Hand Hygiene Among EMTs, Paramedics, “Remarkably Low”: Study

EMTs and paramedics often fail to properly wash their hands before treating patients, and often fail to use clean gloves after touching contaminated surfaces, according to the findings of a new report.

In a study published last week in the Emergency Medicine Journal, researchers warn that compliance with hand hygiene (HH) standards, which includes policies regarding hand washing, hand sanitizer use, glove use, and personal hygiene, are often very low among emergency medical technicians (EMTs) and paramedics.

Researchers conducted an observational study of ambulance services in Finland, Sweden, Australia, and Denmark from December 2016 to May 2017.

They observed 77 emergency medical responders in a total of 87 patient encounters for 1,344 instances where hand hygiene protocols were required. Overall, researchers conducted 60 hours of observation in each country.

Hand hygiene compliance was recorded for each instance, which was considered washing hands or using hand sanitizer. This included whether hygiene was conducted before patient contact, before a clean procedure, after the risk of body fluids, after patient contact, and after contact with patient surroundings.

They also recorded compliance with glove use and other personal grooming items like not wearing jewelry, keeping hair short or pulled back, and keeping nails short and clean.

In general, emergency medical service (EMS) providers, such as EMT and paramedics, complied with hand hygiene protocols and glove use in only 15% of patient contacts. According to the findings, they only washed their hands or used hand sanitizer three percent of the time before treating a patient. They followed hand hygiene rules two percent of the time before conducting cleaning procedures, which require sanitization, and eight percent of the time after encountering a risk of contacting body fluid.

Comparatively, they followed hand hygiene procedures 29 percent of the time after treating a patient and 38 percent of the time after coming into contact with patient surroundings, like their home or a gurney.

The findings suggest EMS providers seemed to be more concerned about hand hygiene following patient encounters than before treating a patient.

EMS providers used gloves only about half of the time (54 percent), the researchers noted. They used new gloves about 48 percent of the time before touching patients after touching something else in the immediate surroundings, like the patient’s belongings or a stretcher, and only 14 percent of time before conducting clean procedures.

According to the findings, EMS providers often used the same gloves after touching contaminated sites and then treating the patient. This was done in 21 percent of standard procedures. However, 64 percent of clean procedures were done with the same gloves used to touch contaminated objects.

Regarding personal grooming, EMS providers followed hair requirements to keep it short or pull it back 99 percent of the time. Keeping short clean nails was done by 84 percent of providers and not wearing jewelry was followed only 62 percent of the time.

Hygiene Standards Necessary For Infection Control

World Health Organization guidelines call for EMS providers to wash their hands, use hand sanitizer and use new gloves when treating patients. New gloves are also called for to conduct clean procedures and after touching a contaminated surface.

However, these findings suggest many EMS providers are not following guidelines. In fact, the guidelines are not adhered to in the majority of instances, according to this study.

The guidelines are put into place to help protect the patient and prevent the spread of infections. Healthcare-related infections affect one in 10 patients in developed countries.

“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,” the researchers warned. “We recommend further research on contextual challenges and hygiene perceptions among EMS providers to clarify future improvement strategies.”