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Author: Emanuelsson, L. / Karlsson, L. / Castrèn, M. / Lindström, V. (2012) Source: Emanuelsson, L. et al. Ambulance personnel adherence to hygiene routines: still protecting ourselves but not the patient. European Journal of Emergeny Medicine, 2013, Vol 20 No 4.

STUDY

Emanuelsson, L. / Karlsson, L. / Castrèn, M. / Lindström, V. (2012)

Compliance with hygiene measures in emergency medical services

Background: Many emergency patients are treated by emergency medical technicians (EMTs) before they arrive in the emergency room. Also in emergency medical care, good hygiene compliance is crucial for the patient safety and the quality of patient care. Hence, Emanuelsson et al. examined the hygiene compliance among EMS (emergency medical service) staff during their work.


Methods: Emanuelsson et al. conducted an observational study in Värmland, Sweden. On one day in November 2010, EMS employees were randomly selected to observe their colleagues and check the compliance during seven differing hygiene measures:

 

  1. hand disinfection before touching the patient (alcohol-based hand disinfectant)
  2. hand disinfection after touching the patient (alcohol-based hand disinfectant)
  3. correct use of protective gloves (blood or infectious fluid exposure risk) and exchange of gloves between measures when treating the patient
  4. correct use of gowns (blood or infectious fluid exposure risk)
  5. correct use of short-sleeved work clothes
  6. no wearing of rings, watches and bracelets during patient care
  7. short or tied back hair.

Furthermore, a checklist was used to determine whether alcohol-based hand disinfectants, gloves, gowns and eye protection was available in the ambulance and in the emergency backpack.


Results: A total of 168 employees participated in the study: 123 nurses and 45 EMTs. 71 observations were carried out in 21 ambulances; 68 of these observations were analysed.
The study showed that only two of the observed employees (3 %) properly adhered to the seven observed hygiene measures. Compliance with hand disinfection was 34 % before and 72 % after touching a patient. Gloves were correctly used in 69 % of the situations, gowns in 91 %. However, short-sleeved uniforms were only used in 28 % of the observations. Correct adherence to the rule not to wear rings, watches or bracelets was observed in 74 % of the situations. Hair was short or tied back in 91 % of the observations.
The checklists showed that hand disinfectants, gloves and gowns were available in all ambulances. Eye protection was available in approx. 90 % of the ambulances. Hand disinfectants were available in almost every fifth backpack, gloves in every second.


Conclusions: The results of the study show that the hygiene compliance in EMS varies very much depending on the hygiene measure: all seven hygiene measures were only adhered to in 3 % of the observations. The analysis of the checklists reveals that the access to the respective equipment was limited outside the ambulance, which may have a negative influence on the compliance. Here, Emanuelsson et al. recommend equipping employees with pocket bottles for them to always have a hand disinfectant handy. The compliance with not wearing rings, watches and bracelets was relatively high. According to the authors, a possible explanation are regular checks by a supervising hygiene nurse. Hence, Emanuelsson et al. assume that such checks could also have a positive impact on other hygiene areas.


Source:
Emanuelsson, L. et al. Ambulance personnel adherence to hygiene routines: still protecting ourselves but not the patient. European Journal of Emergeny Medicine, 2013, Vol 20 No 4.


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