Hygeine In EMS

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This story appeared on line the other day,

Many paramedics ignore hand hygiene rules, study finds

Paramedics have a “remarkably low” rate of compliance with hand hygiene standards, which could put patients at risk for deadly infections, according to a new report.

For the study, researchers observed 77 paramedics in Finland, Sweden, Denmark and Australia as they dealt with 87 patients. The paramedics’ compliance with basic hygiene was high: short, clean nails at 83 percent; hair short or tied back at 99 percent and no jewelry worn at 62 percent.

But many ignored World Health Organization guidelines in five situations when cleansing with soap and water or an antiseptic rub is needed. Too many relied instead on gloves, suggesting they care more about protecting themselves than patients, the study authors said.

77 paramedics, 87 patients, and from that they draw general conclusions.

Unfortunately, there is no link to the original study and no information as to what organization conducted it.

There seems, at least from my reading, to be a lot of false assumptions and bad information in the article. There is also nothing to suggest that this is the same in the US as it is in the systems studied.

We wear gloves for two reasons. The primary one is to protect ourselves from becoming infected by the patients. The second, and lesser, is to prevent contaminating our equipment and thus possibly infecting the current or a future patient.

If anything, in the US we wear gloves too often, don’t remove them promptly, and don’t reglove when we should. I worked with people who “double gloved, but I always felt it was pointless from a protection standpoint and made it harder to perform some tasks.

I, and a lot of the people I worked with would go through a couple of pairs of gloves on a call. If they got bloody, or torn, or contaminated with “yuck”, off they’d go and on would go another pair.

One thing that drove me crazy is when the EMT that was driving us to the hospital kept his gloves on while driving. Which meant that we had to decontaminate the cab of the ambulance. Or, sometimes they’d take the gloves off and drop them on the cab floor. More than once I retrieved a pair of used gloves and dropped them on the front seat of the BLS ambulance that assisted us. Crude, maybe a bit childish, but it got the message across.

I’m not making it up when I say I had a partner that put on gloves to answer the radio when we were dispatched. She was a bit odd in many ways, so I just laughed at her.

One thing that I do agree with in the article is that we often put gloves on when they are not needed. On some calls, because I was running the call and not going to touch the patient (the luxury of having an adequate number of personnel on a call), I wouldn’t put gloves on.

On a note from the article, if you’re putting your gloves on after touching bodily fluids, you’re not putting the patient at risk, you’ve already put yourself at risk.

One thing that is not clear from the article is that the researchers actually understand that the risk of contamination FROM the patient is much higher than the risk of contamination TO the patient.

As to the risk of cross contamination, the only times I’ve seen providers touch more than one patient without changing gloves was at a Mass Casualty Incident. Especially if it’s something such as the Boston Marathon Bombing for example, patients are going to be moved quickly and there wouldn’t be time to change gloves. In that case, anyone with an open injury is going to get antibiotics at the hospital, so the point is moot.

One area that many providers can improve is in cleaning equipment after calls. I was a bit of nut about that. After every ALS contact, the EKG and all other cables got cleaned, my stethoscope got cleaned, the stretcher got cleaned, and any areas that the patient might have touched got cleaned. Sheets and blankets were changed after every call.

I don’t know that everyone I worked with was that thorough, but most of them were.

In sum, I think that this article is over blown and if there was an actual study, it was poorly structured.

Pretty typical of the Main Stream Media reporting on medical issues. Flashy, scary headlines without much substance.

 

3 COMMENTS

  1. Sounds like yet another ‘study’ with no real data behind it, and only 87 responders? That doesn’t even meet the requirement for basic statistical significance.

  2. I was reading an article a while back, about how DNA collected at the scene of a crime might not be as cut and dried as is often implied.

    Turns out there was a case out in Cali, where a guy was beaten to death, and guy 2’s DNA was collected from the dead guys skin. So obviously guy 2 was the one who did the beating, right? Turns out he had a pretty iron clad alibi. He was in the hospital when the beating happened. Infact, he’d been transported to the hospital by the same ambulance crew who’d later that night responded to the call for the dying guy. It made me wonder what hadn’t been cleaned right. Not to mention, why are we putting so much weight behind said DNA collection if thats all it takes to throw it off.

    But I also know, from my own experience, that people will frequently not use gloves when they should, and not change them when they should. Some people are definitely better at it than others.

    • That’s an interesting case. Crime scene preservation is a whole different subject, which should be on the list of things needing better education in EMS. My agency used to do a lot of it in cooperation with the police department. We had a class on it every couple of years, with information on how not to contaminate the scene, how to preserve any clothing that we had to remove, and how to store it without destroying it’s value as evidence. We also had a policy of limiting access to crime scenes. Even in EMS, there are rubber neckers who will get in the way.

      Speaking of which, there was one time when the fire department showed up at a homicide. The officer on the engine insisted on going into the building, despite our advising him that it was a bad idea. This so pissed off the cops that they put crime scene tape around the engine and insisted checking the soles of the fire fighters boots to see WHO exactly had stomped through the blood on the floor. That tied them up for about two hours of valuable middle of the night sleep time before they were released.

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