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\begin{document}

\title{Compliance and challenges of Transmission Based Precaution Practices
among Nurses in Jordanian Hospitals during the Novel SARS-CoV-2: A
descriptive Study}



\author[1]{Ahmed Al-Smadi}%
\author[1]{Salam Banihani}%
\author[1]{Marwa Halabi}%
\author[1]{Areej Mosa }%
\affil[1]{Al al-Bayt University}%


\vspace{-1em}



  
  \date{June 17, 2024}


\begingroup
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\selectlanguage{english}
\begin{abstract}
Background: Standard precautions (SPs) practices are of crucial
management skills among Health Care Workers (HCWs) including nurses
against the highly infectious novel virus SARS-CoV-2. Aim of the study:
The study aimed to assess level of nurse's compliance with SPs, and
identify the main challenges that experienced by nurses during their
work with infected SARS-CoV-2 patient's. Methods: A cross-sectional
survey design was used. The study was conducted in different sectors
that represent the health care sector in Jordan. 386 nurses recruited
from the different sectors. Results: Data were collected from 386
participants. 66.8\% of the participants were female. Most of them
revealed that they were dealt previously SARS-CoV-2 patients (73.6\%).
Generally, nurses demonstrated good level of compliance with SPs
practices (71\%). The staff reported that they mostly adhere with
performing hand hygiene after all procedures (65.8\%). On the other
hand, they were least adherence with maintaining a physical distance of
patient and staff of at least 6ft apart (28.5\%). conclusion: It was
concluded that nurses have a good level of SPs practices. Many
challenges were experienced by nurses while caring of SARS-CoV-2
patients.%
\end{abstract}%



\sloppy


\textbf{Compliance and challenges of Transmission BasedPrecaution
Practices among Nurses in Jordanian Hospitals during the Novel
SARS-CoV-2: A descriptive Study}

\textbf{Abstract}

\textbf{Background:} Standard precautions (SPs) practices are of crucial
management skills among Health Care Workers (HCWs) including nurses
against the highly infectious novel virus SARS-CoV-2.

\textbf{Aim of the study} : The study aimed to assess level of nurse's
compliance with SPs, and identify the main challenges that experienced
by nurses during their work with infected SARS-CoV-2 patient's.

\textbf{Methods:} A cross-sectional survey design was used. The study
was conducted in different sectors that represent the health care sector
in Jordan. 386 nurses recruited from the different sectors.

\textbf{Results:} Data were collected from 386 participants. 66.8\% of
the participants were female. Most of them revealed that they were dealt
previously SARS-CoV-2 patients (73.6\%). Generally, nurses demonstrated
good level of compliance with SPs practices (71\%). The staff reported
that they mostly adhere with performing hand hygiene after all
procedures (65.8\%). On the other hand, they were least adherence with
maintaining a physical distance of patient and staff of at least 6ft
apart (28.5\%).

\textbf{conclusion:} It was concluded that nurses have a good level of
SPs practices. Many challenges were experienced by nurses while caring
of SARS-CoV-2 patients.

\textbf{key words:} SARS-CoV-2, Precaution, Practices, Compliance,
Transmission, Nurses

\textbf{What's known ?}

Standard precautions practices are the most crucial and basic skills
management among all health care provides.

The pandemic of novel SARS-CoV-2 is a serious challenge for health care
authorities from the aspects of spread, treatment, and prevention.

Little evidences about the compliance of health care providers including
nurses about standard precautions practices and the main challenges that
may face during the novel SARS-CoV-2

\textbf{What's new?}

Generally, nurses demonstrated a good level of compliance with SPs
practices (71\%).

Most nurses revealed performing hand hygiene after all procedures as a
SPs practice (65.8\%).

The main challenges faced by nurses were fear of infecting family
members, work overload, fear of contracting the virus, and shortage of
staff .

Keywords: Compliance, SARS-CoV-2, Standard Precautions, Hospital
acquired infection.

