Challenges in Infection Prevention and Control in Paramedicine: A Modified Nominal Group Technique Consensus Study

Healthcare-associated infections (HAIs) are a major patient safety concern, yet infection prevention and control (IPC) in emergency ambulance services is challenging due to unpredictable environments, operational pressures, and equipment limitations. Evidence is limited regarding how ambulance fleet and equipment design influence IPC compliance. This study aimed to identify expert priorities for improving the availability and utility of IPC equipment and consumables in paramedicine.

A modified Nominal Group Technique was conducted with experts in infection prevention, paramedicine, clinical governance, education, and operations. Participants collectively generated ideas concerned with IPC in emergency ambulance services and subsequently ranked these through an anonymous survey to determine priority areas.

Ten experts participated. Human factors were ranked as the most influential determinant of IPC compliance, followed by education and training, physical environment, equipment and consumables, and contaminated equipment management. Key barriers included organizational culture, compliance fatigue, inconsistent education, uncontrolled environments, and fleet design limitations.

IPC compliance in ambulance services is primarily shaped by behavioral, organizational, and environmental factors rather than equipment provision alone. Systems-based, co-designed interventions addressing human factors, education, organizational support, and equipment design are essential to improve IPC adherence and enhance patient and clinician safety.