Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
Medical Office, Falck Danmark A/S, Kolding, Denmark.
Emerg Med J. 2019 Mar;36(3):171-175. doi: 10.1136/emermed-2018-207872. Epub 2019 Jan 28.
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.
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.
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).
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.
由于卫生条件不足导致的医源性感染与死亡率、经济负担和患者痛苦有关。急救医疗服务（EMS）提供者在不同的环境中会接触到许多患者，因此他们有传播微生物的风险。手部卫生（HH）作为一种经过验证的感染控制干预措施，在 EMS 中很少被研究。
这项多中心前瞻性观察研究于 2016 年 12 月至 2017 年 5 月在芬兰、瑞典、澳大利亚和丹麦的救护服务机构中进行。两名观察者记录了以下参数：根据世界卫生组织（WHO）指南的 HH 依从性（接触患者前、清洁/无菌操作前、接触体液风险后、接触患者后和接触患者周围环境后）。还记录了手套使用情况以及指甲、头发和首饰使用等基本参数。
每个国家观察了 60 小时，总共观察了 87 例患者。共有 1344 次 HH 指征。观察到手部消毒剂或洗手液的使用情况：接触患者前为 3%；清洁/无菌操作前为 2%；接触体液风险后为 8%；接触患者后为 29%；接触患者周围环境后为 38%。在所有 HH 指征中，有 54%的情况下戴了手套。留短发、指甲短而清洁无指甲油、不戴首饰的依从率分别为 99%、84%和 62%。HH 依从性与戴手套（比值比 45；95%置信区间 10.8 至 187.8；p=0.000）和提供者级别（比值比 1.7；95%置信区间 1.1 至 2.4；p=0.007）有关，但与性别无关（比值比 1.3；95%置信区间 0.9 至 1.9；p=0.107）。
EMS 提供者的 HH 依从性明显较低，与接触患者前相比，接触患者后 HH 依从性更高，而且过度依赖手套。我们建议对 EMS 提供者的背景挑战和卫生认知进行进一步研究，以明确未来的改进策略。