\textbf{Introduction}

The novel SARS-CoV-2 is an infectious respiratory disease that is
described as a pandemic global threat leading to high mortality and
morbidity rate among population\textsuperscript{1}. The outbreak of the
disease limits the quality of health care and lead to crises in the
health care services due to the scarcity of resources, workload, and
lack of infection control policies\textsuperscript{2}. All of these
mentioned factors were contributing toward non-compliance of Health Care
Workers (HCWs) to Standard Precautions (SPs). SPs as well were known as
universally accepted policies and guidelines for infection control
practices, these practices help to protect HCWs from getting infected
while introducing care to infectious patients and reducing the spread of
infection among patients simultaneously\textsuperscript{3}. In Jordan,
the first case of confirmed SARS-CoV-2 was detected in March 2020, then
the pandemic was accelerated on epidemic curve. Since that time, a
strict lock down took a place to limit the spread of the pandemic.
However, the number of SARS-CoV-2 has rapidly increasing, which alarming
the situation among health care workers and threat the health care
institutions \textsuperscript{4}.

Nowadays, the pandemic of novel SARS-CoV-2 became a serious challenge
for health care authorities, communities, and other health care agencies
from the aspects of spread, treatment, and
prevention\textsuperscript{5}. According to the Center of Disease
Control and Prevention recognized that the common symptoms of SARS-CoV-2
ranging from mild symptoms such as fever, fatigue, cough, dyspnea, sore
throat, muscle pain, loss of smell and taste, and abdominal
discomfort\textsuperscript{1} to severely symptoms of pneumonia, acute
respiratory distress syndrome, renal failure, shock that leading to end
organ damage\textsuperscript{6}. Recognizing risk factors and identify
the severity of each case is vital to improve the quality of patient
care and help the care providers to introduce the best care and improve
patient safety.

Based on the available knowledge, SARS-CoV-2could be spread through
droplets, airborne, and contact as modes of
transmission\textsuperscript{7}. However, according to current
literatures and evidences, SARS-CoV-2virus is transmitted between people
through respiratory droplets and contact routes\textsuperscript{8}. This
requires to take the recommended practices of airborne precautions for
any situation involving the care of SARS-CoV-2 patients. Also, it should
follow the recommendation of the circumstances and settings in which
aerosol-generating procedures and support treatment are
performed\textsuperscript{9}. Contact precautions as well are an
important recommendations to be followed through the emphasis on the
importance of frequent hand hygiene, environmental cleaning, and
disinfection, as well as the importance of maintaining physical
distances and avoidance of close, unprotected contact with people with
respiratory symptoms\textsuperscript{10}. A cross-sectional study was
conducted by Al-Faouri, Okour, Alakour, Alrabadi \textsuperscript{11}
that crucial role of following the guidelines of standard precautions by
raising the awareness of knowledge and compliance of nurses during the
era of SARS-CoV-2. Also, they focused on the importance of conducting a
specific training program in relation to SARS-CoV-2.

HCWs among different health care institutions were the front liners in
managing and treating the patients who were suspected or diagnosed as
positive carriers of SARS-CoV-2. Specifically, the nurses who were the
heaviest takers of direct contact with those infected persons. This put
all medical staff at high risk of being infected with this highly
contagious virus, which alarming the situation of health care
authorities \textsuperscript{5}. Infected nurses and other medical staff
lead them to arrive at critical stages of both physical and
psychological problems. Psychological threats including stress, anxiety,
and worriedness that replicate the risks to mediating morbidity of
SARS-CoV-2 among staff members and nurses\textsuperscript{12}. Besides,
the close contact of medical staff with infected patients, a substantial
shortage of Personal Protective Equipment (PPE), and limited clinical
supplies\textsuperscript{13}.

This alarming situation calls for the urgent need to develop a strategy
to consider all these factors especially the workload for long hours in
their duty, rest, exercise, protective clothing, and psychological
counseling among medical staff to avoid infection\textsuperscript{5}.
Without taking the appropriate effective measures, the situation will be
out of control which will eventually lead to massive pandemics
worldwide\textsuperscript{14}.

