Hand sanitization rates in an urban emergency medical services system

Hand sanitizing, although often a "forgotten" practice, has been demonstrated to be a leading factor in preventing infectious disease transmission in health care environments. Previous studies have looked at hand-sanitization rates in hospital settings, but we are aware of very few describing this in the prehospital setting. Because emergency medical services (EMS) providers are potential vectors of infectious disease spread, it is important to know if their hand-sanitization practices are sufficient.

The objective of this study was to describe the hand-sanitization rates for a convenience sample of an urban EMS system.

A convenience sampling of paramedics employed by an urban paramedic ambulance service (55,000+ runs/year) underwent prospective, blinded observation during a 6-month period. Observations were conducted by paramedic students during 8-h and 12-h shifts. Recorded data points included any modality of hand sanitizing (e.g., soap/water, anti-germicidal gels or foams, anti-germicidal wipes) immediately surrounding all patient contacts and meals. Glove use during patient contact was also recorded. Trips to the restroom were not directly observed and hand sanitizing after this event was assumed. Duration of any sanitizing event was not recorded. Data points were analyzed using simple and descriptive statistics.

Fifty-three paramedics (of 108 paramedic employees) were observed during 258 patient contacts. Paramedics were observed to sanitize their hands after 162 of these (62.8%). If hand sanitizing is assumed in the 16 immediate trips to the restroom after patient contact, the compliance rate increased to 68.9%. Hands were sanitized immediately before patient contact only three times (1.1%) and nine times during patient contact (3.5%). Gloves were not worn during 32 of the patient contacts (12.4%). Hand sanitizing occurred before 8 of 42 meals (19%) and after 25 of 42 meals (59.5%).

Hand-sanitization events were noted in this convenience sample group a majority of times in association with patient contact. However, there appears to be substantial room for improvement. This suggests that EMS services should work to improve hand-sanitization compliance. Increased instruction, education, or access to hygiene equipment should be investigated as avenues to improve future compliance.