Utilization of Personal Protective Equipment and Its Determinants Among Health Care Professionals in Public Hospitals in Resource-Limited Settings

Abstract

Background

Personal Protective Equipment protects healthcare workers from harmful exposures, reducing the risk of illness and injury. However, adherence to its proper use is often low, increasing infection risks and lowering care quality. Consistent use of personal protective equipment (PPE) is essential for safeguarding both healthcare workers and patients.

Objective

To assess utilization of personal protective equipment and its determinants among health care professionals in public hospitals in resource-limited settings, 2025.

Methods

A facility-based cross-sectional study was conducted among 422 health professionals selected by simple random sampling from four public hospitals. Data were collected using a pretested self-administered questionnaire. After data cleaning and entry into EpiData 3.1, analysis was performed using SPSS version 27. Descriptive statistics were presented using tables and figures. Binary and multivariable logistic regression analyses were conducted to identify factors associated with PPE utilization, with statistical significance declared at p < .05.

Result

A total of 416 respondents participated in the study, yielding a response rate of 98.6%, and the magnitude of personal protective equipment utilization was 51.7%, 95% CI [46.4%, 55.8%]. Higher PPE utilization was significantly associated with monthly income, working hours, knowledge, and attitude toward PPE. Participants earning more than 10,000 ETB (AOR = 2.31; 95% CI: 1.31, 4.10), those working 40 hours or less per week (AOR = 0.53; 95% CI: 0.29, 0.96), respondents with good knowledge (AOR = 1.88; 95% CI: 1.30, 2.72), and those with a positive attitude (AOR = 1.70; 95% CI: 1.13, 2.58) had higher odds of utilizing PPE at a P-value < .05.

Conclusion

Only about half of the health professionals regularly used personal protective equipment, indicating a considerable gap in adherence to safety practices. Higher income, reasonable working hours, good knowledge, and a positive attitude were key factors that enhanced utilization. Therefore, healthcare institutions and stakeholders should strengthen continuous training, ensure adequate availability of PPE, and promote supportive working conditions to encourage consistent utilization.

Keywords

personal protective equipment utilization public hospitals health care professionals Ethiopia

Introduction

Personal protective equipment (PPE), including gloves, masks, gowns, helmets, and goggles, is essential for safeguarding healthcare professionals against exposure to infectious agents, hazardous chemicals, and other occupational risks encountered during routine clinical practice (Ludy & Eyre, 2024).

Healthcare facilities play a vital role in delivering diagnostic, preventive, and curative services. While providing these services, healthcare professionals are frequently exposed to occupational hazards, particularly contact with blood and other body fluids through needle stick injuries, sharp-related accidents, and fluid splashes. Such exposures place healthcare workers at increased risk of blood-borne infections, including hepatitis B, hepatitis C, HIV/AIDS, and other communicable infectious diseases (Muleta et al., 2025; Nicholson, 2020). Appropriate and consistent use of PPE protects healthcare professionals from occupational exposures, prevents cross-infection, and ultimately enhances patient safety (Alemu et al., 2020).

Globally, the use of PPE is a mandatory occupational health requirement aimed at preventing workplace-related illness and injury. Within healthcare systems, such equipment serves as a critical protective barrier between healthcare professionals and potentially infectious materials, thereby reducing the risk of occupational exposure and disease transmission (Ashari, 2022). Effective infection prevention depends on the appropriate selection of PPE based on the nature of the task and the level of exposure. Hospitals are expected to implement an integrated infection prevention strategy that incorporates administrative, engineering, and PPE control measures. This approach requires healthcare institutions to ensure proper hazard assessment, availability and maintenance of equipment, and adequate staff training, while healthcare professionals are responsible for using PPE correctly and consistently (Guan et al., 2019; Madziatera, 2020).

Despite the critical importance of PPE, its utilization remains suboptimal across many healthcare settings and requires explanation through a conceptual framework of behavioral determinants. Understanding PPE utilization requires moving beyond descriptive recommendations toward a theoretical explanation of how individual and organizational factors influence behavior (Torrence et al., 2023). In this study, PPE utilization is conceptualized as a health-protective behavior influenced by individual, organizational, and environmental determinants (Aguwa et al., 2016; Otu et al., 2016).

The World Health Organization estimates that, of the approximately 35 million healthcare workers worldwide, about three million experience occupational exposure to blood each year, resulting in an estimated 150,000 hepatitis C, 70,000 hepatitis B, and 500 HIV infections (Yenesew & Fekadu, 2014). More than 90% of these infections occur in developing countries, particularly in sub-Saharan Africa (Reda et al., 2021). Furthermore, 34% of occupational accidents are attributable to PPE nonuse and 13% to improper use. In resource-limited settings, structural constraints such as inadequate supply, limited training opportunities, and high patient load may increase barriers and reduce perceived control over PPE use (Jafaralilou et al., 2019; Savoia et al., 2020).

The utilization of PPE varies widely across settings, with reported rates of 18.1% in India (Haji et al., 2020), 4.3% in southeast Nigeria (Lakshmi et al., 2018), and 45.7% in Kenya (Usman, 2021). In Ethiopia, PPE utilization has been reported at 32% in South Wollo, 55.3% in Debre Markos town, and 78.2% at Adare Comprehensive Hospital, while access to occupational health services remains very limited, with only 5–10% of workers covered (Alamneh et al., 2020; Keleb et al., 2021; Teym & Zeleke, 2025).

Almost half of Ethiopian health care workers experience occupational injuries, mainly due to unsafe working conditions, inadequate PPE, heavy workloads, and limited occupational health and safety services (Bijani, 2013; Hassanipour et al., 2021). Beyond the physical risks, healthcare workers exposed to blood borne infections experience psychological problems such as anxiety and depression, which negatively affect the quality of services. The CDC’s Universal Precautions and infection prevention policies of Ethiopia aim to reduce such risks; however, low compliance persists due to poor training, resource shortages and limited institutional support (Adeleye et al., 2020; Appiagyei et al., 2021; Manyazewal & Matlakala, 2018; Saia et al., 2010; World Health Organization, 2020a).

This study uses an integrated framework combining socio-demographic, behavioral (knowledge and attitude), and organizational factors (working conditions and resources) to explain PPE utilization. While conducted in public hospitals in Northwest Ethiopia, the findings are relevant to other low- and middle-income countries facing similar challenges, such as limited PPE supply, workforce shortages, high patient loads, and gaps in infection prevention training. Determinants like income, workload, knowledge, and attitudes reflect systemic and behavioral factors reported globally. These insights can inform policy, training, and institutional strategies to improve PPE adherence and protect healthcare workers in comparable resource-limited settings.