Healthcare-Associated Infections (HAIs) which is referred to an
infection that is acquired during the process of introducing care during
hospitalization \textsuperscript{15}. Health care professionals are
constantly exposed to many types of microorganisms that can cause
serious or lethal infection. Nurses, in particular, are more exposed to
the infection during their routine nursing care activities with their
patients. Although infection control measures that can be taken such as
hand hygiene, and committed to the protective handling of equipment is a
low cost, simple, and protective\textsuperscript{16}, it requires
restrictive staff accountability and behavioral adaptation with the
current situation. This is could be achieved by continuous training to
enhance the adherence to SPs, which were designated to minimize the
spread of microorganisms\textsuperscript{17}. SPs are defined as a group
of infection prevention practices and strategies for all patients
whatever if they were suspected or confirmed the diagnosis of infection
\textsuperscript{18}. Knowledge and compliance of nurses with the SPs
are efficient and effective practices to minimize and prevent HAIs among
patients and other health care providers \textsuperscript{19}.

Unfortunately, poor knowledge and compliance with SPs were revealed
among many studies that could explain the high number of medical staff
who were infected by COVID-19 among hospitalized
patients\textsuperscript{2,20}. In Jordan, little evidences available
about the level of adherence of nurses about SPs practices and the main
challenges that experience by them during their care of SARS-CoV-2
patients. Hence, the purpose of the current study is to explore the
level of transmission-based practice precautions, the challenges
experienced by nurses with the management of SARS-CoV-2 patients at
Jordanian hospitals during the outbreak of the pandemic.

\textbf{Methods}

\textbf{Research design}

A cross-sectional survey design was used.

\textbf{Sample and sampling technique}

Data were collected conveniently from 386 nurses recruited from the
different sectors including governmental, private, military, and
university affiliated hospitals. The target population for the current
study included all nurses who were assigned to bed side care. Whereas,
the accessible population included the available nurses who accept to
participate in the current study. The inclusion criteria were (1) nurses
who provide direct contact with patients who were infected with
SARS-CoV-2; (2) educational level of diploma, bachelor and a higher
degree in nursing; (3) agreed to participate; and (4) have an experience
of at least one year in nursing. Exclusion criteria were all nurses in
the managerial position including head nurses of the assigned wards or
nurses who have an administrative role in their clinical settings. Data
were collected through on-line form that filled and submitted through
Google survey link that was started from period of 8-february-2021 to
the period of 21-february-2021.

\textbf{Settings}

The study was conducted in different sectors including governmental,
private, military, and university affiliated settings in which they
represent the health care sector in Jordan. The data were collected from
different departments and units in the hospitals. Data were collected by
sending the questionnaire link to different WhatsApp groups from
different department. Each group contains around 30 participants. Also,
the link was distributed among different nursing clubs and forum via
Facebook groups. Each willing participant fill the link and send it.

\textbf{Data collection procedure}

The data was collected by preparing an electronic questionnaire through
a specialized internet website-Google forum (via docs.google.com/form).
This e-questionnaire enabled the participants to review and answer the
questionnaires in a more convenient manner. The prepared electronic
questionnaire was embedded in an electronic attachment link and sent to
participants through a social-media application (WhatsApp and Facebook).
A timeframe was set for participation in filling out the questionnaire
for two weeks. After the expiration of the period, the form was
deactivated.

\textbf{Ethical consideration}

Ethical approval to conduct the study was granted from the Ethics
Committees of the investigators university. There were no known risks
from participating in the study. The, anonymity and confidentiality were
maintained. An information sheet was provided to each participant
describing the purpose of the study, confirming the privacy, anonymity
and confidentiality of participants, and the voluntary nature of their
participation. Informed consent was implied by completing and returning
the survey. Permission was obtained from the copyright holder to use the
questionnaire developed by Afemikhe, Esewe, Enuku, Ehwarieme
\textsuperscript{1}.

