SUPPLYING WITH PERSONAL PROTECTIVE EQUIPMENT

• During the March – May 2020 period - the COVID-19 outbreak and spread initial stage, only 1/3rd of the staff claims that they had the necessary PPE in their institution, 1/4th had sufficient amounts of PPE, while 1/10th had no PPE at all. A more positive situation is noticed in the COVID-19 hospitals (UHC and “Shefqet Ndroqi”), yet less than half of the staff confirms the PPE compatibility and sufficiency, while the primary health care (bedless) system, has mostly suffered the lack of both the adequate PPE and sufficient quantity. Although the situation has been improving from March to May 2020, the secondary and tertiary healthcare (with beds) system staff, COVID-19 hospitals included, indicates of more significant situation improvement rate, almost twice higher than in the primary system (around 58% vs. 33% respectively)   
• Considering the overall PPE shortages, the primary system staff has used the PPE more sparingly, not simply rationally, but rather not using them in some occasions when they were necessary, and this happened almost twice as much in the primary system as in COVID-19 hospitals (60% vs. 34% respectively). Frugal use is more common among physicians than with nurses (60% vs. 38% respectively).        
• Physicians and nurses at COVID-19 hospitals are better supplied with all of the Personal Protective Equipment but regardless, less than half of them have sufficient PPE quantities which are vital for their work with COVID-19 confirmed patients, such as FFP3, FFP2 or N95 respirator masks, long sleeved surgical gowns which provide total isolation and eye protectors (goggles or face shields).
• Hand sanitizers, alcohol based solutions, gloves and fluid resistant surgical masks or FFP1 are the three top personal protective equipment available for most health staff of all levels, nevertheless, significantly higher in percentage in COVID-19 hospitals and significantly lower in the primary system, independently whether they are provided by the relevant institution or purchased at personal expense by the health staff themselves. Consequently, the primary (bedless) system health staff has felt themselves forced to work with patients without the proper PPE more often, almost twice as much as in COVID-19 hospitals (36% vs. 19% respectively).
• Considering the fact that the health staff worked in conditions of obvious protective equipment (PPE) shortages during March-May 2020 period, which then forced them to use PPE sparingly and sometimes even buy it at personal expense, the complaint level  is relatively low (37%). The primary system staff has raised significantly more complaints than the COVID-19 hospitals staff (respectively 44% vs. 29%), while on the other side, compared to the primary system, COVID-19 hospitals have felt less need to set up a complaint, as they have been better supplied with PPE.

STAFF INFORMING AND TRAINING ON SAFE PPE USE: WEARING, REMOVING AND DISPOSAL

• Information, guidance and training provided by the management bodies, including training on the safe PPE use: wearing (donning), removing (doffing) and disposal, are among health staff rights listed by the WHO in the COVID-19 pandemic framework. However, almost 2/5th of the staff states that they have received such training in the COVID-19 pandemic context; and again this training ratio among the COVID-19 hospitals staff is still significantly higher than among primary or bedless system. It is disturbing that almost 2/5th of the primary system, regional and municipal hospitals, the Trauma University Hospital and the two maternity hospitals "Mbretëresha Geraldinë" and "Koço Gliozheni" staff claim that they have never received such training, nor after the pandemic outbreak, neither earlier during their work experience and not even during their studies. The percentage is significantly lower among the two COVID hospitals staff (17%) and nurses (22%).
• Insufficient  training also explains the self-declared information level on the safe PPE use, wearing (donning), removing (doffing) and disposal; where 2/5th of the staff at all levels claim to be very well-informed, while about 1/10th believe they have poor information. In order to guarantee the adequate information obtaining, less than half of the staff themselves have explored the internet and 1/5th have been informed through professional organizations and networks such as the WHO, etc. State authorities such as the MHSP, IPH, National Emergency Agency and the management bodies of the health institution where they work for are the second and third health staff information source, respectively.
   

WORKPLACE SAFETY AND MENTAL HEALTH

• Staff testing institutional policies indicate the significant differences between different levels, where COVID-19 hospitals physicians and nurses have naturally taken precedence, and almost half of them state that testing has been a general practice regardless of whether the staff exhibited symptoms or not. This percentage is significantly lower among other hospitals and even lower in the primary system.
• Claims on low health staff testing level in case they have shown symptoms (40%) or after being self-isolated as consequence of any symptoms shown by their family members (34%) are highly disturbing. Even in these cases, the tests percentage is still higher among COVID-19 hospital staff and almost twice lower in the primary system.A detailed information can be find in the report attached.
• The adequate and necessary PPE quantity shortage, as well as the lack of broad training and staff testing poor institutional policies has impacted 30% of the staff who feel completely unsafe and unprotected at the workplace. This uncertainty level is higher among the primary (bedless) health care system staff as compared to the COVID-19 hospitals staff, which can be explained by the higher PPE availability, more training and more frequent staff tests at COVID-19 hospitals which all are significantly less frequent in the primary system. However, the number of the primary system COVID-19 infected staff, or self-isolated staff due to infected family members is almost twice as low as among COVID-19 hospitals staff (4% and 5% versus 9% and 12%) .
• Furthermore, the fact that physicians seem significantly less safe and infection protected in the workplace than nurses is quite interesting. This is understandable as we see that physicians have filed more complaints than nurses about PPE deficiencies, use them sparingly and state that they lack the PPE safe use training.
• Some of the health staff psychological burden reasons, as they work with self-denial and witness the COVID-19 patients loss are: the high concern on the PPE shortage (84%); applying pandemic protocol procedures for the first time (82%); the long working hours (42%); the change of their living arrangements (65%) by physically distancing themselves from family members; and the high concern for their potential infection (94%).
• During the March-May 2020 period, three most common health staff symptoms are fatigue, distress and insomnia, respectively in 83%, 79% and 76% of the Albanian health system physicians and nurses. Anxiety and lack of interest in activities are also significant, at 63% and 56%, respectively; while depression’s symptoms are significantly lower (18%).