Review of Literature

Recent global evidence indicates that proper utilization of PPE remains a major challenge, particularly in low- and middle-income countries. During the COVID-19 pandemic, substantial gaps in both availability and use of PPE items were reported across multiple low- and middle-income countries (LMICs), with only about 43% of health facilities having a complete set of recommended PPE, and proper use still below recommended standards even when items were available (Drouard et al., 2023).

The World Health Organization (WHO) guidance on rational use of PPE emphasised that consistent and correct use is essential to infection prevention and control and highlighted strategies for PPE distribution and management during severe shortages, particularly in resource-constrained settings (World Health Organization, 2020b). Further, a global systematic review and meta-analysis stated that occupational exposure to blood and body fluids remains a significant risk for healthcare workers worldwide, underscoring the urgent need for strengthened PPE compliance and infection control measures to protect frontline staff and reduce preventable exposures to infectious agents (Mengistu et al., 2022).

In addition to exposure risk, multiple studies have documented barriers to PPE access and usage in low-resource settings. National survey evidence from eight LMICs shows that basic PPE items such as eye protection were often among the least available, and fewer than 13% of facilities had all PPE items measured in the study, demonstrating widespread shortages that compromise infection prevention capacity (Hakim et al., 2024). These availability gaps contribute to poor PPE utilization, as also demonstrated in Ethiopia and other LMICs where inadequate training, inconsistent supply, and weak institutional support were major determinants of non-compliance with recommended practices (Deressa et al., 2021).

Behavioural and organizational factors also play a role in PPE practices. A Cochrane review on PPE use for preventing highly infectious diseases found that structured training and user-oriented guidance may improve correct usage, although evidence remains limited and often low-certainty, especially in African contexts (Iwu et al., 2020). Despite increasing research attention during and after the COVID-19 pandemic, there remains limited updated evidence from public hospitals in Northwest Ethiopia and similar low-resource healthcare settings. This lack of context-specific data highlights a gap in understanding how organizational, behavioral, and supply-side factors interact to influence PPE utilization among healthcare workers in these environments. Therefore, this study contributes recent empirical evidence to address this gap and inform occupational health interventions to improve PPE adherence and protect healthcare workers in resource-limited settings.

Method and Materials

Study Area and Period

The study was conducted East Gojjam Zone, Ethiopia, which has a total of 11 public hospitals: one comprehensive specialized hospital (Debre Markos), one general hospital (Motta), and nine primary hospitals distributed across various woredas. These hospitals serve both urban and rural communities, providing services such as outpatient care, surgery, and maternal health. They operate within a decentralized health system and serve as referral centers for nearby health facilities (Damtew et al., 2024). The data collection was carried out from February 15 to April 15, 2025, in Dejen Hospital, Bichena Hospital, Lumamie Hospital, and Shebel Berenta Hospital.

Study Design

A hospital-based cross-sectional study design was conducted.

Source Population

All healthcare workers working in selected public hospitals of East Gojjam Zone, Ethiopia during the study period.

Study Population

All health professionals working in randomly public hospitals of East Gojjam Zone, Ethiopia during the study period.

Study Unit

Selected health professionals working in selected public hospitals of East Gojjam Zone, Ethiopia, during the study period and that fulfill inclusion criteria.

Inclusion Criteria

All health professionals working in selected public hospitals found in East Gojjam Zone, Ethiopia during the data collection period. Health care worker who had direct contact with patients in the selected hospital.

Exclusion Criteria

Health professionals who were not available on the day of data collection due to annual leaves or sick leaves and Health care workers who had working duration of less than six month in the selected hospital.

Sample Size Determination

Sample size was determined using the single population proportion formula, assuming a prevalence of 50%, a 95% confidence interval, and a 5% margin of error. The 50% prevalence was used because there was no consistent or reliable estimate of PPE utilization in similar settings, and this assumption provides the maximum sample size, ensuring adequate statistical power. In addition, previous studies in Ethiopia have reported widely varying PPE utilization rates, further supporting the use of a conservative estimate. Based on these assumptions, the formula is as follows:

n = \frac{\frac{(Z α) 2}{2} P (1 - P)}{d^{2}}

Were

P = proportion of PPE utilization (0.50)

d = Margin of sampling error (5%)

A (Z a/2) = Critical value at 95% confidence interval of certainty (1.96)

= n = \frac{{(1.96)}^{2} * 0.50 (1 - 0.50)}{{(0.05)}^{2}} n = 384

n₀ = initial sample size = 384. An additional 10% was added to account for potential non-responses, resulting in a final sample size of 422.

Sampling Procedure/Technique/

Out of the eleven public hospitals in East Gojjam Zone, four were selected using simple random sampling based on a complete list obtained from the zonal health office. The total number of eligible healthcare workers in these hospitals was identified from human resource records (N = 1,060). The final sample size (n = 422) was proportionally allocated to each hospital and further distributed across departments according to the number of eligible staff. Study participants were then selected using simple random sampling from departmental staff lists, which served as the sampling frame.

Study Variables

Dependent Variable

PPE utilization.

Independent Variables

Socio-demographic and economic characteristics: Sex, Age, marital status, educational status, Average monthly income. Work environment and work-related characteristics: Profession, Service years in current unit experience, Availability of shift work, Availability of committee, Training on safety, working hours per week, working department, Availability of PPE and Availability of safety guidelines. Behavioral factors: Use of PPE, Use of safety guide line, Disposal of waste, needles and sharps and following universal precautions.

Previous exposure to injury: Has history of exposure, type of injury and action taken.

Operational Definitions and Terms

PPE

Refers to protective clothing, helmets, gloves, face shields, goggles, facemasks and other equipment designed to protect the wearer from injury and the spread of infection (Getachew, 2022).

Proper Utilization of PPE

Proper utilization of PPE was assessed using a 20-item structured questionnaire with dichotomous (Yes/No) response options. Each item measured a specific PPE practice, and responses were coded as “1” for correct practice (Yes) and “0” for incorrect practice (No). A composite PPE utilization score was calculated by summing the responses across all 20 items, yielding a total score ranging from 0 to 20. The internal consistency of the scale was confirmed using Cronbach’s alpha (α = 0.82). Participants who scored 70% or higher (i.e., ≥ 14 out of 20 items) were classified as having good (adequate) PPE utilization, while those scoring below 70% (<14 items) were considered to have poor (inadequate) PPE utilization, consistent with previous studies (Atinafu Ataro et al., 2017).

Knowledge

Knowledge of PPE was assessed using structured questions. Each correct response was scored as 1 and incorrect response as 0. The total knowledge score was computed for each participant, and those scoring above or equal to the mean value were categorized as having good knowledge, while those scoring below the mean were categorized as having poor knowledge (Alemu et al., 2020).

Attitude

Attitude toward PPE utilization was measured using Likert-scale items (e.g., strongly agree to strongly disagree). Responses were scored and summed to generate an overall attitude score. Participants scoring above or equal to the mean were categorized as having a favorable attitude, while those scoring below the mean were categorized as having an unfavorable attitude (Atinafu Ataro et al., 2017).

