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

Abstract

IntroductionHealthcare-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.MethodsA 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.ResultsSixty 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).ConclusionHH 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.

Examining the hand hygiene beliefs and practices of nursing students and the effectiveness of their handwashing behaviour

“…Studies in the literature exploring which parts of the hand remain dirty or unclean after handwashing are scarce. Studies that have been carried out on the hand hygiene practices of healthcare workers and their compliance with these practices, however, have indicated that hand hygiene practices are insufficient and compliance is poor (Kelcikova, Skodova, & Straka, 2012; Kosucu, Göktas, & Yıldız, 2015; MacDonald, McKillop, Trotter, & Gray, 2006; Škodová et al, 2015; Vikke et al, 2019).…”

Hand Hygiene Compliance in a Medical-Surgical Intensive Care Unit in La Habana

“…9,10 The overall compliance observed in the current study was similar to the data in the literature. [2][3][4][5][6][7] There was no evidence of improvement during the study period, which could be related to various factors including deficiencies in staff education, irregular feedback, and loss of timely analysis of compliance data. Another factor, one relevant to improvement, is the weak leadership support to the infection control recommendations.…”

Higiene das mãos e uso de luvas: mensuração integrada da autoeficácia

“…A conformidade da higiene das mãos entre os prestadores foi notavelmente baixa, com maior conformidade após os contatos com os pacientes em comparação com antes dos contatos e dependência excessiva de luvas. Recomendamos mais pesquisas sobre desafios contextuais e percepções de higiene entre os profissionais para melhor compreensão da situação (VIKKE et al, 2019 de infecção e a taxa de adesão às boas práticas como a higiene das mãos e o uso de luvas (ROCK et al, 2013;ZOTTELE et al, 2017). As unidades de pronto socorro são consideradas críticas para a adesão à higiene das mãos, pois somam-se fatores como superlotação, carga de trabalho, falta de tempo e, muitas vezes, déficit de funcionários (CARTER, POUCH, LARSON, 2014;GRABOWSKI et al, 2018).…”