\textbf{Instrument}

Nursing staff compliance with SPs practices was measured by a self-built
tool based on principles issued by the world Health Organization (WHO),
the National Center for Disease Control (CDC), and the Prevention and
the Edo State Task Force for the Control of the SARS-CoV-2 Pandemic. The
questionnaire was developed by Afemikhe, Esewe, Enuku, Ehwarieme
\textsuperscript{1}. The questionnaire was administered in English,
because Jordanian nurses are able to understand and answer questions in
the original language of the tool. The instrument is composed of three
parts. Part-A includes demographic characteristics items such as gender,
age, qualification, years of experience, marital status. Other
demographics were added in the current study such as, the name of
hospital, department, health sector, if the nurse previously deal with
SARS-CoV-2 patients, if the nurse diagnose previously with COVID-19, if
the nurse receive the vaccine of SARS-CoV-2, or if the nurse willing to
receive COVID-19 vaccine. Part-B includes items on transmission-based
precaution practices which consist of 12-items with the options of
4-point Likert scale ``Never=0'', ``Sometimes=1'', ``Often=2'', and
``Always=3''. Higher score indicate higher compliance of nurses with SPs
practices. Furthermore, classification of practices were leveled
according to the total scores as follow 0-50 was considered as poor
level, 50-70 classified as fair level, and 70-100 classified as good
practice. Part-C includes items on perceived challenges as experienced
by nurses that could affect their adherence to transmission-based
precaution practices. It consists of 15 closed-ended questions with
options of ``Yes'' or ``No'' answers\textsuperscript{1}.

The questionnaire was tested for validity and reliability in a previous
studies and was found valid and reliable. The reliability values
obtained from the split-half reliability test for parts (B \& C) were
(0.79) and (0.85) respectively\textsuperscript{1}

\textbf{Results}

\textbf{Participants' Demographics}

A total of 386 participants from different sectors in Jordanian
hospitals completed the questionnaire. The majority (n=258, 66.8\%) were
female, with a mean age of 30.8 (SD= 6.2) years, ranging from 21 to 56
years. Approximately two-thirds of the sample had a diploma and
bachelor's degree in nursing (n=323, 83.7\%). Most of respondents
reported that they were healthy with no chronic disease (n=329, 85.2\%).
Also, most of them revealed that they dealt previously SARS-CoV-2
patients (n=284, 73.6\%). Table 1 provides a detailed description of the
participants' demographics.

\textbf{{[}insert table 1{]}}

\textbf{Nursing compliance with Standard precautions practices with
SARS-CoV-2} Generally, the findings of the current study showed a good
level of practice of SPs practices by nurses. Since, they revealed
performing hand hygiene after all procedure (n=254, 65.8\%). Similarly,
248 nurses reported that they covered their mouth and nose with tissue
when they were cough or sneeze. Around half of the participants offering
mask to symptomatic patient upon arrival to ward (n=191, 49.5\%). On the
other hand, less than half of the participants offering mask to a
symptomatic patient on arrival to the ward (n=162, 42\%). Nurses were
least compliance with physical distancing of both patient and staff at
least 6ft apart (n=110, 35.8\%). See table 2

Based upon classification of respondents to the transmission based
practiced by nurses, table 3 shows that majority of participants
maintained good level of practice (n=274, 71.0\%), and 73 (18.9\%)
participants performed fair level of SPs practices, while only 39
(10.1\%) display poor practices with compliance of SPs with SARS-CoV-2
patients.

{[}insert table 2{]}

{[}insert table 3{]}

\textbf{Challenges experienced by nurses while dealing with SARS-CoV-2
patients}

Table 4 revealed that majority of nurses were perceived that fear of
infecting family members (87.6\%), work overload (86.8\%), fear of
contracting the virus (87\%), and shortage of staff (86\%) were the main
challenges they faced during their care of SARS-CoV-2 patients. Followed
by reporting that lack of motivation (77.5\%) and lack of training
program were another factors that affect their compliance with SPs
practices.

{[}insert table 4{]}

\textbf{Discussion}

The current study assessed the compliance of Jordanian nurses with SPs
practices, and the main challenges that experienced by them during the
contact of infected patients with the novel SARS-CoV-2 pandemics. It was
found that Jordanian nurses had a good level of SPs practices. This
result was consistent with a study conducted among nurses in Edo state,
in Nigeria, during the pandemic of SARS-CoV-2 conducted by Afemikhe,
Esewe, Enuku, Ehwarieme\textsuperscript{1}. They found that the nurses
had a good level of transmission based practices precautions in relation
to SARS-CoV-2. This results could indicate the adherence of nurses with
infection control policies, and the internalized pressure of nurses,
receiving a training and conferences about SARS-CoV-2, adherence to the
guidelines of healthcare institutions policies, since they were the
front liners in fighting against the pandemic during out breaking the
virus. On the other hand, the result of the current study was contradict
a survey that was conducted in Saudi Arabia among 1216 HCWs, who
reported that nurses have a poor knowledge about the emerging outbreak
of Middle East Respiratory Syndrome (MERS) coronavirus, and suboptimal
performance practices\textsuperscript{21,22}.