Health Care Workers

Health professionals, including nurses, physicians, midwives, and health officers, have frequent contact with blood and body fluids (Yenesew & Fekadu, 2014).

Data Collection Tool and Procedure

Data were collected using a standardized, structured self-administered questionnaire (Supplemental file 1) adapted from the World Health Organization Infection Prevention and Control Assessment Framework and relevant literature conducted in similar low-resource settings (World Health Organization, 2018). The questionnaire assessed socio-demographic characteristics, work environment and work-related factors, behavioural factors, previous exposure to injury, knowledge of PPE, attitudes toward PPE, and PPE utilization practice.

To ensure contextual relevance and clarity, the tool was translated into Amharic and then back-translated into English by independent bilingual experts. A pretest was conducted on 5% of the sample in a non-selected hospital to evaluate clarity, feasibility, and consistency. Internal consistency of the multi-item scales was assessed using Cronbach’s alpha. The knowledge scale, consisting of 15 items, demonstrated good reliability (α = 0.78). The attitude scale, with 10 items, showed acceptable reliability (α = 0.72). The PPE utilization practice scale, comprising 20 items, demonstrated good reliability (α = 0.81). The final questionnaire consisted of seven sections covering socio demographic and economic characteristics work environment and work related factors behavioral factors previous exposure to injury attitudes toward PPE knowledge of PPE and PPE utilization which included 20 yes or no items Data were collected at the facility level by trained data collectors Four BSc nurses and four environmental health supervisors were recruited from the selected hospitals and received two days of training prior to data collection.

Data Quality Assurance

To ensure data quality, first the data collection tool was checked for internal consistence of each question. Training of the data collectors and supervisors was undertaken for two days by the principal investigator on the objectives, relevance of the study, methods of data collection, confidentiality of information and informed consent. Pre–test was done by taking 5% of the sample size in hospital which is not included in the study (Motta general hospital) before the actual data collection work started to check for the accuracy of responses and to estimate time needed. Then questionnaire was adjusted accordingly. Daily discussions and check-ups of data completeness was made with supervisor and the principal investigator.

Data Processing and Analysis

Data were checked for completeness and consistency before being entered into EpiData version 3.1 and exported to SPSS version 27 for analysis. Descriptive statistics were used to summarize participant characteristics; however, the primary focus of the analysis was to identify determinants of PPE utilization. Accordingly, binary logistic regression analysis was first performed to assess the association between each independent variable and PPE utilization. Variables with a p-value ≤ 0.25 in the bivariate analysis were selected as candidates for the multivariable logistic regression model to avoid excluding potential confounders. Multivariable logistic regression was then conducted to identify independent determinants while controlling for confounding variables. Multicollinearity among independent variables was assessed using the Variance Inflation Factor (VIF), with a cutoff value of less than 10 considered acceptable. All variables included in the final model had VIF values below 2.5, indicating no significant multicollinearity. Adjusted odds ratios with 95% confidence intervals were used to measure the strength of associations, and statistical significance was declared at p < .05. Model fitness was assessed using the Hosmer–Lemeshow goodness-of-fit test.

Results

Socio-Demographic Characteristics of the Respondents

A total of 422 eligible health professionals were approached, and 416 participated, yielding a response rate of 98.6%. Of the participants, 214 (51.4%) were females and 202 (48.6%) were males. The mean age of the respondents was 29.4 years (SD ± 6.2). The majority, 239 (57.5%), were in the age group of 25–35 years. Nearly half, 200 (48.1%), were single, while 165 (39.7%) were married. Most held a degree (59.8%) and were permanent employees (95.9%), reflecting a relatively stable workforce. Regarding monthly income, 32.0% earned 6,500–10,000 ETB, followed by 29.8% earning 3,500–6,500 ETB (Table 1).

Table 1.

Socio-Demographic Characteristics of Health Care Professionals in Public Hospitals in Resource-Limited Settings, 2025

Variables	Category	Frequency	Percent
Sex	Male	202	48.6
Sex	Female	214	51.4
Age	<25 years	42	10.1
	25-35 years	231	55.5
	>35 years	139	34.4
Marital status	Married	165	39.7
	Single	200	48.1
	Divorced	32	7.7
	Widowed	19	4.5
Educational status	Diploma	42	10.1
	Degree	249	59.8
	Masters and above	125	30.1
Employment pattern	Permanent	398	95.7
Employment pattern	Temporary	18	4.3
Monthly income (ETB)	<3500	53	12.7
	3500-6500	124	29.8
	6500-10000	133	32.0
	>10000	106	25.5

Work Environment and Work-Related Factors

Among 416 healthcare professionals, nurses constituted 45.4%, followed by physicians (18.0%). Most participants had more than three years of experience (55.2%) and worked ≥40 hours per week (84.1%). Although PPE was available to 76.0% of respondents, only 24.0% had received infection prevention training, and regular PPE provision was limited, with just 7.7% reporting daily access. Detailed information is presented in (Table 2).

Table 2.

Work Environment and Work-Related Factors of Health Care Professionals in Public Hospitals in Resource-Limited Settings, 2025

Variables	Category	Frequency	Percent
Profession	Doctors	75	18.0
	Nurse	189	45.4
	Others	152	36.6
Current unit you are assigned to work	Surgery	32	7.6
	Emergency	57	13.7
	Laboratory	27	6.5
	Inpatient	83	20.0
	OPD	76	18.3
	Pediatrics	21	5.0
	GynObs	72	17.3
	Others	48	11.5
Duration of working in current section	<3months	107	25.7
Duration of working in current section	>=3 months	309	67.9
Total service year in the health facility	<1	45	10.8
	1-3	158	40.0
	>3	213	55.2
Average hours working in the public hospital per week	<40hr	66	15.9
Average hours working in the public hospital per week	>=40hr	350	84.1
Number of patients/clients attended per day	<20patient	206	49.5
Number of patients/clients attended per day	>=20patient	210	50.5
Presence of infection prevention committee in the public hospital	Yes	259	62.3
	No	157	37.7
Training on IP in the last 1 year	Yes	100	24.0
Training on IP in the last 1 year	No	316	76.0
Presence of safety guidelines	Yes	254	61.1
Presence of safety guidelines	No	162	38.9
Availability of supervision last one year	Yes	253	60.8
Availability of supervision last one year	No	163	39.2
Availability of PPE at your working department	Yes	316	76.0
Availability of PPE at your working department	No	100	24.0
Frequency PPE provided to your work station	every day	32	7.7
	every week	211	50.7
	every month	131	31.0
	Others	42	10.6

Participants’ Behavioural Factors

A total of 79.1% of respondents reported regularly applying universal precautions, and 73.8% consistently used PPE. Among PPE users, 86.7% reported always using it, while 13.3% used it only occasionally. Regarding job satisfaction, 33.9% of participants were neutral, 33.4% unsatisfied, 16.1% satisfied, 15.1% very unsatisfied, and only 1.4% very satisfied. Moreover, 74.8% of respondents reported regular use of safety containers for waste disposal (Table 3).

