Compliance with hand hygiene in emergency medical services: an international observational study

Vikke, H.S. et al | 2019| Compliance with hand hygiene in emergency medical services: an international observational study |

An observational study, published in the Emergency Medicine Journal, identified sub-optimal levels of hand hygiene compliance among emergency medical service indications. 

The study’s results indicate a tendency to self-protection and over-reliance on gloves among emergency medical service providers (less than or equal to 15 per cent).

The research team found average hand hygiene compliance was low (3 per cent) before touching the patient and less than a fifth (19 per cent)  after having touched the patient. Gloves were worn  in more than half (54 per cent) of all hand hygiene indications.

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Abstract

Introduction Healthcare-associated infection caused by insufficient hygiene is associated with mortality, economic burden, and suffering for the patient. Emergency medical service (EMS) providers encounter many patients in different surroundings and are thus at risk of posing a source of microbial transmission. Hand hygiene (HH), a proven infection control intervention, has rarely been studied in the EMS.

Methods A multicentre prospective observational study was conducted from December 2016 to May 2017 in ambulance services from Finland, Sweden, Australia and Denmark. Two observers recorded the following parameters: HH compliance according to WHO guidelines (before patient contact, before clean/aseptic procedures, after risk of body fluids, after patient contact and after contact with patient surroundings). Glove use and basic parameters such as nails, hair and use of jewellery were also recorded.

Results Sixty hours of observation occurred in each country, for a total of 87 patient encounters. In total, there were 1344 indications for HH. Use of hand rub or hand wash was observed: before patient contact, 3%; before clean/aseptic procedures, 2%; after the risk of body fluids, 8%; after patient contact, 29%; and after contact with patient-related surroundings, 38%. Gloves were worn in 54% of all HH indications. Adherence to short or up done hair, short, clean nails without polish and no jewellery was 99%, 84% and 62%, respectively. HH compliance was associated with wearing gloves, but not associated with gender.

Conclusion HH compliance among EMS providers was remarkably low, with higher compliance after patient contacts compared with before patient contacts, and an over-reliance on gloves. We recommend further research on contextual challenges and hygiene perceptions among EMS providers to clarify future improvement strategies.

The full open-access article is available to download from the BMJ

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