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Taylor N, Simpson M, Cox J, Ebbs P, Vanniasinkam T. Infection prevention and control among paramedics: A scoping review. Am J Infect Control 2024:S0196-6553(24)00575-3. [PMID: 38925500 DOI: 10.1016/j.ajic.2024.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 06/10/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Paramedics are exposed to many infectious diseases in their professional activities, leading to a high risk of transmitting infectious diseases to patients in out-of-hospital settings, possibly leading to health care associated infections in hospitals and the community. The COVID-19 pandemic highlighted the importance of infection prevention and control in health care and the role of paramedics in infection control is considered even more critical. Despite this, in many countries such as Australia, research into infection prevention and control research has mainly been focused on in-hospital health care professionals with limited out-of-hospital studies. METHODS This scoping review was based upon Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Literature on knowledge and awareness of infection prevention and control in paramedics in Australia and other countries was evaluated. RESULTS Based upon selection criteria applied, six papers were identified for inclusion in this review. In many studies, infection prevention and control was identified as being important, however compliance with hand hygiene practices was low and most studies highlighted the need for more education and training on infectious disease for paramedics. CONCLUSION Current evidence suggests that paramedics have poor compliance with recommended IPC practices. The profession needs to improve IPC education, training, and culture.
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Affiliation(s)
- Nicholas Taylor
- School of Nursing, Paramedicine and Healthcare Sciences, Charles Sturt University, Port Macquarie, New South Wales, Australia; Queensland Ambulance Service, Queensland Government Department of Health, Brisbane, Queensland, Australia.
| | - Maree Simpson
- School of Dentistry and Medical Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Jennifer Cox
- School of Dentistry and Medical Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Phillip Ebbs
- School of Nursing, Paramedicine and Healthcare Sciences, Charles Sturt University, Port Macquarie, New South Wales, Australia
| | - Thiru Vanniasinkam
- School of Dentistry and Medical Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia
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Strandås M, Vizcaya-Moreno MF, Ingstad K, Sepp J, Linnik L, Vaismoradi M. An Integrative Systematic Review of Promoting Patient Safety Within Prehospital Emergency Medical Services by Paramedics: A Role Theory Perspective. J Multidiscip Healthc 2024; 17:1385-1400. [PMID: 38560485 PMCID: PMC10981423 DOI: 10.2147/jmdh.s460194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Timely and effective prehospital care significantly impacts patient outcomes. Paramedics, as the frontline providers of emergency medical services, are entrusted with a range of critical responsibilities aimed at safeguarding the well-being of patients from the moment they initiate contact in the out-of-hospital environment to the time of handover at healthcare facilities. This study aimed to understand the multifaceted roles of paramedics in promoting patient safety within the context of prehospital emergency medical services. A systematic review with an integrative approach using the Whittemore and Knafl's framework was performed examining qualitative, quantitative, and mixed-methods research, then conducting data assessment, quality appraisal, and narrative research synthesis. Literature search encompassed PubMed (including MEDLINE), Scopus, Cinahl, ProQuest, Web of Science, and EMBASE, with the aim of retrieving studies published in English in the last decade from 2013 to 2023. To conceptualize the roles of paramedics in ensuring patient safety, the review findings were reflected to and analyzed through the role theory. The preliminary exploration of the database yielded 2397 studies, ultimately narrowing down to a final selection of 16 studies for in-depth data analysis and research synthesis. The review findings explored facilitators and obstacles faced by paramedics in maintaining patient safety in terms of role ambiguity, role conflict, role overload, role identity, and role insufficiency in the dynamic nature of prehospital care. It also highlighted the diverse roles of paramedics in ensuring patient safety, which encompassed effective communication and decision making for the appropriate management of life-threatening emergencies. The effectiveness of paramedics in playing their roles in promoting patient safety relies on acknowledging the contributions of paramedics to the culture of patient safety; training and educational initiatives focused on enhancing their decision-making abilities and both their non-technical and technical competencies; developing relevant guidelines and protocols; improving collaboration between paramedics and other healthcare peers; optimizing environmental conditions and equipment; fostering a supportive work environment.