However, Jordanian nurses who participated in the current study have a
higher proportion in the item of performing hand hygiene after all
procedures (65.8\%). This means that around one --third of the
participants does not perform hand hygiene after each contact or
procedure with the infected SARS-CoV-2 patients, a surprising results
indicate the alarming situation of maintaining the crucial and efficient
step in eradicating the transmission of contracting the virus. This was
contradict results that were found among Nigerian nurses, when they
reported that they were generally maintained hand hygiene practices with
a percent of 89.1\% \textsuperscript{1}. The non-compliance of nurses
with hand hygiene practice is need a call of behavioral changes along
enhance their accountability about the importance of frequent hand
washing, since it is the most efficient and simplest way to prevent the
spreading of SARS-CoV-2 among patients and staff. This could be related
to the staff shortage, workload, and lack of knowledge regarding the
guidelines the followed in their health care institutions, and
cumbersome nature of sanitizing hands a lot of
times\textsuperscript{23}.

Generally nurses in the current study experienced many challenges that
restrict them to maintain high level of compliance with the SPs
practices including fear of infecting family members, work overload,
fear of contracting the virus, and shortage of staff, respectively. This
result were not surprising, since HCWs still in fear about the nature of
the virus and the management of it, so they in worry to transmit the
novel virus to themselves or other family members. This was consistent
with a study conducted by Clark, Jit, Warren-Gash, Guthrie, Wang,
Mercer, Sanderson, McKee, Troeger, Ong\textsuperscript{24}, they pointed
out that most of nurses worried to be a vehicles to transmit the virus
among their family members who already had a co-morbidity conditions,
immunocompromised, or fragile to bear this virus. Also, the results of
nursing staff shortage and work-pressure load are in agreement with
other studies that reported lack of resources, workload, and lack of
adherence with infection control policies as the main contributing
factors of noncompliance of nurses with the SPs
practices\textsuperscript{2,22,25}.

\textbf{Conclusion}

To sum up, strict observation among the compliance of nurses with the
SPs practices is crucial to be maintained at the highest level to
eliminate the spreading of SARS-CoV-2 among other community members.
More concentrated efforts should be come under the light including
continuous training and education sessions, seminars, and conferences to
enhance nurses' level of knowledge and practice in relation to
controlling the outbreak of the novel pandemic. Furthermore, it is
recommended to conduct studies covering all health care workers in
different geographical areas with frequent follow up to identify areas
of non-compliance with SPs practices. Also, Jordanian staff must perform
their patients' care while being protected from the transmission of
SARS-CoV-2, by completely adhering to SPs practices guidelines and
policies. This will occur by adhering to SPs practices by all HCWs at
different settings.

\textbf{Limitation}

This study has a limitation of collecting the data among nurses
conveniently, which could affect the generalizability of data. However,
great efforts were done to recruit many participants from different
sectors in Jordanian hospitals including governmental, private,
military, and University-affiliated sectors. Secondly, this study is
descriptive in nature, since little evidences were established regarding
nursing compliance with SPs practices and the main challenges they
experienced during SARS-CoV-2 pandemics. It is recommended to do mixed
study to reveal in-depth information about study participants in
relation to the purpose of this study.

\textbf{Conflicts of Interest and Source of Funding}

Nothing to declare. No funding from any source.

\textbf{References}

\textbf{1.} Afemikhe JA, Esewe RE, Enuku CA, Ehwarieme TA. Transmission
Based Precaution Practices among Nurses in Edo State, Nigeria during
COVID-19 Pandemic. \emph{African Journal of Reproductive Health.}
2020;24(2):98-107.