Table 3.

Participants’ Behavioral Factors Related to PPE Utilization and Practice of Health Care Professionals in Public Hospitals in Resource-Limited Settings, 2025

Variables	Category	Frequency	Percent
regularly apply universal precautions	Yes	329	79.1
regularly apply universal precautions	No	87	20.9
Regularly use PPE’s	Yes	307	73.8
Regularly use PPE’s	No	109	26.2
Frequency of using PPE	Always	266	86.7
Frequency of using PPE	Occasionally	41	13.3
Satisfaction with your job	very unsatisfied	63	15.1
	Unsatisfied	139	33.4
	Neutral	141	33.9
	Satisfied	67	16.1
	very satisfied	6	1.4
Regular use safety containers	Yes	311	74.8
Regular use safety containers	No	105	25.2

Occupational Injury Related to PPE Practice

In the past 12 months, 25.5% of healthcare professionals reported occupational injuries. Among those injured, 45.3% experienced a single injury, while 29.2% reported four or more incidents. The leading causes were medical waste spillage (44.3%) and droplet exposure (43.8%), with injuries most frequently occurring in the laboratory (64.2%) and delivery units (44.3%). Despite the availability of reporting protocols (66.3%) and safety guidelines (52.6%), only 50.0% of injuries were reported, and regular preventive practices such as training and timely response remained limited. Detailed results are presented in (Table 4).

Table 4.

History of Occupational Injury Related to PPE Utilization and Practice of Health Care Professionals in Public Hospitals in Resource-Limited Settings, 2025

Variables	Category	Frequency	Percent
Faced an occupational injury at work place in the last twelve months	Yes	106	25.5
	No	310	74.5
Frequency of injury	Once	48	45.3
	Twice	27	25.5
	four and above	31	29.2
Item caused this injury? (Including needles and Sharps	spillage of medical waste	47	44.3
	droplet from the mouth and nose	45	43.8
	syringe needle, lancet and surgical	28	26.4
Unit of injury occurred	OPD	7	6.6
	injection and dressing room	18	17.0
	Delivery	47	44.3
	Emergency	17	15.7
	Laboratory	68	64.2
Reason to sustain the injury	during injection	22	20.8
	Recapping	16	15.0
	Others	99	94.3
Action taken after the injury	Yes	6	5.7
Action taken after the injury	No	73	72.3
Immediate action after the injury	washing with soap and water	22	21.8
	get tested for HIV	6	5.9
	take PEP	53	50.0
Reporting the injury to IPC department	Yes	53	50.0
Reporting the injury to IPC department	No	140	33.7
Availability of protocol for reporting	Yes	276	66.3
Availability of protocol for reporting	No	197	47.4
Availability of safety guidelines	Yes	219	52.6
Availability of safety guidelines	No	106	25.5

Knowledge of Participants About Proper Utilization of PPE

Two hundred forty-four (58.7%) of the study participants scored at or above the mean on the knowledge assessment and were categorized as having above-average knowledge relative to the study population (Figure 1).

Figure 1.

Knowledge of participants about proper utilization of PPE of health care professionals in public hospitals in resource-limited settings, 2025

Attitude of Participants Towards Proper Utilization of PPE

239 (57.5%) of participants scored at or above the mean on the attitude scale and were categorized as having above-average attitude toward PPE relative to the study population (Figure 2).

Figure 2.

Attitude of participants towards proper utilization of PPE of health care professionals in public hospitals in resource-limited settings, 2025

Level of Practice of PPE Utilization

Of the total 416 participants, 215 (51.7%; 95% CI: 46.4–55.8) were classified as having good PPE utilization, based on correctly answering ≥ 14 out of 20 PPE items on the questionnaire (Figure 3).

Figure 3.

Level of practice of PPE utilization of health care professionals in public hospitals in resource-limited settings, 2025

Factors Associated With PPE Utilization

In the multivariable logistic regression analysis, several variables were examined for their independent association with PPE utilization. Age, profession, employment pattern, number of patients attended per day, frequency of PPE use, and availability of PPE at the working department were not significantly associated with PPE utilization after adjustment for potential confounders. However, after controlling for other variables, average monthly income, working hours per week, knowledge about PPE, and attitude toward PPE were found to be significantly associated with PPE utilization at p < .05.

Participants earning 6,500–10,000 ETB had 1.92 times higher odds of using PPE compared to those earning less than 3,500 ETB (AOR = 1.918; 95% CI: 1.110–3.300), while those earning more than 10,000 ETB had 2.31 times higher odds of using PPE (AOR = 2.312; 95% CI: 1.308–4.096). Health professionals working more than 40 hours per week were significantly less likely to use PPE compared to those working 40 hours or less (AOR = 0.532; 95% CI: 0.290–0.956). Moreover, participants with above-average knowledge about PPE were 1.88 times more likely to use PPE compared to those with below-average knowledge (AOR = 1.88, 95% CI: 1.30–2.72), and those with a positive attitude toward PPE had 1.70 times higher odds of practicing proper PPE use compared to those with a negative attitude (AOR = 1.700; 95% CI: 1.130–2.580) (Table 5).

Table 5.

Multiple Regression Table on Utilization of PPE and Associated Factors of Health Care Professionals in Public Hospitals in Resource-Limited Settings, 2025

Variables	Category	PPE utilization		COR	AOR	P value
Variables	Category	Yes	No	COR	AOR	P value
Age of the respondents	<25 years	27	16	1	1
	25-35 years	117	115	0.603 (0.340–1.100)	0.625 (0.350–1.120)	0.110
	>35 years	71	70	0.601 (0.320–1.150)	0.620 (0.330–1.180)	0.130
Average monthly income	<3500	23	30	1	1	-
	3500-6500	43	81	0.690 (0.390–1.230)	0.710 (0.390–1.280)	0.250
	6500-10000	80	53	1.972 (1.160–3.360)	1.918 (1.110–3.300)	0.120
	>10000	69	37	2.426 (1.378–4.278)	2.312 (1.308–4.096)	0.004
Employment pattern	Permanent	202	196	1	1	-
Employment pattern	Temporary	13	5	2.52 (0.600–5.440)	1.750 (0.580–5.250)	0.320
Working hour/weeks	<=40hr	46	20	1	1	-
Working hour/weeks	>40hr	169	181	0.514 (0.280–0.930)	0.532 (0.290–0.956)	0.035
Profession	Doctor	40	35	1	1	-
	Nurse	98	91	0.940 (0.551–1.613)	0.91 (0.523–1.589)	0.740
	Other	77	75	0.901 (0.521–1.550)	0.883 (0.49–1.561)	0.660
Number of patient attended per days	<=20patient	105	101	1	1	-
Number of patient attended per days	>20patient	110	100	0.954 (0.620–1.460)	0.970 (0.630–1.500)	0.880
Availability of PPE	No	45	55	1	1	-
Availability of PPE	Yes	170	146	1.121 (0.702–1.804)	1.050 (0.635–1.747)	0.840
Frequency of using PPE	Occasionally	30	11	1	1	-
Frequency of using PPE	Always	185	190	0.919 (0.450–1.880)	0.940 (0.460–1.920)	0.870
knowledge	Poor knowledge	72	98	1	1	-
knowledge	Good knowledge	143	101	1.930 (1.350–2.770)	1.880 (1.300–2.720)	0.003
Attitude	Negative attitude	74	96	1	1	-
Attitude	Positive attitude	141	105	1.740 (1.150–2.630)	1.700 (1.130–2.580)	0.005

