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Self-reported behaviors and perceptions of Australian paramedics in relation to hand hygiene and gloving practices in paramedic-led health care

Published:April 03, 2017DOI:https://doi.org/10.1016/j.ajic.2017.02.020

      Highlights

      • Noncompliance by Australian paramedics with recommended hand hygiene and gloving practices has been identified.
      • The hands of paramedics have a potential role in the spread of health care–associated infection.
      • Participants perceived that hand hygiene had been a minor aspect of their training.
      • All participants wore gloves for every patient contact.
      • Over half of the participants only changed their gloves post patient care.
      • Improvements in both gloving practices and hand hygiene compliance among Australian paramedics are necessary.

      Background

      Noncompliance with recommended hand hygiene and gloving practices by workers in the emergency medical services may contribute to the transmission of health care–associated infections and lead to poor patient outcomes. The aim of this study was to explore the self-reported behaviors and perceptions of Australian paramedics in relation to their hand hygiene and gloving practices in paramedic-led health care.

      Methods

      A national online survey (n = 417; 17% response rate) and 2 semistructured focus groups (6 per group) were conducted with members of Paramedics Australasia.

      Results

      Although most of the study participants perceived hand hygiene and gloving to be important, the findings suggest poor compliance with both practices, particularly during emergency cases. All participants reported wearing gloves throughout a clinical case, changing them either at the completion of patient care or when visibly soiled or broken. Hand hygiene was missed at defined moments during patient care, possibly from the misuse of gloves.

      Conclusions

      Paramedic hand hygiene and gloving practices require substantial improvement to lower potential transmission of pathogens and improve patient safety and clinical care. Further research is recommended to explore how to alleviate the barriers to performing in-field hand hygiene and the misuse of gloves during paramedic-led health care.

