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Observational Study
. 2019 Mar;36(3):171-175.
doi: 10.1136/emermed-2018-207872. Epub 2019 Jan 28.

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

Heidi Storm Vikke  1   2 , Svend Vittinghus  2 , Matthias Giebner  3 , Hans Jørn Kolmos  1   4 , Karen Smith  5   6   7 , Maaret Castrén  8 , Veronica Lindström  9   10
Affiliations
Observational Study

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

Heidi Storm Vikke et al. Emerg Med J. 2019 Mar.

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.

Keywords: emergency medical services; hand hygiene; prehospital care.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Five moments for hand hygiene according to WHO recommendations.
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