Discussion

The overall PPE utilization in this study was 51.7% (95% CI: 46.4–55.8), which is higher than reported in St. Francis Hospital, Uganda (33.3%) (Osman et al., 2022), Tamil Nadu in India (18.1%) (Lakshmi et al., 2018), South East Nigeria (4.3%) (Aguwa et al., 2016), Kenya (45.7%) (Usman, 2021), and Eastern Ethiopia (37.6%) (Birhanu et al., 2021), and South Wollo Zone, Ethiopia (32%) (Keleb et al., 2021). On the contrary the finding is lower than from study done at, Adare Comprehensive Hospital, Ethiopia 78.2% (Atinafu Ataro et al., 2017), PhiBela edible oil factory workers in Burie (Teym et al., 2025). Differences across countries may stem from variations in health system capacity, PPE supply, workforce training, and safety culture. Yet common barriers such as insufficient training, high workload, and limited resources appear in both LMICs and high-income settings during crises like COVID-19. This indicates these factors reflect broader occupational health challenges. Interventions targeting knowledge, workload, and behavior may be broadly relevant, though causal links cannot be inferred from this cross-sectional study (Amoakoh-Coleman et al., 2016). Overall, the findings of this study are largely consistent with evidence from other low-resource healthcare settings, reinforcing the generalizability of the identified associations (Ataro et al., 2024; Tolera et al., 2025).

In this study, several factors were found to have a statistically significant association with PPE utilization among health professionals. These included average monthly income, working hours per week, knowledge, and attitude toward PPE use. In this study, income was found to be a significant factor associated with PPE utilization among health professionals. Those earning above 10,000 ETB per month had 2.31 times higher odds of using PPE compared to those earning less than 3,500 ETB (AOR = 2.312, 95% CI: 1.308–4.096). This finding is supported by previous studies (Dong et al., 2025; Drouard et al., 2023; Migheli, 2021). Similarly, participants with lower income had lower odds of utilizing PPE, which is consistent with the results of earlier studies (Boakye et al., 2022; Sarfraz et al., 2020). This association may be explained by differences in access to resources, perceived control over health, and workplace conditions. Individuals with higher income may have better access to PPE and work in environments with stronger safety practices and supervision, which may support PPE utilization (Capasso et al., 2022). Higher income may also reflect better job positions with improved access to PPE and a stronger organizational culture emphasizing occupational safety. Similar findings have been reported in other studies, where higher income was positively associated with adherence to PPE use among healthcare professionals (Savoia et al., 2020).

Health professionals working more than 40 hours per week had 0.53 times lower odds of using PPE compared to those working 40 hours or less (AOR = 0.532; 95% CI: 0.290–0.956), this is also in line with a study conducted in six countries (Kim et al., 2021). Extended working hours can induce cognitive fatigue, stress, and burnout, which impair attention and decision-making, leading to lower adherence to PPE protocols. From a theoretical perspective, prolonged exposure to high workload may overwhelm healthcare workers’ coping capacities and reduce perceived behavioral control over safe practices, as suggested by the theory of planned behavior. Organizational factors, such as insufficient staffing and high patient load, may compound these effects, creating systemic barriers to consistent PPE use. Long working hours can also lead to burnout, which negatively affects safety practices. This finding emphasizes the importance of managing workloads effectively to help health workers use PPE properly and stay protected from work-related hazards (Koh et al., 2011).

One of the important findings of this study was that participants with above-average knowledge about PPE were 1.88 times higher odds of using PPE than those with below-average knowledge (AOR = 1.88, 95% CI: 1.30–2.72). This result is consistent with findings from Kembata Tembaro Zone (Tesfahun, 2020)., where health professionals with better knowledge demonstrated higher PPE utilization rates, and is also in line with previous studies conducted in public hospitals in Eastern Ethiopia (Tolera et al., 2024). Greater knowledge may be associated with improved awareness of occupational risks and the importance of consistent PPE use (Verbeek et al., 2020). Training and continuous professional education may therefore support appropriate PPE practices (Ataro et al., 2024; Atinafu Ataro et al., 2017).

Furthermore, in this study, respondents who had an above-average attitude toward PPE were 1.70 times more likely to utilize it compared to those with below-average attitude (AOR = 1.70, 95% CI: 1.13–2.58), which is consistent with findings from studies conducted in Bangladesh (Hossain et al., 2021), St. Francis Hospital (Osman et al., 2022), Slamet Hospital Garut (Khoerudin et al., 2020), and Addis Ababa, Ethiopia (Tadesse et al., 2020). A positive attitude may be associated with increased motivation, self-efficacy, and adherence to safety practices. This suggests that behavior change communication and motivation programs may help improve PPE utilization.

Strengths and Limitations of the Present Study

This study has several strengths. First, it included a relatively large sample size with a high response rate (98.6%), which enhances the reliability of the findings. Second, the study employed multivariable logistic regression analysis to control for potential confounders, improving the validity of associations identified. Third, the study incorporated multiple dimensions including socio-demographic, work-related, behavioral, knowledge, and attitude factors, providing a comprehensive assessment of determinants of PPE utilization.

However, certain limitations should be acknowledged. The cross-sectional design precludes establishing causal relationships between the identified factors and PPE utilization. In addition, PPE utilization, knowledge, and attitude were assessed using self-reported measures, which may be affected by social desirability and recall bias, potentially leading to overestimation of safe practices. Furthermore, the use of the mean score as a cut-off point to categorize utilization, knowledge, and attitude may not reflect standardized or clinically meaningful thresholds and could result in misclassification of participants. Accordingly, the findings should be interpreted with caution.