      Key Words

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      References

        • NHMRC
        Australian guidelines for the prevention and control of infection in healthcare.
        Commonwealth of Australia, Canberra, Australia2010
        • Woodside J.
        • Rebmann T.
        • Williams C.
        • Woodin J.
        Guide to infection prevention in emergency medical services.
        Association for Professionals in Infection Control and Epidemiology, Washington (DC)2013
        • Teter J.
        • Millin M.G.
        • Bissell R.
        Hand hygiene in emergency medical services.
        Prehosp Emerg Care. 2015; 19: 313-319
        • Ho J.D.
        • Ansari R.K.
        • Page D.
        Hand sanitization rates in an urban emergency medical services system.
        J Emerg Med. 2014; 47: 163-168
        • McGuire-Wolfe C.
        • Haiduven D.
        • Hitchcock C.D.
        A multifaceted pilot program to promote hand hygiene at a suburban fire department.
        Am J Infect Control. 2012; 40: 324-327
        • Boal W.L.
        • Leiss J.K.
        • Ratcliffe J.M.
        • Sousa S.
        • Lyden J.T.
        • Li J.
        • et al.
        The national study to prevent blood exposure in paramedics: rates of exposure to blood.
        Int Arch Occup Environ Health. 2010; 83: 191-199
        • Association for Professionals in Infection Control and Epidemiology
        Guide to infection prevention in emergency medical services.
        Association for Professionals in Infection Control and Epidemiology, Washington (DC)2013
        • Leiss J.K.
        • Sousa S.
        • Boal W.L.
        Circumstances surrounding occupational blood exposure events in the National Study to Prevent Blood Exposure in Paramedics.
        Ind Health. 2009; 47: 139-144
        • Leiss J.K.
        • Ratcliffe J.M.
        • Lyden J.T.
        • Sousa S.
        • Orelien J.G.
        • Boal W.L.
        • et al.
        Blood exposure among paramedics: incidence rates from the national study to prevent blood exposure in aramedics.
        Ann Epidemiol. 2006; 16: 720-725
        • Fullera C.
        • Savage J.
        • Bessera S.
        • Haywarda A.
        • Cooksona B.
        • Coopera B.
        • et al.
        “The dirty hand in the latex glove”: a study of hand hygiene compliance when gloves are worn.
        Infect Control Hosp Epidemiol. 2011; 32: 1194-1199
        • Girou E.
        • Chaia S.H.T.
        • Oppeina F.
        • Legrand P.
        • Ducelliera D.
        • Cizeaua F.
        • et al.
        Misuse of gloves: the foundation for poor compliance with hand hygiene and potential for microbial transmission?.
        J Hosp Infect. 2004; 57: 162-169
        • Australian Commission on Safety and Quality in Health Care
        Safety and quality improvement guide standard 3: preventing and controlling healthcare associated infections.
        Australian Commission on Safety and Quality in Healthcare (ACSQHC), Sydney, Australia2012
        • Hand Hygiene Australia
        National hand hygiene initiative.
        Australian Commission on Safety and Quality in Health Care, Sydney, Australia2008
        • Queensland Parliament
        Record of proceedings: First session of the fifty-fifth parliament.
        (Wednesday, 20 May 2015)2015 (Available from) (Accessed March 21, 2017)
        • Shaban R.Z.
        Paramedic knowledge of infection control principles and standards in an Australian emergency medical system.
        Aust Infect Contr. 2006; 11: 13-19
        • Shaban R.Z.
        • Clark M.J.
        • Creedy D.K.
        Management of sharps in ambulance care: a state wide survey of paramedic knowledge and repoted practice.
        Aust Infect Contr. 2004; 9: 120-124
        • Shaban R.Z.
        • Creedy D.K.
        • Clark M.J.
        Paramedic knowledge of infectious disease aetiology and transmission in an Australian Emergency Medical System.
        J Emerg Primary Health Care. 2003; 1 (990046)
        • Creswell J.W.
        Research design: qualitative, quantitative and mixed methods approaches.
        3rd ed. Sage, London, UK2009
        • Hall J.
        PA annual report 2013: membership.
        Response. 2013; 40: 5-19
        • Green L.
        • Kreuter M.K.
        Health program planning: an educational and ecological approach.
        4th ed. McGraw Hill, New York (NY)2005
        • Crosby R.
        • Noar S.M.
        What is a planning model? An introduction to PRECEDE-PROCEED.
        J Public Health Dent. 2011; 71: S7-15
        • Glasgow R.E.
        Planning models and theories: integrating components for addressing complex challenges.
        J Public Health Dent. 2011; 71: S17
        • Stewart D.W.
        • Shamdasani P.N.
        Focus groups: theory and practice.
        Sage Publications, London, UK2015
        • Special Broadcasting Service
        HELP.
        (Available from) (Accessed December 12, 2014)
        • MacNamara J.
        Media content analysis: uses, benefits & best practice methodology.
        Carma International, Sydney, Australia2006
        • Stemler S.
        An overview of content analysis.
        Pract Assess Res Eval. 2001; 7: 1-6
        • Krippendorf K.
        Content analysis: an introduction to its methodology.
        2nd ed. Sage Publications, London, UK2004
        • Chelimsky E.
        Content analysis: a methodology for structuring and analyzing written material.
        United States Government Accountability Office, Washington (DC)1989
        • Steering Committee for the Review of Government Service Provision
        Report on government services 2014. Vol. D. Productivity Commission, Canberra, Australia2014 (Emergency management)
        • Paramedics Australasia
        Paramedic role descriptors.
        (Available from) (Accessed August 23, 2015)
      1. Grayson M.L. Russo P. Ryan K. Havers S. Heard K. HHA manual. 3rd ed. The Australian Commission on Safety and Quality in Health Care, Sydney, Australia2013
        • Council of Ambulance Authorities
        Discussion paper for the review of the report on government services for consultation.
        The Council of Ambulance Authorities, Flinders Park, Australia2009
        • McCoy C.E.
        • Menchine M.
        • Sampson S.
        • Anderson C.
        • Kahn C.
        Emergency medical services out-of-hospital scene and transport times and their association with mortality in trauma patients presenting to an urban level I trauma center.
        Ann Emerg Med. 2013; 61: 167-174