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Affiliation(s)
- Maria Strandås
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
| | | | - Kari Ingstad
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
| | - Jaana Sepp
- Tallinn Health Care College, Academic and International Affairs Office, Tallin, Estonia
| | - Ljudmila Linnik
- Tallinn Health Care College, Academic and International Affairs Office, Tallin, Estonia
| | - Mojtaba Vaismoradi
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- Faculty of Science and Health, Charles Sturt University, Orange, NSW, Australia
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Jimenez YA, Hill S, Lewis S, Abu Awwad D. Infection prevention and control in CT Part 2: Radiographers' and radiology nurses' perceptions of high-risk scenarios contributing to non-adherence to IPC protocols. Radiography (Lond) 2024; 30:265-273. [PMID: 38035444 DOI: 10.1016/j.radi.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/27/2023] [Accepted: 11/14/2023] [Indexed: 12/02/2023]
Abstract
INTRODUCTION Adherence to standard and transmission-based precautions in the computed tomography (CT) setting is central to effective infection prevention and control (IPC), yet there is limited evidence about medical imaging (MI) professionals' self-reported predictors of IPC breaches. This is the second of a two-part series on IPC in the CT setting. Part 1 reported on Australian baseline data relating to intravenous contrast media administration and power injectors. Part 2 presents Australian radiographers' and radiology nurses' perceptions of clinical situations that reduce adherence to standard and transmission-based precautions in CT. METHODS A self-administered survey was distributed to Australian radiographers and radiology nurses working in CT. Responses to an open-ended question "If I was to not adhere to the standard and transmission-based precautions in the CT department, it is most likely when …" was analysed using inductive coding for themes, followed by deductive analysis mapped to the Systems Engineering Initiative for Patient Safety (SEIPS) model. RESULTS Study participants (n = 136) were radiographers (n = 119; 87.5%) and nurses (n = 17; 12.5%). 'Four themes were derived from the inductive analysis: (1) high-risk working conditions, (2) compliance with good practice, (3) attitudes and practice, and (4) quality of communication. Deductive analysis, using the SEIPS domains revealed that predominant issues related to 'Tasks' (43.7%) and 'Organisation' (30.6%) followed by issues related to 'Person' (16.9%), 'Tools and technology' (6.9%) and 'Environment' (1.9%). CONCLUSION Multi-faceted pressures on radiology staff may compromise adherence to standard and transmission-based precautions in CT. Task difficulty, time pressures whilst undertaking tasks, and reduced staffing could lead to lower adherence to standard and transmission-based precautions. IMPLICATIONS FOR PRACTICE Future studies that focus on evaluation of 'Tasks' and 'Organisation' domains of the SEIPS model may provide further insights to non-adherence behaviours in MI.
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Affiliation(s)
- Y A Jimenez
- Faculty of Medicine and Health, Discipline of Medical Imaging Science, Susan Wakil Health Building (D18), Western Avenue, University of Sydney, NSW 2006, Australia.
| | - S Hill
- Faculty of Medicine and Health, Discipline of Medical Imaging Science, Susan Wakil Health Building (D18), Western Avenue, University of Sydney, NSW 2006, Australia
| | - S Lewis
- Faculty of Medicine and Health, Discipline of Medical Imaging Science, Susan Wakil Health Building (D18), Western Avenue, University of Sydney, NSW 2006, Australia. https://twitter.com/@SarahLewisUSYD
| | - D Abu Awwad
- Faculty of Medicine and Health, Discipline of Medical Imaging Science, Susan Wakil Health Building (D18), Western Avenue, University of Sydney, NSW 2006, Australia
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Pereira ER, Paes GO. Incidents in the context of pre-hospital care by ambulances: contributions to patient safety. Rev Bras Enferm 2023; 76:e20220657. [PMID: 38018615 PMCID: PMC10680398 DOI: 10.1590/0034-7167-2022-0657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 07/21/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVES to analyze the occurrence of incidents in the context of mobile terrestrial pre-hospital care. METHODS a descriptive research was carried out through the observation of 239 treatments performed by 22 healthcare professionals at the Mobile Emergency Care Service, located in Baixada Fluminense, Rio de Janeiro, Brazil. Fisher's exact test and chi-square test were used for data analysis. RESULTS the total time dedicated to patient care was 439.5 hours, during which 2386 security incidents were observed. The most notable ones were related to written communication (235), patient identification through bracelets (238), and safety in medication preparation (81). CONCLUSIONS the need to promote and implement initiatives aimed at patient safety is evident, with special focus on international safety goals within the scope of mobile pre-hospital care services.