Implications for Practice

The findings of this study have important implications for occupational health practice and policy in resource-limited healthcare settings. Healthcare institutions should prioritize regular and structured infection prevention training to improve knowledge and attitudes toward personal protective equipment (PPE) utilization, while ensuring a continuous and adequate supply of PPE at the point of care to enhance compliance. Addressing workload and excessive working hours is also essential to reduce fatigue-related non-compliance. Strengthening infection prevention committees and supportive supervision mechanisms can further promote consistent PPE use, and integrating occupational safety indicators into routine hospital performance evaluation frameworks may improve accountability and sustainability. Within this broader system, nurses, as the largest group of frontline healthcare providers, play a central role in translating these measures into practice; therefore, empowering nurses through targeted PPE training, supportive supervision, and active involvement in infection prevention committees is critical. Nurse Managers should reinforce adherence to PPE protocols through continuous monitoring, mentorship, and role modelling, while also engaging in patient and family education on infection prevention practices. Strengthening nursing capacity in these areas will enhance PPE compliance and contribute to a safer healthcare environment.

Conclusion

Almost half of (51.7%) health professionals regularly used PPE, indicating a considerable gap in adherence to safety practices. Higher income, reasonable working hours, good knowledge, and a positive attitude were key factors associated with higher utilization. Therefore, it is recommended that healthcare institutions and relevant stakeholders strengthen continuous training programs to improve knowledge and attitudes toward PPE use, ensure the availability and accessibility of protective materials, and promote supportive working conditions that encourage consistent utilization.

Supplemental Material

Supplemental Material - Utilization of Personal Protective Equipment and Its Determinants among Health Care Professionals in Public Hospitals in Resource-Limited Settings

Supplemental Material for Utilization of Personal Protective Equipment and Its Determinants among Health Care Professionals in Public Hospitals in Resource-Limited Settings by Abraham Teym, Mekonnen Moges, Balew Adane, Yenewa Bewket, Tirsit Ketsela Zeleke, Abrham Keffale Mengistu, Getnet Gedif and Ayenew Negesse in Sage Open Nursing.

Footnotes

Acknowledgments

First, the authors would like to thank Debre Markos University’s College of Health Sciences for providing us with an ethical clearance letter and writing a letter of support for the study area. Second, East Gojjam zone health office administrator deserves our gratitude for giving us all the data we needed for this study. Last but not least, the authors express gratitude to all of the health care workers who responded to the survey for their willingness to participate.

ORCID iD

Abraham Teym

Ethical Considerations

This study was approved by Debre Markos University’s College of Medicine and Health Science College Ethical Review Committee with approval number of Ref No: CHS/PGC/385/02/2025.

Consent to Participate

Data collectors explained the purpose of the investigation, its benefits, and its procedures to each potential respondent, and any respondent seeking further clarification was assisted. The written informed consent to participate was then obtained from all participants before the start of the study. Any person unwilling to participate was not forced to do so and any person wishing to withdraw at any time during the study was free to do so. Confidentiality and privacy were strictly maintained. Only the principal investigator and research assistants accessed the data. In general, the study was carried out in accordance with the Declaration of Helsinki of the World Medical Association (WMA).

Author Contributions

Abraham Teym contributed to the conceptualization, methodology, formal analysis, investigation, data curation, and writing of the original draft. Mekonnen Moges and Balew Adane contributed to the methodology and critically reviewed and edited the manuscript. Yenewa Bewket and Tirsit Ketsela Zeleke were involved in the investigation and manuscript review and editing. Abraham Keffale Mengistu contributed to data curation and manuscript review and editing. Getnet Gedif and Ayenew Negesse contributed to manuscript review and editing and provided supervision of the study. All authors read and approved the final manuscript.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

The datasets analysed during the current study are available from the corresponding author upon reasonable request.*

Supplemental Material

Supplemental material for this article is available online.

References

Adeleye

Adeyemi

Oyem

Akindokun

Ayanlade

(2020). Rational use of personal protective equipment (PPE) among health workers in COVID-19 frontline. European Journal of Pharmaceutical and Medical Research, 7(12), 445–451.

Aguwa

E. N.

Arinze-Onyia

S. U.

Ndu

(2016). Use of personal protective equipment among health workers in a tertiary health institution, South East Nigeria: Pre-Ebola Period. International Journal of Health Sciences and Research, 6(8), 12–18.

Alamneh

Y. M.

Wondifraw

A. Z.

Negesse

Ketema

D. B.

Akalu

T. Y.

(2020). The prevalence of occupational injury and its associated factors in Ethiopia: a systematic review and meta-analysis. Journal of occupational medicine and toxicology, 15(1), 14. https://doi.org/10.1186/s12995-020-00265-0

Alemu

A. A.

Yitayew

Azazeh

Kebede

(2020). Utilization of personal protective equipment and associated factors among building construction workers in Addis Ababa, Ethiopia, 2019. BMC Public Health, 20(1), 794. https://doi.org/10.1186/s12889-020-08889-x

Amoakoh-Coleman

Agyepong

I. A.

Kayode

G. A.

Grobbee

D. E.

Klipstein-Grobusch

Ansah

E. K.

(2016). Public health facility resource availability and provider adherence to first antenatal guidelines in a low resource setting in Accra, Ghana. BMC Health Services Research, 16(1), 505. https://doi.org/10.1186/s12913-016-1747-1

Appiagyei

Nakua

E. K.

Donkor

Mock

(2021). Occupational injuries among health care workers at a public hospital in Ghana. Pan African medical journal, 39(1), 103. https://doi.org/10.11604/pamj.2021.39.103.23542

Ashari

M. R.

(2022). Occupational disease prevention strategies through ohs interventions: global evaluation and challenges. Journal of Health Literacy and Qualitative Research, 2(2), 66–80. https://doi.org/10.61194/jhlqr.v2i2.531

Ataro

B. A.

Bilate

D. S.

Mulatu

Geta

Agana

Endirias

E. E.

Bolado

G. N.

Toru

Kebede

Haile

K. E.

Mulualem Gete Feleke (2024). Knowledge, attitude, and practice of personal protective equipment utilization among health care workers. International Journal of Africa Nursing Sciences, 20, 100658. https://doi.org/10.1016/j.ijans.2024.100658

Atinafu Ataro

Bilate

D. S.

Addisie

GebreMickael

Dinku

Mulatu

(2017). Knowledge, Attitude and Practice on Personal Protective Equipment Utilization Among Health Care Workers at Adare Comprehensive Hospital, Ethiopia, 2017. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3770672

10.

Bijani

(2013). Epidemiology and risk factors of needle stick injuries. Advances in Nursing & Midwifery. 22(78), 1–9.

11.

Birhanu

Balis

Assebe Yadeta

Bayu

(2021). Personal protective equipment utilization practice and psychological preparedness of health care workers against COVID-19 pandemic in Eastern Ethiopia. 9, 20503121211051925. Sage Open Medicine. https://doi.org/10.1177/20503121211051925

12.

Boakye

M. K.

Adanu

S. K.

Coffie

G. H.

Adzivor

E. K.

Ayimah

J. C.

(2022). Building construction artisans’ level of access to Personal Protective Equipment and the perceived barriers and motivating factors of adherence to its use. Journal of Environmental and Public Health, 2022(1), 4870731. https://doi.org/10.1155/2022/4870731

13.

