Current Evidence for Infection Prevention and Control Interventions in Emergency Medical Services: A Scoping Review

Abstract

Objectives: The aim of this review was to summarize current evidence from the United States on the effectiveness of practices and interventions for preventing, recognizing, and controlling occupationally acquired infectious diseases in Emergency Medical Service (EMS) clinicians. Report and Methods: PubMed, Embase, CINAHL, and SCOPUS were searched from January 1, 2006 through March 15, 2022 for studies in the United States that involved EMS clinicians and firefighters, reported on one or more workplace practices or interventions that prevented or controlled infectious diseases, and included outcome measures. Eleven (11) observational studies reported on infection prevention and control (IPC) practices providing evidence that hand hygiene, standard precautions, mandatory vaccine policies, and on-site vaccine clinics are effective. Less frequent handwashing (survey-weight adjusted odds ratio [OR] 4.20; 95% confidence interval [CI], 1.02 to 17.27) and less frequent hand hygiene after glove use (survey-weight adjusted OR 10.51; 95% CI, 2.54 to 43.45) were positively correlated with nasal colonization of Methicillin-resistant Staphylococcus aureus (MRSA). Lack of personal protective equipment (PPE) or PPE breach were correlated with higher severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seropositivity (unadjusted risk ratio [RR] 4.2; 95% CI, 1.03 to 17.22). Workers were more likely to be vaccinated against influenza if their employer offered the vaccine (unadjusted OR 3.3; 95% CI, 1.3 to 8.3). Active, targeted education modules for H1N1 influenza were effective at increasing vaccination rates and the success of on-site vaccine clinics. Conclusions: Evidence from the United States exists on the effectiveness of IPC practices in EMS clinicians, including hand hygiene, standard precautions, mandatory vaccine policies, and vaccine clinics. More research is needed on the effectiveness of PPE and vaccine acceptance.

Knowledge of Infection Prevention and Control and Practice Behaviors among Career and Volunteer Firefighters in Rural Communities

“…Career firefighters are expected to have received comprehensive training in emergency response including infection control and best practices. Previous studies have found that first responders are often faced with various challenges including working under an emerging threat environment, keeping up to date with growing information, the lack of available training and education, and changes in their daily work responsibilities [4,19,20]. Professional groups like firefighters need to have sustainable strategies to improve knowledge through continuing education that focuses on targeting emerging and reemerging infectious agents, while also including technologies with proven efficiency to protect patient and worker health.…”

“…Throughout the pandemic, first responders have been found to experience high levels of fatigue, reduced motivation and productivity, and increased risks of exposure to both chemical contaminants and infectious agents [3]. Because of these and other factors, the firefighter occupation has been ranked among the top high-risk occupations in the United States [4,5].…”

“…It is extremely important to protect these high-risk workers against biological contaminants. Effective methods of IPC include continuous action at all levels of emergency response systems [4,10,11]. Firefighter knowledge on transmission pathways of biologic contaminants, precautionary actions needed to minimize exposure, and practice behaviors that promote efficient service provision is critical.…”

“…Which of the following is the best control method to prevent exposure to bloodborne pathogens? = Training on how to handle soiled linens 1[4] = Retractable and self-sheathing needles 1 [5] = Don't know 0 Select best answer It is best practice to start with the dirtiest surfaces when cleaning and disinfecting in a training area/dayroom or emergency response vehicle. How do you know if the surfaces are cleaned?…”