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Xu Y, Liu WJ, Wang X, Yang QM. Occupational protection behavior and its influencing factors of newly recruited nurses. BMC MEDICAL EDUCATION 2023; 23:797. [PMID: 37880657 PMCID: PMC10601324 DOI: 10.1186/s12909-023-04780-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 10/16/2023] [Indexed: 10/27/2023]
Abstract
AIM Aim The objective of this study was to understand the occupational protective behaviors of newly recruited nurses and explore the influencing factors. METHODS A convenience sampling method was used to select newly recruited nurses in our hospital from July 2018 to November 2019. The survey was conducted using the general information questionnaire, work attitude scale (Wa), and occupational protective behavior scale. RESULTS The total score of occupational protective behaviors of 150 newly enrolled nurses was 18.94 ± 3.59. There was a significant negative correlation between work attitude score and occupational protective behaviors (r = -0.324, p < 0.001). Multiple linear regression analysis showed that gender, previous participation in nursing skill-based competitions, experience of needlestick injuries before recruit, work attitude score, average daily sleep time (p < 0.05) were independent factors influencing occupational protective behaviors. CONCLUSIONS The overall occupational protective awareness of newly enrolled nurses is relatively weak and needs to be further improved. The group's ability to improve occupational protective behaviors may be positively impacted through increased adaptability, improved sleep, active participation in nursing skill-based competitions, strengthening guidance and education on occupational protection.
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Affiliation(s)
- Yang Xu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- School of Nursing, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China
| | - Wen-Jie Liu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- School of Nursing, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China
| | - Xia Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- School of Nursing, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China
| | - Qian-Mei Yang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China.
- School of Nursing, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China.
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Do we need a pandemic to improve hygiene routines in the ambulance service? A cross-sectional study. Int Emerg Nurs 2022; 62:101171. [PMID: 35487042 PMCID: PMC9042148 DOI: 10.1016/j.ienj.2022.101171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 02/14/2022] [Accepted: 03/23/2022] [Indexed: 11/20/2022]
Abstract
Background We know that ambulance staff may have sparse knowledge on how to comply with care approaches that ensure appropriate hygiene in the ambulance, but we do not know if and how the COVID-19 pandemic has affected ambulance staff’s perceived compliance with hygiene routines. Aim To investigate ambulance staff’s self-reported hand hygiene (HH) perceptions and compliance; and to explore if and how the COVID-19 pandemic has affected ambulance staff’s perceived compliance with hygiene routines. Methods A cross-sectional study design using the WHO-validated Perception Survey for Healthcare Workers regarding hygiene. Thematic analysis and descriptive statistics were used for analysis. Results 204 surveys were analysed, 92% of participants stated that their hygiene routine compliance had improved during the COVID-19 pandemic, and some participants also described that their colleagues’ practice had improved. These improvements were reportedly driven by the need to acquire new knowledge to deal with the pandemic and sometimes with fear. Conclusions Experience acquired during the pandemic needs to be sustainable if we are to increase HH and hygiene routine compliance in ambulance services. Interventions aimed at changing ambulance staff’s perceived behaviour are warranted, and stakeholders should try and identify the personal motivations that lead these staff to seek self-betterment regarding HH and hygiene routine compliance. Otherwise, the risk of patients suffering from healthcare-associated infection may not decrease as wished.
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Pelzer ES, Stewart Z, Peters H, O'Callaghan J, Bryan E, Wager L, Chiruta J. Implementation of a structured practical activity to analyse student healthcare worker perceptions and compliance with prescribed infection control procedures. BMC MEDICAL EDUCATION 2021; 21:617. [PMID: 34906108 PMCID: PMC8672573 DOI: 10.1186/s12909-021-03048-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 11/12/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Non-compliance with infection control guidelines has been reported within healthcare settings. Infection control education in undergraduate healthcare education programs forms a critical component in preparing student healthcare workers for vocational roles. METHODS Clinical sciences students (nutrition science, paramedicine, pharmacy, podiatry, optometry studying for qualifications recognised by the Australian Health Practitioner Regulation Agency) self-reported hygiene perceptions and practices and collected microbiological swabs from personal or medical equipment items before and after recommended disinfection procedures. RESULTS Cultivable microorganisms were isolated from 95% of student medical equipment items. Disinfection significantly reduced microbial growth on student medical equipment items (P < 0.05). CONCLUSIONS Student perceptions of infection control procedures do not always correlate with infection control practice. Infection control education of undergraduate healthcare students requires ongoing assessment to ensure successful translation into clinical practice.
