Journal of Preventive Medicine

Introduction
The COVID-19 pandemic is the biggest threat to human health in the last century. During this pandemic, the vulnerability of health care providers has been a serious challenge for countries’ health systems. According to the report of the World Health Organization (WHO), 10% of those infected with COVID-19 in the world are health care providers. Today, improving the operating room in terms of quantity and quality of care plays an important role. Paying attention to the standards of infection control and hygiene in surgical team and patients is one of the basic concerns of hospitals in the pandemic. Operating room team provide specialized and often complex treatments for the patients. Their compliance with the protective guidelines to prevent infection can reduce the risk of contracting this disease. The WHO, the Centers for Disease Control and Prevention, and the American College of Surgeons have provided these guidelines, which include limiting surgeries to emergency and necessary surgeries, using personal protective equipment for the surgical team, complying with operating room safety and equipment standards (proper ventilation and filtration systems), and separation of operating room for confirmed patients with COVID-19. The present study aims to assess the compliance of the operating room staff with protective guidelines to prevent infection with COVID-19 in Iran.

Methods
This descriptive-analytical study with a cross-sectional design was conducted on 876 operating room staff in 2021 in 10 cities of Iran. Sampling was done using a multi-stage cluster sampling method. In the first stage, 10 cities (clusters) were selected. In the second stage, three main hospitals accepting patients with COVID-19 in each city were selected by simple random sampling method (using lottery method). The inclusion criteria were at least an associate degree in the operating room and more than 3 months of work experience as a scrub or circular staff in the operating rooms. The exclusion criteria were the return of incomplete questionnaire and transfer to other departments or hospitals. The data collection tools were a demographic form and a researcher-made questionnaire on the guidelines for the prevention of COVID-19 infection in the operating rooms, which was sent online to the participants. Face validity, content validity and construct validity were used. For quantitative content validity, the CVR of all 20 items was higher than 0.62 and the CVI of the questionnaire was 0.94. The construct validity was determined by using the opinions of experts and conducting exploratory factor analysis using principal component analysis with varimax rotation. The reliability of the questionnaire in a pilot study on 200 participants was obtained 0.84. Therefore, the questionnaire had acceptable validity and reliability. It had 20 questions with a 3-point Likert scale (1= fully complied, 2= somewhat complied, 3= not complied at all). The total score ranged from 20 to 60. A score of 20-30 shows low compliance, a score of 31-45 indicates moderate compliance and a score of 46-60 shows high compliance. The collected data were analyzed in SPSS software, version 26 using descriptive (mean and standard deviation) and inferential (chi-square test) statistics.

Results
The mean age of the participants was 28.5±5.4 years. The majority of them were female (82.3%) and single (52.6%). Among participants, 59% were willing to receive the COVID-19 vaccine, but 41% did not want to receive the vaccine due to the fear of the vaccine side effects. The mean compliance rate was 42.29±7.11; 6.5% had low compliance, 59.4% had moderate compliance, and 34.1% had high compliance with the guidelines. The highest level of compliance was in the dimension of personal protective equipment instructions and the lowest level was in the dimension of surgical type instructions. There was a significant relationship between participation in training courses and the level of compliance with COVID-19 infection prevention and control guidelines (P=0.002).

Discussion
According to the results of the present study, the Iranian operating room staff’s compliance with COVID-19 infection prevention and control guidelines was moderate. Guidelines for the type of surgery, the diagnostic screening for COVID-19 in patients candidate for surgery, the presence of separate ventilation system and a warning sign about entry and exit restrictions for patients with COVID-19, limiting surgeries to emergency and necessary surgeries, and the use of smoke evacuation systems needed special attention. It is recommended that hospital managers develop programs with the focus on reducing the infection of operating room staff by providing standard protective equipment and holding educational courses for them and monitoring their compliance with the infection prevention and control guidelines.

Ethical Considerations

Compliance with ethical guidelines
The ethics committee of Shiraz University of Medical Sciences has approved this research (Code: IR.SUMS.REC.1400.008).

Funding
The Research and Technology Vice-Chancellor of Shiraz University of Medical Sciences has supported this plan.

Authors' contributions
Designing the study, writing the study, supervising the implementation process of the study: Armin Fereidouni; Designing the study, writing and final editing of the article: Fatemeh Vizeshfar; Writing, discussion and sampling: Maryam Ghanavati; Statistical analysis and writing of study methodology: Zahra Maleki; Sampling reading and writing introduction: Esmaeil Teymoori; Study sampling and article editing: Salman Barasteh.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgements
The researchers express their gratitude to the Research and Technology Vice-Chancellor of Shiraz University of Medical Sciences for supporting this project and the operating room personnel for participating and cooperating in this study.
 

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