Study: Hand hygiene low among paramedics

Paramedics appear to be more concerned with protecting themselves than reducing their patients’ risk of infection, according to a new study.

The study observed ambulance staff practice in four countries, including Australia, and found that paramedic compliance with hand hygiene standards appears to be “remarkably low”.

The study, published in the Emergency Medicine Journal, assessed how paramedics in four countries complied with recommended hand and basic hygiene standards, including the use of gloves, to protect themselves and their patients from the risk of infection.

The study assessed compliance with World Health Organization guidelines on the five triggers for hand hygiene using either antiseptic rub or soap and water. These triggers were:

1. Before touching the patient.
2. Before any ‘clean’ procedure, such as an injection or cleaning a wound.
3. After contact with bodily fluids/wounds.
4. After touching the patient.
5. After handling the patient’s belongings or anything in the immediate vicinity, such as the stretcher harness.

In all, 240 hours of observation were clocked up between December 2016 and May 2017 in Finland, Sweden, Denmark and Australia, during which time 77 paramedics dealt with 87 patients.

Researchers found that while compliance with basic hygiene standards was high (short, clean nails (83%), hair short or tied back (99%) and no jewellery worn (62%)), compliance with hand hygiene was poor. In all, 1344 hand hygiene triggers were recorded during this period, but complied with in only 15% of instances.

When broken down separately by trigger, compliance was just 3% before touching a patient and 2% before any ‘clean’ procedure. This rose to 8% after contact with bodily fluids, 29% after touching the patient and 38% after touching belongings, etc.

Compliance rate varied substantially among the four countries, with paramedics in Denmark topping the league table.

Paramedics used gloves in just over half (54%; 720) of the recommended instances, with new gloves worn before touching patients around half the time (48%), but in only 14% of ‘clean’ procedures.

And there was a tendency to wear the same pair of gloves throughout different indications — for example, after touching a contaminated site and touching the patient for the first time (21%) or before a ‘clean’ procedure (64%).

Gloves were also worn when there was no obvious need — no risk of bodily fluids, for example. And hand hygiene was less likely when gloves were worn.

Proper hand hygiene was observed in 2% of such instances, and in nearly a third of the indications (30%) when no gloves were worn, suggesting an over-reliance on gloves to ward off the risk of infection, said the researchers.

“Hand hygiene compliance among [emergency medical service] providers was remarkably low and higher after patient encounters compared with before patient encounters,” they wrote. “In addition, there was an over-reliance on gloves, indicating a tendency towards self-protection instead of patient protection.”

They added: “It is important to note that [hand hygiene] is about preventing the spread of microbes and thus protecting the patient. Whereas the use of gloves primarily is about protecting oneself from bodily fluids, and so on.”

This is an observational study, and it is very likely that behaviours might have been influenced by the presence of the observers, said the researchers. As such, no firm conclusions can be drawn about the findings.

Nevertheless, their findings indicate that further research is warranted on the barriers to good hand hygiene and how healthcare providers understand its value.

Image credit: ©stock.adobe.com/au/thanatphoto