Hand hygiene compliance among paramedics may be "remarkably low," according to a study that monitored ambulance workers in Scandinavia and Australia over six months.
Paramedics tended to wash their hands more often after handling patients than before, and to rely on gloves too much, which suggests they're thinking more of their own infection risk than of the patient's risk, the study authors note in the Emergency Medicine Journal.
"'Emergency medical services' implies that a high number of invasive procedures are performed outside of controlled hospital environments on a regular basis, potentially leading to an increased risk of infection," said lead study author Heidi Vikke of the University of Southern Denmark in Odense.
"Also, many of the patients have compromised immunity due to age, morbidity or trauma, and thus are at greater risk of infection," she told Reuters Health by email.
The World Health Organization (WHO) has recommended hygiene precautions to be taken before and after interacting with patients, the study team notes. They include handwashing before patient contact, before procedures, after possible exposure to bodily fluids, after patient contact and after contact with patient surroundings.
Gloves are recommended only when there is a likelihood of contacting patients' bodily fluids. WHO also recommends that providers keep their hair short or tied up; their fingernails short, clean and without nail polish; and that they wear no jewelry.
Each country in the study also has its own, similar guidelines, the authors note.
To see how often emergency providers are following these policies, Vikke and colleagues spent 240 hours observing ambulance service workers in Australia, Denmark, Finland and Sweden in 2016 and 2017. Overall, they observed 77 paramedics at work in 87 patient cases and 1,344 instances in which hand hygiene was indicated by the guidelines.
Handwashing occurred seven times, each one after contact with patients. At other times, paramedics used hand sanitizer.
Overall, hand hygiene policies were followed in 15 percent of the instances when the guidelines recommended them, the researchers found. It happened in 3 percent of the times before patient contact, 2 percent before procedures, 8 percent after risk of exposure to bodily fluids, 29 percent after patient contact and 38 percent after contact with patient surroundings.
Danish paramedics had the highest compliance rate. In addition, gloves were worn during about half of all the hand hygiene opportunities.
"The use of gloves was a direct obstacle for proper hand hygiene," Vikke said. "They continued to wear the same pair of gloves throughout several indications for hand hygiene, potentially transferring microbes across the ambulance environment, patient and equipment."
Interestingly, 99 percent of paramedics adhered to the personal hygiene rules about their own hair and fingernails.
Vikke and colleagues have also surveyed paramedics in the four countries about hand hygiene perceptions and the barriers to compliance. They recommend that emergency medical services management provide access to hygiene supplies such as pre-soaked wipes and pocket-sized hand rubs.
"The public should expect the same level of hygiene or infection prevention within EMS as it does for any other health organization," said Nigel Barr of the University of the Sunshine Coast in Sippy Downs, Australia, in an email.
Barr, who wasn't involved in the study, added, "It is OK for EMS to say we are different so that we can develop suitable methods of infection control for our work setting, but not to excuse ourselves from the responsibility."
"Human nature being what it is, we know that we are not great at simple, self-protective behaviors," said Dr. Jeffrey Ho of the University of Minnesota Medical School in Minneapolis, who wasn't involved in the study.
"Things such as hand hygiene and wearing eye protection to avoid fluid exposures are such easy things to do, but of course, they are the first things that we forget when we are stressed, sleep deprived, time crunched and under duress," he said by email. "Hand hygiene is for everyone, and it's the right thing to do for yourself and many people around you."