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\begin{document}

\title{Availability of personal protective equipment among healthcare workers
in Jordan during the COVID-19 pandemic: A web based survey}



\author[1]{ARASH NEMAT}%
\author[2]{Nahid Raufi}%
\author[3]{khalid kheirallah}%
\author[4]{Eva Inam  Al Zein}%
\author[5]{Mohammad Yousuf Mubarak}%
\affil[1]{Affiliation not available}%
\affil[2]{Kabul Medical University}%
\affil[3]{Jordan University of Science and Technology}%
\affil[4]{Jordan Food and Drug Administration}%
\affil[5]{Kabul Medical University Faculty of Curative Medicine}%


\vspace{-1em}



  
  \date{June 13, 2024}


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\selectlanguage{english}
\begin{abstract}
Aim of the study: The inception of the COVID-19 has put healthcare
workers (HCWs) in a precarious situation across the world. Despite the
challenges in Jordan, the high awareness and preparedness of HCWs made
it feasible for the country to control the contagious virus. COVID-19
has created a critical situation in the health sector for many countries
in the world. Healthcare workers (HCWs) include physicians, dentists,
nurses, pharmacists, laboratory technicians etc.; have provided the
front-line healthcare services facing challenges. The study aimed to
provide a useful insight into availability of Personal Protective
Equipment (PPE) among HCWs in Jordan, which could help the
policy/decision makers of public health to design better programs based
on the information reported. Method: This cross-sectional online survey
was conducted during July 2020 for the evaluation of the availability of
Personal Protective Equipment (PPE) among HCWs in Jordan. Result: A
total of 751 HCWs responded from different parts of the country, who
were actively working at different hospitals in Jordan. Most of the
participants (94\%) had sufficient knowledge about COVID-19, and more
than two-thirds of participants (68\%) reported that Personal Protective
Equipment (PPE) were provided by Jordan ministry of health. The majority
(91\%) of participants reported availability of medical face masks,
while only 26\% reported having facial protective shields. Conclusion:
The study highlighted sufficient availability of personal protective
equipment (PPE) which could prevent exposure of the front-line health
workers from the high dose of virus as well as the best management of
Jordanian HCWs during COVID-19 pandemic. It is obvious that availability
and proper donning and doffing of the PPE is important for the safety of
the HCWs specifically in the pandemic settings. Keywords: Jordan,
COVID-19, healthcare workers, personal protective equipment%
\end{abstract}%



\sloppy


Availability of personal protective equipment among healthcare workers
in Jordan during the COVID-19 pandemic: A web-based survey

\subsection*{ABSTRACT}

{\label{abstract}}

\textbf{Aim of the study:}

The inception of the COVID-19 has put healthcare workers (HCWs) in a
precarious situation across the world. Despite the challenges in Jordan,
the high awareness and preparedness of HCWs made it feasible for the
country to control the contagious virus.

COVID-19 has created a critical situation in the health sector for many
countries in the world. Healthcare workers (HCWs) include physicians,
dentists, nurses, pharmacists, laboratory technicians etc.; have
provided the front-line healthcare services facing challenges.

The study aimed to provide a useful insight into availability of
Personal Protective Equipment (PPE) among HCWs in Jordan, which could
help the policy/decision makers of public health to design better
programs based on the information reported.

\textbf{Method:}

This cross-sectional online survey was conducted during July 2020 for
the evaluation of the availability of Personal Protective Equipment
(PPE) among HCWs in Jordan.

\textbf{Result:}

A total of 751 HCWs responded from different parts of the country, who
were actively working at different hospitals in Jordan. Most of the
participants (94\%) had sufficient knowledge about COVID-19, and more
than two-thirds of participants (68\%) reported that Personal Protective
Equipment (PPE) were provided by Jordan ministry of health. The majority
(91\%) of participants reported availability of medical face masks,
while only 26\% reported having facial protective shields.

\textbf{Conclusion:}

The study highlighted sufficient availability of personal protective
equipment (PPE) which could prevent exposure of the front-line health
workers from the high dose of virus as well as the best management of
Jordanian HCWs during COVID-19 pandemic. It is obvious that availability
and proper donning and doffing of the PPE is important for the safety of
the HCWs specifically in the pandemic settings.

