The present study provides the first insight into the infection status of HCWs in Iran during the COVID-19 pandemic along with the need for proper equipment use and education of these individuals. Our report demonstrated an incidence of 273 individuals (5.62%) amongst HCW which can be assumed with a great magnitude that they acquired their disease based on occupational-related.
Based on our results the highest infection rate was among nurses (51.3%); However, the highest CIR was among physicians (3.2%). Our results are consistent with studies regarding HCW infection in Wuhan, China demonstrating a rate of 52% among nurses. This may be due to the fact that generally, nurses have more patient contact time compared to other HCW occupations such as physicians. Focusing on educating and providing appropriate safety measures in these groups which are higher at risk is essential for their physical and mental health. 
Our study demonstrated the highest CIR to be among physicians (3.2%) which was higher than the reported a lower CIR among physicians in China (1.92%) . Also, our data demonstrated that 1.6% of HCWs didn’t use masks, 18.7% didn’t use gloves, 65.9% didn’t use protective goggles and 58.2% didn’t use face shields. This data is supported by a previous study regarding the knowledge, attitude and practice towards COVID-19 in Iran, which demonstrated that personnel with healthcare-related occupations, although with higher knowledge, had significant lower practice towards the diseases . This imposes a need for better implantation of precative measures by HCWs for decreasing infection rates in these groups.
In the early phase of the COVID-19 outbreak, the number of HCWs and personal protective equipment (PPE) was both insufficient, and the continuous working hours of HCWs were relatively longer. Therefore, the HCWs were exhausted physically and mentally. In this situation, decreased immunity and an increased chance of infection could occur in HCWs. Therefore, it is recommended that HCWs at the frontline receive sufficient rest time to ensure adequate sleep, avoid overwork and consume a nutritious diet and supplements to ensure adequate nutrition to increase the body immunity and reduce the likelihood of infection. 
Various methods of dealing with the disease have been implanted by the government and the healthcare system. The health ministry of Iran has dedicated several hospitals as centers for solitary COVID-19 patients, resulting in the isolation of these patients and decreasing contact, and periodic screening among hospitals to provide early detection of the disease amongst HCWs; However there is still a high rate of infection in sections such as the emergency ward (30.6%), were first hand, undiagnosed patients are in contact with personnel and HCWs, which lack of indulgence and proper safety percussions results in obtaining the virus. Among other containment methods, one can name Singapore's Ministry of Health to manage and treat all COVID-19 cases within hospitals, along with employing rapid contact tracing to detect, isolate and monitor all associates with noteworthy exposure to the index cases . It should be mentioned that there was a lack of sufficient reserves and resources of hospital protective equipment for a pandemic in such magnitude. Countless medical staff is not effectively equipped and get infected by unwitting contact with carriers or COVID-19 patients. Furthermore, protective equipment, including N95 masks, protective clothing, and goggles are prioritized to first-line HCWs in high contact centers, while other staff and centers often utmost have only surgical masks, which can result in the lower rates of infection in HCWs directly facing COVID-19 patients compared to HCWs who are less exposed.
One of the most significant findings of our study is that a considerable number of infected HCWs were asymptomatic (35.5%) and the most frequent symptoms were myalgia (46%) and cough (45.5%). Other studies have also reported a rate of 78% regarding asymptomatic COVID-19 patients.  This is important due to asymptomatic carriers can result in the person-to-person transmission of the disease and should be considered a source of COVID-19 infection . The disease might also present with non-specific symptoms such as myalgia, which has also been reported as the most frequent (66%) syndrome in Fars province for COVID-19 in previous studies , making it hard to distinguish. In this regard, our data shows that 28 cases of individuals with close contact with HCWs were reported positive subsequently after the infection of the index case. The fact that detecting these individuals are challenging since they don’t present with any signs or symptoms emphasizes the need for preventing the spread of the disease compared to detecting and treating the infection in order to control and end the pandemic.
It is worth mentioning that among the patients of our study there was only 5.5% hospital admission with no reports of severe cases of mortality due to COVID-19, which were considerably lower than other studies. Chu et al reported 54 hospital staff infection which included 40 severe cases and 3 critical cases (79% in total) , and Li et al  reported 32% of the 41 hospitalized patients were severe or critical cases from Wuhan Jinyintan Hospital. These variations may be due to that the majority of patients in our study were under 45 years (mean 35) and 80% had no underlying diseases which makes the virus less likely to progress to a severe form in these individuals.
It should be noted our province was affected less than other large province in the early phase of pandemic and this degree of HCW involvement may change with subsequent disease surge. Healthcare infection varies based on the geographical location, magnitude, involving centers of the study, and also the method of disease confirmation. For instance, Peng et al  in a single-center study in Wuhan, China reported 40 medical staff out of 138 patients (29%) while another retrospective analysis of 1099 confirmed patients with COVID-19 in 552 hospitals from 31 provinces in China found that the proportion of health professionals was 2.09% . Among other causes variations, one can name the method of including patients in the study, which in our study focused on positive SARS‐Cov‐2 tests, while in other studies, such as Chu et al , reported a rate of 57 cases during 5 weeks using World Health Organization interim guidance  The method of detection (either clinical or molecular) and which should be interpreted as the authentic number of infection rate is still a matter of disease debate . For the purpose of this study, we only included molecular confirmed SARS-CoV2 PCR positive patients, however, although high specificity, based on the chance of false-negative the actual number of cases might much as well be considerably higher. However, it cannot be denied that HCW are amongst the highest groups at risk of infection with COVID-19 which necessitates prompt decision and action-taking for plummeting infection rates in these individuals not only to safeguard continuous patient care but also to ensure they do not transmit the virus.