\textbf{2.} Zeb A, Muhammad D, Khan A. Factors Affecting Nurses'
Compliance to Standard Precautions in Resource Scarce Settings.
\emph{American Journal of Biomedical Science \& Research.}
2019;4(5):384-389.

\textbf{3.} Jordan V. Coronavirus (COVID-19): infection control and
prevention measures. \emph{Journal of primary health care.}
2020;12(1):96-97.

\textbf{4.} 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;17(9):3181.

\textbf{5.} Khan S, Siddique R, Ali A, et al. The spread of novel
coronavirus has created an alarming situation worldwide. \emph{Journal
of infection and public health.}2020;13(4):469.

\textbf{6.} Struyf T, Deeks JJ, Dinnes J, et al. Signs and symptoms to
determine if a patient presenting in primary care or hospital outpatient
settings has COVID-19 disease.\emph{Cochrane Database of Systematic
Reviews.} 2020(7).

\textbf{7.} Wiwanitkit V. Atypical modes of COVID-19 transmission: how
likely are they? \emph{Epidemiology and health.} 2020;42:e2020059.

\textbf{8.} Morawska L, Tang JW, Bahnfleth W, et al. How can airborne
transmission of COVID-19 indoors be minimised? \emph{Environment
international.} 2020;142:105832.

\textbf{9.} Asadi S, Bouvier N, Wexler AS, Ristenpart WD. The
coronavirus pandemic and aerosols: Does COVID-19 transmit via expiratory
particles? : Taylor \& Francis; 2020.

\textbf{10.} Hellewell J, Abbott S, Gimma A, et al. Feasibility of
controlling COVID-19 outbreaks by isolation of cases and contacts.
\emph{The Lancet Global Health.}2020;8(4):e488-e496.

\textbf{11.} Al-Faouri I, Okour SH, Alakour NA, Alrabadi N. Knowledge
and compliance with standard precautions among registered nurses: A
cross-sectional study.\emph{Annals of Medicine and Surgery.}
2021;62:419-424.

\textbf{12.} Khan S, Nabi G, Han G, et al. Novel coronavirus: how things
are in Wuhan. \emph{Clinical Microbiology and Infection.}
2020;26(4):399.

\textbf{13.} Wang Y, Wu W, Cheng Z, et al. Super-factors associated with
transmission of occupational COVID-19 infection among healthcare staff
in Wuhan, China. \emph{Journal of Hospital Infection.}
2020;106(1):25-34.

\textbf{14.} Shah AUM, Safri SNA, Thevadas R, et al. COVID-19 outbreak
in Malaysia: Actions taken by the Malaysian government.
\emph{International Journal of Infectious Diseases.} 2020;97:108-116.

\textbf{15.} Almoghrabi R, Aldosari N, Bakhsh A, Al Garni F, Alseragi E,
Omer T. Standard precaution among nurses in primary health care centers:
Knowledge and compliance.\emph{JOurnal of nursing an d health science.}
2018:57-63.

\textbf{16.} Harding AD, Almquist LJ, Hashemi S. The use and need for
standard precautions and transmission-based precautions in the emergency
department.\emph{Journal of Emergency Nursing.} 2011;37(4):367-373.

\textbf{17.} Sprague E, Reynolds S, Brindley P. Patient isolation
precautions: are they worth it?\emph{Canadian respiratory journal.}
2016;2016.

\textbf{18.} Moralejo D, El Dib R, Prata RA, Barretti P, Corr\selectlanguage{ngerman}êa I.
Improving adherence to Standard Precautions for the control of health
care\selectlanguage{english}-associated infections.\emph{Cochrane Database of Systematic
Reviews.} 2018(2).

\textbf{19.} Asmr Y, Beza L, Engida H, Bekelcho T, Tsegaye N, Aschale Y.
Assessment of knowledge and practices of standard precaution against
blood borne pathogens among doctors and nurses at adult emergency room
in Addis Ababa, Ethiopia.\emph{Emergency medicine international.}
2019;2019.

\textbf{20.} Powers D, Armellino D, Dolansky M, Fitzpatrick J. Factors
influencing nurse compliance with Standard Precautions. \emph{American
Journal of Infection Control.}2016;44(1):4-7.