\textbf{Keywords:~} Jordan, COVID-19, healthcare workers, personal
protective equipment

\section*{INTRODUCTION}

{\label{introduction}}

COVID-19 is a global health concern which started in Wuhan,
China.{[}1{]} The novel coronavirus, SARS-CoV-2, is a highly
transmissible virus that spreads from one person to another via
respiratory droplets and aerosols. {[}2{]} Countries across the world
are taking preventative measures to control the spread of the virus. On
the individual-level; social distancing, using hand sanitizer, washing
hands, and wearing masks are some of the measures taken to prevent the
infection. {[}3{]}

In Jordan, the first case of COVID-19 was confirmed when a national
infected case arrived from Italy early March 2019. {[}4{]} Since then,
the government initiated a cascade of Non-Pharmaceutical Interventions
(NPIs) that included a strict lockdown and a curfew.{[}5{]} The
Jordanian government is strictly following the World Health Organization
(WHO) recommendations to mitigate the spread of the virus. In Jordan,
which is considered an upper-middle-class country in the Eastern
Mediterranean region, the health system is advanced in comparison to its
neighboring Syria and Iraq.{[}6{]} The inception of the COVID-19 has put
HCWs in a precarious situation across the world. {[}7{]} In spite of the
challenges in Jordan, the high awareness and preparedness of HCWs made
it feasible for the country to control the contagious virus. The study
findings provide a useful insight into availability of PPE among HCWs in
Jordan, which could help the policy/decision makers of public health to
design better programs based on the information reported.

\section*{2. METHODS}

{\label{methods}}

\subsubsection*{2.1 Sample and data
collection}

{\label{sample-and-data-collection}}

A cross-sectional study was conducted to assess the availability of PPE
among HCWs during the COVID-19 pandemic in Jordan. The questionnaire,
administered through the SurveyMonkey website, was distributed from
21\textsuperscript{st} to 23\textsuperscript{rd} June by Jordanian
health workers in Jordan through social media platforms (Facebook,
WhatsApp). A total of 751 Jordanian HCWs filled the form.

\subsubsection*{2.2 Assessment tool}

{\label{assessment-tool}}

The questionnaire consisted of 10 questions in total and had 3 queries
that were used for the purpose of demographics; age (18 - 24, 25 - 34,
35 - 44, 45 - 54, 55 or \textgreater{}55 years); sex (male or female);
and occupation (Medical specialist, Medical doctor/Trainee, Dentist,
Nurse, Midwife, Pharmacist, Anesthesiologist, Lab Technician,
Physiotherapist, Administration staff and other healthcare
professionals). The remaining questions were about availability of PPE,
Testing rate, infection rate, and COVID-related clinical symptoms.

\subsubsection*{2.3 Statistical analysis}

{\label{statistical-analysis}}

The SurveyMonkey website was used for sharing the questionnaire, and
data analysis was conducted using SPSS version 25. Descriptive
statistics and percentages were used to summarize the data.

\subsubsection*{2.5 Ethical considerations}

{\label{ethical-considerations}}

This study was conducted conforming to the Declaration of Helsinki.
Ethical approval was obtained from the Hashemite University IRB.
Respondents' participation was completely consensual, anonymous, and
voluntary.

\section*{3. RESULTS}

{\label{results}}

A total number of 751 HCWs completed the online survey. Out of which,
59\% were females, about half (45\%) were medical doctors, 24\% were
nurses, 9\% dentists, and 8\% were pharmacists. More than half of
participants (51\%) were between 25 and 34 years old (Table 1). The
majority (91\%) of participants reported availability of medical face
masks, about two-thirds reported having N95 masks (65\%), 64\% reported
having disposable gowns, three quarters reported having boot cover
(75\%), while only 26\% reported having facial protective shields (Table
2).

More than two-thirds of participants (68\%) reported that PPE were
provided by the ministry of health while about one quarter (21\%)
reported that they provided their own PPE, and 11\% accessed~PPE from
other sources (Figure 1). Most of the participants (94\%) had sufficient
knowledge about COVID-19 (Figure 2).

Regarding participants' main concerns during the COVID-19 pandemic, the
following were reported by study participants: spreading the virus to
their family members (69\%), contracting the virus from patients (32\%),
work overload (12\%), absence of suitable place for accommodation (10\%)
and shortage of PPE (3\%) (Figure 3).

