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

Heidi Vikke, Svend Vittinghus, Matthias Giebner, Hans Jørn Kolmos, Karen Smith, Maaret Castren, Veronica Lindström

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

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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 (OR 45; 95% CI 10.8 to 187.8; p=0.000) and provider level (OR 1.7; 95% CI 1.1 to 2.4; p=0.007), but not associated with gender (OR 1.3; 95% CI 0.9 to 1.9; p=0.107). 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.

OriginalsprogEngelsk
TidsskriftEmergency Medicine Journal
Vol/bind36
Udgave nummer3
Sider (fra-til)171-175
ISSN1472-0205
DOI
StatusUdgivet - 1. mar. 2019

Fingeraftryk

Emergency Medical Services
Nails
Hair
Industrial Oils
Denmark
Finland
Infection Control
Observation
Prospective Studies
Guidelines

Citer dette

Vikke, Heidi ; Vittinghus, Svend ; Giebner, Matthias ; Kolmos, Hans Jørn ; Smith, Karen ; Castren, Maaret ; Lindström, Veronica. / Compliance with hand hygiene in emergency medical services: an international observational study. I: Emergency Medicine Journal. 2019 ; Bind 36, Nr. 3. s. 171-175.
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title = "Compliance with hand hygiene in emergency medical services: an international observational study",
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 (OR 45; 95{\%} CI 10.8 to 187.8; p=0.000) and provider level (OR 1.7; 95{\%} CI 1.1 to 2.4; p=0.007), but not associated with gender (OR 1.3; 95{\%} CI 0.9 to 1.9; p=0.107). 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.",
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author = "Heidi Vikke and Svend Vittinghus and Matthias Giebner and Kolmos, {Hans J{\o}rn} and Karen Smith and Maaret Castren and Veronica Lindstr{\"o}m",
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Compliance with hand hygiene in emergency medical services: an international observational study. / Vikke, Heidi; Vittinghus, Svend; Giebner, Matthias; Kolmos, Hans Jørn; Smith, Karen ; Castren, Maaret; Lindström, Veronica.

I: Emergency Medicine Journal, Bind 36, Nr. 3, 01.03.2019, s. 171-175.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Compliance with hand hygiene in emergency medical services: an international observational study

AU - Vikke, Heidi

AU - Vittinghus, Svend

AU - Giebner, Matthias

AU - Kolmos, Hans Jørn

AU - Smith, Karen

AU - Castren, Maaret

AU - Lindström, Veronica

PY - 2019/3/1

Y1 - 2019/3/1

N2 - 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 (OR 45; 95% CI 10.8 to 187.8; p=0.000) and provider level (OR 1.7; 95% CI 1.1 to 2.4; p=0.007), but not associated with gender (OR 1.3; 95% CI 0.9 to 1.9; p=0.107). 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.

AB - 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 (OR 45; 95% CI 10.8 to 187.8; p=0.000) and provider level (OR 1.7; 95% CI 1.1 to 2.4; p=0.007), but not associated with gender (OR 1.3; 95% CI 0.9 to 1.9; p=0.107). 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.

KW - emergency medical services

KW - hand hygiene

KW - prehospital care

U2 - 10.1136/emermed-2018-207872

DO - 10.1136/emermed-2018-207872

M3 - Journal article

VL - 36

SP - 171

EP - 175

JO - Emergency Medicine Journal

JF - Emergency Medicine Journal

SN - 1472-0205

IS - 3

ER -