Capasso

Kim

Ali

S. H.

Jones

A. M.

DiClemente

R. J.

Tozan

(2022). Employment conditions as barriers to the adoption of COVID-19 mitigation measures: how the COVID-19 pandemic may be deepening health disparities among low-income earners and essential workers in the United States. BMC Public Health, 22(1), 870. https://doi.org/10.1186/s12889-022-13259-w

14.

Damtew

B. S.

Gudayu

T. W.

Temesgan

W. Z.

Hailu

A. M.

(2024). Effect of decision-to-delivery time of emergency cesarean section on adverse newborn outcomes at East Gojjam Zone Public Hospital, Ethiopia, March 2023: multicenter prospective observational study design. International journal of women's health, 16, 433–450. https://doi.org/10.2147/IJWH.S451101

15.

Deressa

Worku

Abebe

Gizaw

Amogne

(2021). Availability and use of personal protective equipment and satisfaction of healthcare professionals during COVID-19 pandemic in Addis Ababa, Ethiopia. Archives of Public Health, 79(1), 146. https://doi.org/10.1186/s13690-021-00668-3

16.

Dong

J. J.

Vogel

Duysen

Rautiainen

(2025). Factors Associated with Personal Protective Equipment Usage Rates in the Central States: Generalized Multilevel Multinomial Models. Journal of Agromedicine, 30(1), 38–48. https://doi.org/10.1080/1059924X.2024.2407983

17.

Drouard

S. H. P.

Ahmed

Amor Fernandez

Baral

Peters

Hansen

Hashemi

Sieleunou

Iyabode Ogunlayi

Karibwami

A.-D.

Ruel Bergeron

Montufar Velarde

E. E.

Yansane

M. L.

Wesseh

C. S.

Mwansambo

Nzelu

Uddin

Tassembedo

Shapira

(2023). Availability and use of personal protective equipment in low-and middle-income countries during the COVID-19 pandemic. Plos one, 18(7), e0288465. https://doi.org/10.1371/journal.pone.0288465

18.

Getachew

(2022). Compliance with standard precautions and associated factors among undergraduate nursing students at governmental universities of Amhara region, Northwest Ethiopia, 2021. BMC nursing, 21(1), 375.

19.

Guan

L. R.

Xian

G. J.

Rajendran

S. D.

Wahab

S. N.

(2019). A study on the effectiveness of Personal Protective Equipment (PPE) on Building Construction Workers. E3S Web of Conferences.

20.

Haji

J. Y.

Subramaniam

Kumar

Ramanathan

Rajamani

(2020). State of personal protective equipment practice in Indian intensive care units amidst COVID-19 pandemic: a nationwide survey. Indian Journal of Critical Care Medicine, 24(9), 809–816. https://doi.org/10.5005/jp-journals-10071-23550

21.

Hakim

Chowdhury

M. A. B.

Uddin

M. J.

Leslie

H. H.

(2024). Availability of basic infection control items and personal protection equipment in 7948 health facilities in eight low-and middle-income countries: Evidence from national health system surveys. Journal of global health, 14, 04042. https://doi.org/10.7189/jogh.14.04042

22.

Hassanipour

Sepandi

Tavakkol

Jabbari

Rabiei

Malakoutikhah

Fathalipour

Pourtaghi

(2021). Epidemiology and risk factors of needlestick injuries among healthcare workers in Iran: a systematic reviews and meta-analysis. Environmental health and preventive medicine, 26(1), 43. https://doi.org/10.1186/s12199-021-00965-x

23.

Hossain

M. A.

Rashid

M. U. B.

Khan

M. A. S.

Sayeed

Kader

M. A.

Hawlader

M. D. H.

(2021). Healthcare workers' knowledge, attitude, and practice regarding personal protective equipment for the prevention of COVID-19. Journal of multidisciplinary healthcare, 14, 229–238. https://doi.org/10.2147/JMDH.S293717

24.

Iwu

C. J.

Jordan

Jaca

Iwu

C. D.

Schutte

Wiysonge

C. S.

(2020). Cochrane corner: personal protective equipment for preventing highly infectious diseases such as COVID-19 in healthcare staff. Pan African medical journal, 37(1), 148. https://doi.org/10.11604/pamj.2020.37.148.24934

25.

Jafaralilou

Zareban

Hajaghazadeh

Matin

Didarloo

(2019). The impact of theory-based educational intervention on improving helmet use behavior among workers of cement factory, Iran. Journal of the Egyptian Public Health Association, 94(1), 1. https://doi.org/10.1186/s42506-018-0001-6

26.

Keleb

Ademas

Lingerew

Sisay

Berihun

Adane

(2021). Prevention practice of COVID-19 using personal protective equipment and hand hygiene among healthcare workers in public hospitals of South Wollo Zone, Ethiopia. Frontiers in Public Health, 9, 782705. https://doi.org/10.3389/fpubh.2021.782705

27.

Khoerudin

M. P.

Yudianto

Shalahuddin

(2020). Nurses’ attitude on the use of personal protective equipment (PPE) in emergency room of dr. Slamet Hospital Garut. Journal of Nursing Care, 3(2), 1–9. https://doi.org/10.24198/jnc.v3i2.24437

28.

Kim

Hegde

LaFiura

Raghavan

Sun

Cheng

Rebholz

C. M.

Seidelmann

S. B.

(2021). Access to personal protective equipment in exposed healthcare workers and COVID-19 illness, severity, symptoms and duration: a population-based case-control study in six countries. BMJ global health, 6(1), e004611. https://doi.org/10.1136/bmjgh-2020-004611

29.

Koh

Hegney

D. G.

Drury

(2011). Comprehensive systematic review of healthcare workers' perceptions of risk and use of coping strategies towards emerging respiratory infectious diseases. International Journal of evidence‐based Healthcare, 9(4), 403–419. https://doi.org/10.1111/j.1744-1609.2011.00242.x

30.

Lakshmi

Jennifer

Stanly

Mary

(2018). A study on personal protective equipment use among health care providers, Tamil Nadu. International Journal of Community, 5(5), 1771–1777.

31.

Ludy

Eyre

A. J.

(2024). Personal protective equipment. In Ciottone’s Disaster Medicine (pp. 323–329). Elsevier.

32.

Madziatera

Msofi

K. S.

Phiri

T. V.

Mkandawire

S. D.

Comber

(2020). Availability, accessibility and proper use of personal protective equipment in wards at Queen Elizabeth Central Hospital (QECH) Blantyre, Malawi: an observational study. Malawi Medical Journal, 32(3), 124–131. https://doi.org/10.4314/mmj.v32i3.4

33.

