pandemic in Tehran, Iran. 23 Methods: Seven hundred HCWs were surveyed between April and May 2020. The study was 24 performed in surgical care wards. Questionnaires were used to assess personal protection 25 equipment (PPE) usage status and reasons for not using PPE, which were sent to HCWs via 26 online platforms, social networks, and emails to different associations. Questionnaires were 27 sent to a total of 1000 HCWs, of whom 700 replied. preventing diseases, unfortunately, many of them become infected due to high exposure to 55 the virus. 7 In China, Italy, and Spain large number of HCWs have been infected and died 56 from COVID-19, indicating the importance of active management and protection. 8,9 57 Therefore, following the principles of infection control and especially, the protection of 58 HCWs is a priority. 10 This cross-sectional study was carried out from April to May 2020 in Tehran. Seven hundred 69 HCWs (physician, nurse, physiotherapist, and midwife) working in hospitals affiliated to 70 Tehran University of Medical Sciences were selected to take part in this study. Only HCWs 71 who directly provided care to surgical patients and were obliged to use PPE at their shift 72 were included in this study. The research was performed in surgical departments (head and 73 neck surgery, gynecology, general surgery, and cardiac surgery). 74 A questionnaire that had 3 sections was used to collect the data which was sent to HCWs via (CVR) was used to ensure that the most important and accurate contents (the necessity of 102 the question) have been selected. Moreover, the content validity index (CVI) was used to 103 ensure that, the questions were best designed to measure the variables. 104 The CVR for the questionnaires that assessed PPE use, the reasons for not using the 105 available equipment, was 0.86, and 0.85, respectively. Again, the questionnaires were given 
The demographic characteristics of the participants are presented in (Table 1 ). The highest 120 average of PPE use in HCWs was related to wearing face masks including surgical and N95 121 (163.8±19.4), which showed that, the level of compliance was good, but the lowest average 122 was related to the use of face shield or goggles (71.4±11.2), which indicated poor 123 compliance ( Table 2) . 124 Lack of equipment, time, monitoring, and awareness were the main reasons for not using 125 the equipment, consecutively (table 3) . 