your position in your Association:
4. Your name:
5. Contact email address:
6. Is it the normal practice in your country for nurses or other operating room professionals to wash and/or
sterilise instruments themselves?
Please tick as applicable:
Yes:
No:
→ Go to Question 8
7. If yes to question 6, what is the grade of staff who undertakes this role?
8. Are surgical instruments kept moist or wet before decontamination in your country?
Please tick as applicable:
9.
Yes:
No:
→ Go to Question 10
If yes to question 8, what process is used to keep instruments moist or wet after they are
used, and before they are returned to a Sterilisation Unit or washed by hand?
Please tick as applicable:
a) Immersion in water
b) Immersion in a chemical
If yes, please give
details of the
chemical used:
c) Spraying with foam
If yes, please give
details of the foam
used:
d) Spraying instruments with a chemical
If yes, please
give details of
the chemical used:
e) Spraying / coating instruments with a gel
If yes, please
give details of
the gel used:
f) Placing a moist cloth or towel over the instruments
g) Placing a special sponge in the instrument set after use
h) Something else
If yes, please give
details:
10. Would you agree for your country and Association details to be highlighted in the report that is compiled
from this information? Your name will not be disclosed.
Please tick as applicable:
Yes:
No:
11. Would you agree for your country and Association details to be quoted in any future conference
presentations on this or another relevant subject in the future?
Please tick as applicable:
Yes:
No:
Thank you for your time in completing this survey.
Can you please return the survey by email to Melanie.vanlimborgh@afpp.org.uk
with a copy to Rachael Whittaker Rachael.whittaker@dh.gsi.gov.uk by 31 July
2009.