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Affiliation(s)
- Elise S Pelzer
- Queensland University of Technology, School of Biomedical Sciences, Faculty of Health, 2 George Street, Brisbane City, QLD, 4000, Australia.
- Queensland University of Technology, PO Box 2434, Brisbane, Queensland, 4001, Australia.
| | - Zachary Stewart
- Queensland University of Technology, School of Biomedical Sciences, Faculty of Health, 2 George Street, Brisbane City, QLD, 4000, Australia
| | - Holly Peters
- Queensland University of Technology, School of Biomedical Sciences, Faculty of Health, 2 George Street, Brisbane City, QLD, 4000, Australia
| | - Jessica O'Callaghan
- Queensland University of Technology, School of Biomedical Sciences, Faculty of Health, 2 George Street, Brisbane City, QLD, 4000, Australia
| | - Emily Bryan
- Queensland University of Technology, School of Biomedical Sciences, Faculty of Health, 2 George Street, Brisbane City, QLD, 4000, Australia
| | - Lucas Wager
- Queensland University of Technology, School of Biomedical Sciences, Faculty of Health, 2 George Street, Brisbane City, QLD, 4000, Australia
| | - Juliana Chiruta
- Queensland University of Technology, School of Biomedical Sciences, Faculty of Health, 2 George Street, Brisbane City, QLD, 4000, Australia
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Barr KL, Sturdivant RX, Williams DN, Harris D. Bacteria Associated with Healthcare-Associated Infections on Environmental Samples Obtained from Two Fire Departments. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211885. [PMID: 34831638 PMCID: PMC8621870 DOI: 10.3390/ijerph182211885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/02/2021] [Accepted: 11/04/2021] [Indexed: 12/14/2022]
Abstract
(1) Background: Firefighters spend about 64% of their time responding to medical emergencies and providing medical care without a patient history, which can render them vulnerable to healthcare-associated infections (HAI). Infection prevention, control, and surveillance systems have been instituted at hospitals. However, the prevalence of firefighters’ exposure to HAI is unknown. The objective of this study was to document evidence of HAI on surfaces in fire stations and engines to inform disinfection procedures and identify which pathogens might contribute to occupational exposures. (2) Methods: High-touch or high-use surfaces of two fire departments were sampled during five separate occasions. One fire station from one fire department was sampled over a 4-week period, whereas four fire stations were sampled from a different fire department only once. Sampled surfaces included: entryway floor, washing machine, medical bag, back seat of engine, keyboard of reporting computer, engine console, and uniform pants. (3) Results: Multiple statistical models determined that bacterial contamination was similar between the two fire departments and their stations. Keyboards were the most contaminated surface for all fire stations and departments, E. coli was the most common bacteria detected, and C. difficile was the least detected bacteria. Adjustments for rates of contamination found that contamination rates varied between fire stations. (4) Conclusions: Comprehensive environmental sampling and clinical studies are needed to better understand occupational exposures of firefighters to HAI.