        • Steering Committee for the Review of Government Service Provision
        Report on government services 2016. Vol. D. Productivity Commission, Canberra, Australia2016 (Emergency management)
        • Cusini A.
        • Nydegger D.
        • Kaspar T.
        • Schweiger A.
        • Kuhn R.
        • Marschall J.
        Improved hand hygiene compliance after eliminating mandatory glove use from contact precautions: is less more?.
        Am J Infect Control. 2015; 43: 922-927
        • Pittet D.
        • Mourouga P.
        • Perneger T.V.
        • The Members of the Infection Control Program
        Compliance with handwashing in a teaching hospital.
        Ann Intern Med. 1999; 130: 126-130
        • Marcil W.M.
        Handwashing practices among occupational therapy personnel.
        Am J Occup Ther. 1993; 47: 523-528
        • Pittet D.
        • Allegranzi B.
        • Sax H.
        • Dharan S.
        • Pessoa-Silva C.L.
        • Donaldson L.
        • et al.
        Evidence-based model for hand transmission during patient care and the role of improved practices.
        Lancet Infect Dis. 2006; 6: 641-652
        • Pittet D.
        • Dharan S.
        • Touveneau S.
        • Sauvan V.
        • Perneger T.V.
        Bacterial contamination of the hands of hospital staff during routine patient care.
        Arch Intern Med. 1999; 159: 821-826
        • Cure L.
        • Van Enk R.
        Effect of hand sanitizer location on hand hygiene compliance.
        Am J Infect Control. 2015; 43: 917-921
        • Harvey J.
        • Bolam H.
        • Gregory D.
        • Erdos G.
        The effectiveness of training to change safety culture and attitudes within a highly regulated environment.
        Personnel Rev. 2001; 30: 615-636
        • DeJoy D.M.
        Behavior change versus culture change: divergent approaches to managing workplace safety.
        Safety Sci. 2005; 43: 105-129
        • Bahn S.
        • Barratt-Pugh L.
        Evaluation of the mandatory construction induction training program in Western Australia: unanticipated consequences.
        Eval Program Plann. 2011; 35: 337-343
        • Scott E.
        • Vanick K.
        A survey of hand hygiene practices on a residential college campus.
        Am J Infect Control. 2007; 35: 694-696
        • Snow M.
        • White G.L.
        • Alder S.C.
        • Stanford J.B.
        Mentor's hand hygiene practices influence student's hand hygiene rates.
        Am J Infect Control. 2006; 34: 18-24
        • O'Meara P.
        • Ruest M.
        • Stirling C.
        Community paramedicine: higher education as an enabling factor.
        Aust J Paramed. 2014; 11 (5)
        • Jang J.-H.
        • Samantha W.
        • Kirzner D.
        • Moore C.
        • Youssef G.
        • Tong A.
        • et al.
        Focus group study of hand hygiene practice among healthcare workers in a teaching hospital in Toronto, Canada.
        Infect Control Hosp Epidemiol. 2010; 31: 144-150
        • Pittet D.
        • Hugonnet S.
        • Harbarth S.
        • Mourouga P.
        • Sauvan V.
        • Touveneau S.
        • et al.
        Effectiveness of a hospital-wide programme to improve compliance with hand hygiene.
        Lancet. 2000; 356: 1307-1312
        • Gilbert K.
        • Stafford C.
        • Crosby K.
        • Fleming E.
        • Gaynes R.
        Does hand hygiene compliance among health care workers change when patients are in contact precaution rooms in ICUs?.
        Am J Infect Control. 2010; 38: 515-517
        • Hand Hygiene Australia
        National Data Period Three 2016.
        (Available from) (Accessed January 22, 2017)
        • Mischke C.
        • Verbeek J.H.
        • Saarto A.
        • Lavoie M.C.
        • Pahwa M.
        • Ijaz S.
        Gloves, extra gloves or special types of gloves for preventing percutaneous exposure injuries in healthcare personnel.
        Cochrane Database Syst Rev. 2014; (CD009573)
        • Macbeth D.
        • Murphy C.
        Auditing hand hygiene rates for quality and improvement.
        Healthc Infect. 2012; 17: 13-17
        • Bellaard-Smith E.R.
        • Gillespie E.E.
        Implementing hand hygiene strategies in the operating suite.
        Healthc Infect. 2012; 17: 33-37
        • Marra A.R.
        • Guastelli L.R.
        • de Araújo C.M.P.
        • dos Santos J.L.S.
        • Filho M.A.O.
        • Silva C.V.
        • et al.
        Positive deviance: a program for sustained improvement in hand hygiene compliance.
        Am J Infect Control. 2011; 39: 1-5
        • Pittet D.
        Improving compliance with hand hygiene in hospitals.
        Infect Control Hosp Epidemiol. 2000; 21: 381-386
        • Hosseinialhashemi M.
        • Kermani F.S.
        • Palenik C.J.
        • Pourasghari H.
        • Askarian M.
        Knowledge, attitudes, and practices of health care personnel concerning hand hygiene in Shiraz University of Medical Sciences hospitals, 2013-2014.
        Am J Infect Control. 2015; 43: 1009-1011
        • Grayson M.L.
        • Russo P.L.
        The National Hand Hygiene Initiative.
        Med J Aust. 2009; 191: 420-421
        • World Health Organisation
        WHO guidelines on hand hygiene in health care: first global patient safety challenge clean care is safer care.
        World Health Organisation, Geneva, Switzerland2009
        • Rowlands J.
        • Yeager M.P.
        • Beach M.
        • Patel H.M.
        • Huysman B.C.
        • Loftus R.W.
        Video observation to map hand contact and bacterial transmission in operation rooms.
        Am J Infect Control. 2014; 42: 698-701
        • Hulebak K.L.
        • Schlosser W.
        Hazard Analysis and Critical Control Point (HACCP): history and conceptual overview.
        Risk Anal. 2002; 22: 547-552
        • Ryan K.
        • Russo P.L.
        • Heard K.
        • Havers S.
        • Bellis K.
        • Grayson M.L.
        Development of a standardised approach to observing hand hygiene compliance in Australia.
        Healthc Infect. 2012; 17: 115-121
        • Zerbe W.
        • Paulhus D.L.
        Socially desirable responding in organizational behavior: a reconception.
        Acad Manage Rev. 1987; 12: 250-264
        • Holtgraves T.
        Social desirability and self-reports: testing models of socially desirable responding.
        Pers Soc Psychol Bull. 2004; 30: 161-172
        • Brenner P.
        • DeLamater J.
        Social desirability bias in self-reports of physical activity: is an exercise identity the culprit?.
        Soc Indic Res. 2014; 117: 489-504