In response to the question of whether participants tested for COVID-19
(Testing rate), the majority (96\%) of participants confirmed such. In
regard to participants' COVID-19 related symptoms, only a small
proportion of participants (3\%) declared being symptomatic (Figure 4).
The following symptoms were reported among the 22 (3\%) symptomatic
participants: fatigue 83\%, cough 71\%, sore throat 59\%, and headache
28\%. After collecting and analyzing the data, it was found that
Jordanian HCWs were properly prepared in fighting against COVID-19.

\section*{4. DISCUSSION}

{\label{discussion}}

This study investigated a sample of HCWs in regard to the availability
of PPE and their main COVID-19 concerns during the early stage of the
pandemic in Jordan. It was found that HCWs in Jordan had high access to
the PPE with a low infection rate (3\%). The advantage of investigating
the preparedness of a country's healthcare system allows us to navigate
the importance of particular public health guidelines in the event of a
health crisis. This enables policymakers to modify policies based on
findings and recommendations. {[}8{]} Each country has its own
healthcare response to outbreaks, thus developing different results of
controlling any infectious disease. A big factor that plays into a
healthcare system is its HCWs. {[}9{]}, who make up a united front for a
well-planned management, especially in infectious diseases, thus having
a better outcome in control.

A recent study done in Jordan proves that the preparedness of HCWs
during the COVID-19 pandemic may be a major reason for the
well-controlled outbreak in the country. {[}10{]} The preparedness in
terms of PPE adherence and institutional protocols led to a
significantly higher percentage of satisfaction with feeling safe at
their work, with feeling safe for their colleagues at work, and with the
feeling that current infection control practices at their institution
will decrease the risk for them and their colleagues to contract
COVID-19. These feelings have an effect in producing a safer and more
productive working environment, which is vital during a global crisis.

In this cross-sectional online survey, 751 HCWs were enrolled from
different governorates. The majority of the responders were medical
doctors actively working in Jordan hospitals. Our study indicates that
most of the participants had the required equipment recommended by the
WHO, particularly N95 masks. In our questionnaire, (91\%) of the
participants declared that they have used medical masks, besides 491
(65\%) used N95 masks. This shows the evidence that PPE adherence was
collectively high. The perception of these HCWs about well-supported
public health authorities and medical institutions regarding their own
safety shows that the Jordan HCWs manage well in the hospitals against
the COVID-19. In this survey-based study, we found that the majority of
HCWs received PPE from the ministry of health. In contrast, only 21\%
provided their own, out of pocket, PPE. The study findings on the
reality and perceptions about the safety and resources available for
HCWs during the COVID-19 pandemic could inform medical institutional
authorities about the need for urgent attention to the HCWs as an
important valuable resource.

Limitations

The findings of this study could not be generalized because it is quite
challenging to determine the universe under this study. The recruitment
of participants were based on their willingness to participate and
access to social networking applications, particularly Facebook.
Therefore, the study population does not encompass participants without
those resources. This study had a limited scope. Participants were asked
to answer very specific questions that might not cover the complex
situation of the personal safety of HCWs.

\section*{5. CONCLUSION}

{\label{conclusion}}

HCWs in Jordan seem to have good access to essential PPE during the
COVID-19 pandemic, which caused minimal infection rates among HCWs in
Jordan and allowed the country to mitigate the infection during its
early stage.

\subsection*{DISCLOSURE}

{\label{disclosure}}

The authors declare that they have no known competing financial
interests or personal relationships that could have appeared to
influence the work reported in this paper. This research received no
external funding.

\section*{AUTHOR CONTRIBUTIONS}

{\label{author-contributions}}

A.N. wrote the manuscript draft and developed the original idea; MY.M
and E.I contributed in the analysis, discussion and proofreading; N.R.
and O.A assisted with the design and distribution of the questionnaire
and revision of the manuscript. K.K and MYM checked, supervised, and
revised the manuscript. All authors have read and approved the final
manuscript.

\subsection*{REFERENCES}

{\label{references}}

1. Xu S, Li Y. Beware of the second wave of COVID-19. \emph{The
Lancet}2020; \textbf{395} : 1321-2.

2. Meselson M. Droplets and Aerosols in the Transmission of
SARS-CoV-2.\emph{New England Journal of Medicine} 2020.

3. Cowling BJ, Aiello AE. Public health measures to slow community
spread of coronavirus disease 2019. \emph{The Journal of infectious
diseases} 2020; \textbf{221} : 1749-51.