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Affiliation(s)
- Kelli L. Barr
- Center for Global Health Infectious Disease Research, College of Public Health, University of South Florida, Tampa, FL 10921, USA;
| | | | - Denise N. Williams
- Department of Human Sciences and Design, College of Health and Human Science, Baylor University, Waco, TX 76798, USA;
| | - Debra Harris
- Department of Human Sciences and Design, College of Health and Human Science, Baylor University, Waco, TX 76798, USA;
- Correspondence: ; Tel.: +1-254-710-7255
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Overbey KN, Hamra GB, Nachman KE, Rock C, Schwab KJ. Quantitative microbial risk assessment of human norovirus infection in environmental service workers due to healthcare-associated fomites. J Hosp Infect 2021; 117:52-64. [PMID: 34403766 PMCID: PMC8978295 DOI: 10.1016/j.jhin.2021.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/05/2021] [Accepted: 08/06/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Healthcare-associated norovirus outbreaks place a large burden on healthcare staff. Environmental service workers (ESWs), however, remain understudied despite high contact with potentially contaminated surfaces. Understanding the magnitude of the risk of norovirus infection in healthcare ESWs can protect workers and improve infection control. AIM This study simulated the risk of norovirus infection for unprotected ESWs after a single fomite contact, assuming no disinfection or protective equipment, in norovirus-positive patient rooms. In addition, the risk of secondary surface transmission from norovirus-exposed ESWs was simulated. METHODS A quantitative microbial risk assessment employing two-dimensional Monte Carlo simulation with parameters extracted from the literature was used to estimate norovirus infection from multiple fomite contact scenarios defined by: norovirus source (patient vomit/diarrhoea), location (bathroom/patient room) and target outcome (ESW/secondary illness). FINDINGS Unprotected ESWs have a maximum estimated risk of norovirus infection of 33% (1:3) for a single fomite contact in a room where a norovirus-positive patient had a diarrhoeal event. Patient vomit events lead to fomite contact risk estimates that are four orders of magnitude lower than those for diarrhoeal events. The estimated risk of secondary illness from touching a common surface is as high as 25% (1:4) after single fomite exposure following a diarrhoeal event. CONCLUSIONS A single fomite contact may lead to sizable risk of norovirus infection in ESWs if personal protective equipment and disinfection are not used appropriately. ESWs can also transfer virus to secondary surfaces, initiating further infections. Interventions are needed to reduce fomite transfer of norovirus, and protect patients and staff from nosocomial infections.
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Affiliation(s)
- K N Overbey
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - G B Hamra
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - K E Nachman
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Risk Sciences and Public Policy Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - C Rock
- Division of Infectious Diseases, Johns Hopkins Medicine, Baltimore, MD, USA
| | - K J Schwab
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Risk Sciences and Public Policy Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Morris D, Fierravanti G, Schrieber A, Johnson S, Bartolo D, Hipsley K, Somani T, Pap R, Agho K, Thyer L, Simpson PM. The Impact of a Novel Operational Readiness Response Model on the Environmental Cleanliness of Emergency Ambulances. PREHOSP EMERG CARE 2021; 26:355-363. [PMID: 33528288 DOI: 10.1080/10903127.2021.1884323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objectives: Environmental cleanliness of emergency ambulances may be associated with increased risk of healthcare acquired infection (HAI). Surface cleanliness, measured using adenosine triphosphate (ATP) testing, has been demonstrated to correlate with potentially harmful levels of microbial pathogens. In most ambulance services, environmental cleanliness of ambulances and the equipment within them is the responsibility of paramedics. In 2016 NSW Ambulance introduced the Make Ready Model (MRM), in which ambulances are systematically cleaned by non-clinical support staff at the end of each shift. This prospective study aimed to 1) provide a baseline level of ambulance cleanliness; and 2) compare the MRM to a standard cleaning model (SCM). Methods: A prospective comparative study was conducted comparing cleanliness of ambulances in the SCM to those in the MRM. Adenosine-triphosphate (ATP) bioluminescence testing was performed in a pseudo-randomised sample of ambulances. Six 'high touch' areas within each ambulance were systematically sampled. Testing occurred without warning to operational staff. The primary outcome was 'overall bioburden' (OB)' measured in radiant light units ('RLU'). Non-parametric tests were used to assess differences in RLU values between each of the test points, while Poisson multivariate regression was used to compare median overall bioburden between the two groups, adjusting for the confounder variable of 14-day ambulance workload. Results: Sixty-eight ambulances were sampled, 32 from the SCM and 36 from the MRM. Median surface bioburden was significantly lower in the MRM for four of the six test points (preparation table, mobile data terminal, stretcher handles and steering wheel). For the primary outcome of overall bioburden, the unadjusted MRM OB was 35% lower than for the SCM group (RR 0.65 (0.64-0.66; p < 0.01)). After adjusting for the significant confounding variable of 14-day workload, the OB was 38% lower for the MRM group (ARR 0.68 (0.61-0.63; p < 0.001)). Conclusion: The innovative MRM cleaning system was associated with significantly improved cleanliness in frontline emergency ambulances. The magnitude of improvement in cleanliness suggests this cleaning model has the potential to make a major contribution to infection control strategies in paramedicine. Future research should focus on cost effectiveness of the MRM and its applicability to regional and remote ambulance service operations.