Manyazewal

Matlakala

M. C.

(2018). Implementing health care reform: implications for performance of public hospitals in central Ethiopia. Journal of global health, 8(1), 010403. https://doi.org/10.7189/jogh.08.010403

34.

Mengistu

D. A.

Dirirsa

Mati

Ayele

D. M.

Bayu

Deriba

Alemu

F. K.

Demmu

Y. M.

Asefa

Y. A.

Geremew

(2022). Global occupational exposure to blood and body fluids among healthcare workers: systematic review and meta‐analysis. Canadian Journal of Infectious Diseases and Medical Microbiology, 2022(1), 5732046. https://doi.org/10.1155/2022/5732046

35.

Migheli

(2021). Income, wealth and use of personal protection equipment in the Mekong Delta. Environmental Science and Pollution Research, 28(29), 39920–39937. https://doi.org/10.1007/s11356-021-13449-w

36.

Muleta

Kasse

Ayele

Haftu

Agegnehu

(2025). Understanding healthcare workers’ risk perception and response to healthcare waste in Arba Minch town, Ethiopia: application of the extended parallel process model. BMC Health Services Research, 25(1), 1019. https://doi.org/10.1186/s12913-025-13142-5

37.

Nicholson

(2020). Infectious diseases: the role of the healthcare professional. In Clinical Forensic Medicine: A Physician's Guide (pp. 343–392): Springer International Publishing. Clinical Forensic Medicine. 343-392.

38.

Osman

A. M.

Mutekanga

D. R.

Ddamulira

Katamba

(2022). Factors influencing use of personal protective equipment among health workers in St. Francis Hospital Nsambya Makindye division Kampala, Uganda. Int. J. Adv. Multidiscip. Res, 9(12), 302–316.

39.

Otu

Ebenso

Okuzu

Osifo-Dawodu

(2016). Using a mHealth tutorial application to change knowledge and attitude of frontline health workers to Ebola virus disease in Nigeria: a before-and-after study. Human resources for health, 14(1), 5. https://doi.org/10.1186/s12960-016-0100-4

40.

Reda

Gebrehiwot

Lingerew

Keleb

Mekonnen

T. C.

Wagaye

Atamo

Daba

Feleke

Adane

(2021). Occupational blood exposure beyond needle stick injuries: hospital-based cross-sectional study among healthcare workers in governmental hospitals of Northern Ethiopia. BMC Health Services Research, 21(1), 1136. https://doi.org/10.1186/s12913-021-07167-9

41.

Saia

Hofmann

Sharman

Abiteboul

Campins

Burkowitz

Choe

Kavanagh

(2010). Needlestick injuries: incidence and cost in the United States, United Kingdom, Germany, France, Italy, and Spain. Biomedical International, 1(2), 41–49.

42.

Sarfraz

Anwer

Sarfraz

Siddiq

(2020). Availability, use, and satisfaction of personal protective equipment among healthcare workers: a cross-sectional assessment of low-and middle-income countries. Journal of Occupational and Environmental Medicine, 62(11), e657–e664. https://doi.org/10.1097/JOM.0000000000002028

43.

Savoia

Argentini

Gori

Neri

Piltch-Loeb

Fantini

M. P.

(2020). Factors associated with access and use of PPE during COVID-19: a cross-sectional study of Italian physicians. Plos one, 15(10), e0239024. https://doi.org/10.1371/journal.pone.0239024

44.

Tadesse

Tesfaye

Alemu

Haileselassie

(2020). Healthcare worker’s knowledge, attitude, and practice of proper face mask utilization, and associated factors in police health facilities of Addis Ababa, Ethiopia. Journal of multidisciplinary healthcare, 13, 1203–1213. https://doi.org/10.2147/JMDH.S277133

45.

Tesfahun

(2020). Infection prevention practice and associated factors among health professionals working in governmental health centers of Kembata Tembaro zone, south Ethiopia [Doctoral dissertation. Jimma University].

46.

Teym

Zeleke

T. K.

(2025). Utilization of personal protective equipment and its key factors among WA oil factory workers in Debre Markos town, Ethiopia. Frontiers in Public Health, 13, 1529436. https://doi.org/10.3389/fpubh.2025.1529436

47.

Teym

Tegegne

Yirdaw

Kumlachew

Ayenew

Ahmednur

Zeleke

T. K.

Alamneh

A. A.

(2025). Personal protective equipment utilization and determinant factors among workers in Phibela Edible Oil Factory, West Gojjam, Ethiopia. Environmental health insights, 19, 11786302251321230. https://doi.org/10.1177/11786302251321230

48.

Tolera

S. T.

Gobena

Geremew

Toseva

Assefa

(2024). Compliance and associated factors of personal protective equipment among sanitary workers in selected public hospitals. Eastern Ethiopia: A cross-sectional study design. 12, 20503121241308303. Sage Open Medicine. https://doi.org/10.1177/20503121241308303

49.

Tolera

S. T.

Gobena

Geremew

Toseva

Assefa

(2025). Occupational health risk perceptions and determinants: knowledge and attitude of sanitary workers in public hospitals of Ethiopia. Frontiers in Public Health, 13, 1509595. https://doi.org/10.3389/fpubh.2025.1509595

50.

Torrence

C. E.

Libby

C. S.

Nie

Stein

J. S.

(2023). Environmental and health risks of perovskite solar modules: Case for better test standards and risk mitigation solutions. Iscience, 26(1), 105807. https://doi.org/10.1016/j.isci.2022.105807

51.

Usman

(2021). Utilization of personal protective equipment and associated factors among nurses at Thika Level 5 Hospital Mount Kenya University. https://erepository.mku.ac.ke/handle/123456789/5717

52.

Verbeek

J. H.

Rajamaki

Ijaz

Sauni

Toomey

Blackwood

Tikka

Ruotsalainen

J. H.

Balci

F. S. K.

(2020). Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane database of systematic reviews, 202(4), 1–53.

53.

World Health Organization . (2018). Infection prevention and control assessment framework at the facility level (No. WHO/HIS/SDS/2018.9). World Health Organization. https://iris.who.int/bitstream/handle/10665/330072/WHO-HIS-SDS-2018.9-eng.pdf

54.

World Health Organization . (2020a). The COVID-19 risk communication package for healthcare facilities (No. WPR/DSE/2020/013). WHO Regional Office for the Western Pacific. https://iris.who.int/handle/10665/331140

55.

World Health Organization . (2020b). Rational use of personal protective equipment for coronavirus disease (COVID-19) and considerations during severe shortages: interim guidance, 6 April 2020. https://iris.who.int/handle/10665/331695

56.

Yenesew

M. A.

Fekadu

G. A.

(2014). Occupational exposure to blood and body fluids among health care professionals in Bahir Dar town, Northwest Ethiopia. Safety and health at work, 5(1), 17–22. https://doi.org/10.1016/j.shaw.2013.11.003

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