\textbf{21.} Alsahafi AJ, Cheng AC. Knowledge, attitudes and behaviours
of healthcare workers in the Kingdom of Saudi Arabia to MERS coronavirus
and other emerging infectious diseases. \emph{International journal of
environmental research and public health.} 2016;13(12):1214.

\textbf{22.} Cheung K, Chan CK, Chang MY, et al. Predictors for
compliance of standard precautions among nursing students.
\emph{American Journal of Infection Control.}2015;43(7):729-734.

\textbf{23.} Bouchoucha SL, Moore KA. Factors influencing adherence to
standard precautions scale: a psychometric validation. \emph{Nursing \&
health sciences.}2019;21(2):178-185.

\textbf{24.} Clark A, Jit M, Warren-Gash C, et al. Global, regional, and
national estimates of the population at increased risk of severe
COVID-19 due to underlying health conditions in 2020: a modelling study.
\emph{The Lancet Global Health.}2020;8(8):e1003-e1017.

\textbf{25.} Agarwal A, Ranjan P, Saraswat A, et al. Are health care
workers following preventive practices in the COVID-19 pandemic
properly?-a cross-sectional survey from India. \emph{Diabetes \&
Metabolic Syndrome: Clinical Research \& Reviews.} 2021;15(1):69-75.

Table 1: Demographics and professional characteristics of nurses (N=386)\selectlanguage{english}
\begin{longtable}[]{@{}lll@{}}
\toprule
\textbf{Characteristic} & \textbf{Mean (SD)} & \textbf{Frequency
(\%)}\tabularnewline
\midrule
\endhead
\textbf{Age} & 30.7 (6.2) &\tabularnewline
\textbf{Nursing experience in years} & 7.9 (5.9) &\tabularnewline
\textbf{Gender} Male Female & & 128 (33.2) 258 (66.8)\tabularnewline
\textbf{Education level} Diploma \&Bachelor Postgraduate studies
\textbf{Marital status} Single Married \textbf{If nurses have chronic
disease} Yes No \textbf{Type of settings} Governmental Private Military
University-affiliated \textbf{If dealt previously with SARS-CoV-2
patients} Yes No \textbf{Receive vaccine of SARS-CoV-2} Yes No
\textbf{Receive training courses of SARS-CoV-2} Yes No & & 323 (83.7) 63
(16.3) 140 (36.3) 246 (63.7) 57 (14.8) 329 (85.4) 197 (51.0) 86 (22.3)
46 (11.9) 57 (14.8) 284 (73.6) 102 (26.4) 167 (43.3) 219 (56.7) 207
(53.6) 179 (46.4)\tabularnewline
\bottomrule
\end{longtable}

\emph{Note:} \textbf{SD=Standard Deviation, \%= percentage.}

\textbf{Table 2:} Compliance of Transmission Based Practice by Nurses\selectlanguage{english}
\begin{longtable}[]{@{}lllll@{}}
\toprule
\begin{minipage}[b]{0.19\columnwidth}\raggedright\strut
\textbf{Always (3)} \textbf{F (\%)}\strut
\end{minipage} & \begin{minipage}[b]{0.19\columnwidth}\raggedright\strut
\textbf{Often (2)} \textbf{F (\%)}\strut
\end{minipage} & \begin{minipage}[b]{0.19\columnwidth}\raggedright\strut
\textbf{Sometimes (1)} \textbf{F (\%)}\strut
\end{minipage} & \begin{minipage}[b]{0.19\columnwidth}\raggedright\strut
\textbf{Never (0)} \textbf{F (\%)}\strut
\end{minipage} & \begin{minipage}[b]{0.19\columnwidth}\raggedright\strut
\textbf{Transmission based precaution practices}\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
254 (65.8)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
85 (22)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
34 (8.8)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
13 (3.4)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Hand hygiene is performed after all procedures\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
204 (52.8)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
106 (27.5)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
47 (12.2)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
29 (7.5)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
Using of Personal Protective Equipment for SARS-CoV-2 patient requiring
healthcare facility admission with aerosol-generating procedure\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
171 (44.3)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
114 (29.5)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
69 (17.9)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
32 (8.3)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Using PPE for every patient with first contact\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
248 (64.5)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
99 (25.6)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
23 (6.0)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
16 (4.1)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Covering mouth and nose with a tissue when coughing or sneezing\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
195 (50.5)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
137 (35.5)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
41 (10.6)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
13 (3.4)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Provision of waste receptacle to dispose tissue after use\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
191 (49.5)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
119 (30.8)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
55 (14.2)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
21 (5.4)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Offering mask to symptomatic patient upon arrival to the ward\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
162 (42.0)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
129 (33.4)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
69 (17.9)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
26 (6.7)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Offer of mask to asymptomatic patients on arrival to the ward\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
165 (42.7)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
142 (36.8)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
62 (16.1)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
17 (4.4)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Providing resources for performing hand hygiene in or near waiting
area\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
165 (42.7)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
142 (36.8)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
62 (16.1)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
17 (4.4)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Educating patient about the disease\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
165 (42.7)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
123 (31.9)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
67 (17.4)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
31 (8.0)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Performing clinical triage for patients on admission\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
110 (28.5)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
142 (36.8)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
93 (24.1)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
41 (10.6)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Physical distancing of patients and staff at least 6ft apart\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
138 (35.8)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
120 (31.1)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
90 (23.3)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
38 (9.8)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Controlling of number of visitors around a patient\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