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Bitely C, Miller B, Glauser J. EMS Disease Exposure, Transmission, and Prevention: a Review Article. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2019; 7:135-140. [PMID: 32226658 PMCID: PMC7100409 DOI: 10.1007/s40138-019-00200-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Purpose of Review This article aims to review recent literature regarding the risks of disease exposure to pre-hospital providers and the patients they serve, as well as the challenges they face in minimizing transmission and exposure. Recent Findings Many studies continue to show poor compliance with consistent universal precautions, as well as proper hand hygiene. Vaccination rates are suboptimal despite attempts to encourage compliance. With the spread of multi-drug resistant organisms, new techniques of decontamination need to be investigated. Summary There remains a general lack of information and studies regarding the risks of disease exposure and transmission to EMS providers despite the significance hazards their profession can pose. However, there remains a continued theme throughout the majority of EMS and pre-hospital studies, demonstrating that hand washing and consistent use of personal protective equipment remains a persistent, preventable means of disease exposure and transmission.
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Affiliation(s)
- Colton Bitely
- Department of Emergency Medicine, MetroHealth Medical System, 2500 MetroHealth Drive, Cleveland, OH 44109 USA
| | - Brian Miller
- Department of Emergency Medicine, MetroHealth Medical System, 2500 MetroHealth Drive, Cleveland, OH 44109 USA
| | - Jonathan Glauser
- Department of Emergency Medicine, MetroHealth Medical System, 2500 MetroHealth Drive, Cleveland, OH 44109 USA
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Munoz-Gutierrez K, Canales R, Reynolds K, Verhougstraete M. Floor and environmental contamination during glove disposal. J Hosp Infect 2019; 101:347-353. [DOI: 10.1016/j.jhin.2018.10.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 10/15/2018] [Indexed: 11/30/2022]
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Vikke HS, Vittinghus S, Giebner M, Kolmos HJ, Smith K, Castrén M, Lindström V. Compliance with hand hygiene in emergency medical services: an international observational study. Emerg Med J 2019; 36:171-175. [PMID: 30692145 PMCID: PMC6580871 DOI: 10.1136/emermed-2018-207872] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 12/04/2018] [Accepted: 12/06/2018] [Indexed: 01/21/2023]
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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Affiliation(s)
- Heidi Storm Vikke
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Medical Office, Falck Danmark A/S, Kolding, Denmark
| | | | | | - Hans Jørn Kolmos
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
| | - Karen Smith
- Centre fro Research and Evaluation, Ambulance Victoria, Melbourne, Victoria, Australia
- Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Maaret Castrén
- Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - Veronica Lindström
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
- SamordnareAkademisk ambulans SLL, Academic EMS, Stockholm, Sweden
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Vikke HS, Vittinghus S, Betzer M, Giebner M, Kolmos HJ, Smith K, Castrén M, Lindström V, Mäkinen M, Harve H, Mogensen CB. "Hand hygiene perception and self-reported hand hygiene compliance among emergency medical service providers: a Danish survey". Scand J Trauma Resusc Emerg Med 2019; 27:10. [PMID: 30722789 PMCID: PMC6362569 DOI: 10.1186/s13049-019-0587-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 01/10/2019] [Indexed: 11/10/2022] Open
Abstract
Background Hand hygiene (HH), a cornerstone in infection prevention and control, lacks quality in emergency medical services (EMS). HH improvement includes both individual and institutional aspects, but little is known about EMS providers’ HH perception and motivations related to HH quality. Therefore, we aimed to investigate the HH perception and assess potential factors related to self-reported HH compliance among the EMS cohort. Methods A cross-sectional, self-administered questionnaire consisting of 24 items (developed from the WHOs Perception Survey for Health-Care Workers) provided information on demographics, HH perceptions and self-reported HH compliance among EMS providers from Denmark. Results Overall, 457 questionnaires were answered (response rate 52%). Most respondents were advanced-care providers, males, had > 5 years of experience, and had received HH training < 3 years ago. HH was perceived a daily routine, and the majority rated their HH compliance rate ≥ 80%. Both infection severity and the preventive effect of HH were acknowledged. HH quality was perceived important to colleagues and patients, but not as much to managers. Access to supplies, simple instructions and having or being “a good example” were perceived most effective to improve HH compliance. Self-reported HH compliance was associated with years of experience and perceptions of HCAI’s impact on patient outcome, HH’s preventive effect, organizational priority, HH’s importance to colleagues and patients, and the effort HH requires (p ≤ 0.05). Conclusion Danish EMS providers acknowledged the impact of infections and the preventive effect of HH, and perceived access to HH supplies at the point of care, having or being “a good example” and simple instructions effective to improve HH compliance. Moreover, several behavioral-, normative- and control beliefs were associated with self-reported HH compliance, and thus future improvement strategies should be multimodal. Electronic supplementary material The online version of this article (10.1186/s13049-019-0587-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Heidi Storm Vikke
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark. .,Medical Office, Falck Denmark A/S, Kolding, Denmark.