4. Al-Balas M, Al-Balas HI, Jaber HM et al. Distance learning in
clinical medical education amid COVID-19 pandemic in Jordan: current
situation, challenges, and perspectives. \emph{BMC medical
education}2020; \textbf{20} : 1-7.

5. Kheirallah KA, Alsinglawi B, Alzoubi A et al. The effect of strict
state measures on the epidemiologic curve of COVID-19 infection in the
context of a developing country: a simulation from
Jordan.\emph{International journal of environmental research and public
health}2020; \textbf{17} : 6530.

6. Al-Tammemi AaB. The battle against COVID-19 in Jordan: an early
overview of the Jordanian experience. \emph{Frontiers in Public
Health}2020; \textbf{8} : 188.

7. Tan L. Preventing the transmission of COVID-19 amongst healthcare
workers. \emph{Journal of Hospital Infection} 2020; \textbf{105} :
364-5.

8. Sundararaman T. Health systems preparedness for COVID-19
pandemic.\emph{Indian Journal of Public Health} 2020; \textbf{64} : 91.

9. Fusco F, Pisaturo M, Iodice V et al. COVID-19 among healthcare
workers in a specialist infectious diseases setting in Naples, Southern
Italy: results of a cross-sectional surveillance study. \emph{Journal of
Hospital Infection} 2020; \textbf{105} : 596-600.

10. Suleiman A, Bsisu I, Guzu H et al. Preparedness of Frontline Doctors
in Jordan Healthcare Facilities to COVID-19 Outbreak.\emph{International
Journal of Environmental Research and Public Health}2020; \textbf{17} :
3181.

Table 1. Demographic characteristics of healthcare workers.\selectlanguage{english}
\begin{longtable}[]{@{}lll@{}}
\toprule
Characteristics & Category & n (\%)\tabularnewline
Gender & Female & 381 (59\%)\tabularnewline
& Male & 370 (41\%)\tabularnewline
& 18 to 24 & 205 (27\%)\tabularnewline
& 25 to 34 & 383 (51\%)\tabularnewline
Age & 35 to 44 & 125 (17\%)\tabularnewline
& 45 to 54 & 31 (4\%)\tabularnewline
& 55 or more & 7 (1\%)\tabularnewline
& Medical doctor & 338(45\%)\tabularnewline
& Dentist & 64 (9\%)\tabularnewline
& Nurse & 182 (24\%)\tabularnewline
& Pharmacist & 61 (8\%)\tabularnewline
Medical Profession & Midwife & 15 (2\%)\tabularnewline
& Anesthesiologist & 22 (3\%)\tabularnewline
& Lab Technician & 46 (6\%)\tabularnewline
& Physiotherapist & 8 (1\%)\tabularnewline
& Administration Worker & 15 (2\%)\tabularnewline
\bottomrule
\end{longtable}

Table 2. Essential personal protective items\selectlanguage{english}
\begin{longtable}[]{@{}ll@{}}
\toprule
PPE item & n (\%)\tabularnewline
\midrule
\endhead
Medical mask & 681 (90.6\%)\tabularnewline
N95 masks & 489 (65.1\%)\tabularnewline
Disposable gloves & 671 (89.3\%)\tabularnewline
Goggles & 221 (29.4\%)\tabularnewline
Disposable gowns & 478 (63.6\%)\tabularnewline
Boot cover & 561 (74.7\%)\tabularnewline
Face shields & 199 (26.5\%)\tabularnewline
\bottomrule
\end{longtable}

\textbf{Figure 1} PPE sources for health care workers in Jordan during
the COVID-19 pandemic

\textbf{Figure 2} Having sufficient knowledge about COVID-19 among study
respondents

\textbf{Figure 3} Main concern of HCWs during the COVID-19 pandemic

\textbf{Figure 4} Testing rate among healthcare worker in Jordan during
the COVID-19 pandemic

\textbf{Hosted file}

\verb`Figures.docx`  available at \url{https://authorea.com/users/443851/articles/709909-availability-of-personal-protective-equipment-among-healthcare-workers-in-jordan-during-the-covid-19-pandemic-a-web-based-survey}

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