\emph{Note}\textbf{: F= Frequency, \%=Percentage}

\textbf{Table 3:} Categorization of Transmission Based Practices by
Nurses\selectlanguage{english}
\begin{longtable}[]{@{}lll@{}}
\toprule
\textbf{F (\%)} & \textbf{Score range} &
\textbf{Categorization}\tabularnewline
\midrule
\endhead
39 (10.1) & 0-50 & \textbf{Poor}\tabularnewline
73 (18.9) & 50-70 & \textbf{Fair}\tabularnewline
274 (71.0) & 70-100 & \textbf{Good}\tabularnewline
\bottomrule
\end{longtable}

\emph{Note}\textbf{: F= Frequency}

\textbf{Table 4:} Challenges Experienced by Nurses while Treating
SARS-CoV-2 Patients\selectlanguage{english}
\begin{longtable}[]{@{}lll@{}}
\toprule
\begin{minipage}[b]{0.32\columnwidth}\raggedright\strut
Challenges\strut
\end{minipage} & \begin{minipage}[b]{0.32\columnwidth}\raggedright\strut
Yes F(\%)\strut
\end{minipage} & \begin{minipage}[b]{0.32\columnwidth}\raggedright\strut
NO F(\%)\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
Fear of infecting family member\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
338 (87.6)\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
48 (12.4)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
Fear of contacting the virus\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
336 (87)\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
50 (13.0)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
Work Overload\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
335 (86.8)\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
51 (13.2)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
Shortage of staff\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
332 (86)\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
54 (14.0)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
Lack of motivation (hazard allowance)\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
299 (77.5)\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
87 (22.5)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
Lack of training program\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
290 (75.1)\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
96 (24.9)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
Seeing elderly suffering\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
288 (74.6)\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
98 (25.4)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
Overcrowding in the ward\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
285 (73.8)\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
101 (26.2)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
Availability of Personal Protective Equipment\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
276 (71.5)\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
110 (28.5)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
Ineffective communication among administrative\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
263 (68.1)\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
123 (31.9)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
Shortage of instrument and supplies\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
261 (67.6)\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
125 (32.4)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
Less commitment to policies and procedures\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
251 (65.0)\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
135 (35.0)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
Inadequate testing material and delay in results\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
234 (60.6)\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
152 (39.4)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
Stigmatization\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
231 (59.8)\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
155 (40.2)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
Moral injury\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
225 (58.3)\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
161 (41.7)\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

\emph{Note}\textbf{: F= Frequency, \%=Percentage}

\textbf{Hosted file}

\verb`Tables.docx`  available at \url{https://authorea.com/users/729429/articles/709846-compliance-and-challenges-of-transmission-based-precaution-practices-among-nurses-in-jordanian-hospitals-during-the-novel-sars-cov-2-a-descriptive-study}

\selectlanguage{english}
\FloatBarrier
\end{document}