| | | | | | | | - Hans Jørn Kolmos
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
| | - Karen Smith
- Ambulance Victoria, Centre for Research and Evaluation, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine and Department Community Emergency Health and Paramedic Practice, Monash University, Melbourne, Australia
| | - Maaret Castrén
- Helsinki University Hospital, Department of emergency medicine and services, Helsinki University, Helsinki, Finland
| | - Veronica Lindström
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Nursing & Academic EMS, Stockholm, Sweden
| | - Marja Mäkinen
- Helsinki University Hospital, Department of emergency medicine and services, Helsinki University, Helsinki, Finland
| | - Heini Harve
- Helsinki University Hospital, Department of emergency medicine and services, Helsinki University, Helsinki, Finland
| | - Christian Backer Mogensen
- Focused Research Unit in Emergency Medicine, Institute for Regional Health Research, University of Southern Denmark, Aabenraa, Denmark
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15
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Barr N, Holmes M, Roiko A, Dunn P, Lord B. Challenges for environmental hygiene practices in Australian paramedic-led health care: A brief report. Am J Infect Control 2018; 46:723-725. [PMID: 29305280 DOI: 10.1016/j.ajic.2017.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 11/04/2017] [Accepted: 11/04/2017] [Indexed: 11/30/2022]
Abstract
This study explored the self-reported behaviors and perceptions of Australian paramedics in relation to their environmental hygiene practices. A national online survey was conducted with Paramedics Australasia members (N = 417). Participants reported working in ambulances often contaminated with body fluids. Widespread noncompliance with routine and deep cleaning of ambulances, and misunderstandings about environmental hygiene practices were apparent. Improvements to environmental hygiene practices of Australian paramedics are recommended to avoid pathogen transmission and ensure patient safety.
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Affiliation(s)
- Nigel Barr
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Maroochydore DC, QLD, Australia.
| | - Mark Holmes
- School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore DC, QLD, Australia
| | - Anne Roiko
- School of Medicine and Menzies Health Institute, Griffith University, Gold Coast, QLD, Australia
| | - Peter Dunn
- School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore DC, QLD, Australia
| | - Bill Lord
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Maroochydore DC, QLD, Australia
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16
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Kampf G, Lemmen S. Disinfection of gloved hands for multiple activities with indicated glove use on the same patient. J Hosp Infect 2017. [PMID: 28648454 DOI: 10.1016/j.jhin.2017.06.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Most hand hygiene guidelines recommend that gloves should be changed during patient care when an indication for hand disinfection occurs. Observational studies indicate that the majority of healthcare workers (HCWs) do not disinfect their hands at all during continued glove wear. The aim of this narrative review is to assess the potential benefits and risks for disinfecting gloved hands during patient care for multiple activities with indicated glove use on the same patient. Continued glove wear for multiple activities on the same patient often results in performing procedures, including aseptic procedures with contaminated gloves, especially in a setting where there are many indications in a short time, e.g. anaesthetics or accident and emergency departments. Of further note is that hand hygiene compliance is often lower when gloves are worn. To date, three independent studies have shown that decontamination is at least as effective on gloved hands as on bare hands and that puncture rates are usually not higher after up to 10 disinfections. One study on a neonatal intensive care unit showed that promotion of disinfecting gloved hands during care on the same patient resulted in a significant reduction in the incidence of late-onset infections and of necrotizing enterocolitis. We conclude that disinfection of gloved hands by HCWs may substantially reduce the risk of transmission when gloves are indicated for the entire episode of patient care and when performed during multiple activities on the same patient.
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Affiliation(s)
- G Kampf
- Knieler und Team GmbH, Infection Control Science, Hamburg, Germany; University Medicine Greifswald, Institute for Hygiene and Environmental Medicine, Greifswald, Germany.
| | - S Lemmen
- University Hospital Aachen, Department of Infection Control and Infectious Diseases, Aachen, Germany
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