Practices, Attitudes, and Beliefs of Emergency Medical Services Personnel Regarding Hand Hygiene

Background: Hand hygiene is widely accepted as the most effective step for preventing the spread of infection.  Despite the extensive literature available regarding hand hygiene practices in various groups of healthcare workers, the topic of hand hygiene among emergency medical services (EMS) personnel has not been extensively explored.  EMS workers function in a unique environment and are likely to provide care in an uncontrolled setting where the risk of hand contamination is high.   Gaining insight into the practices, attitudes, and beliefs of EMS personnel regarding hand hygiene is a critical first step towards including these non-traditional healthcare workers in infection prevention and control efforts. 

Objective: The primary objective of this study was to document the practices, attitudes, and beliefs of personnel regarding hand hygiene in a joint EMS/fire rescue department setting.   

Methods: The sample consisted of paramedics and emergency medical technicians from a suburban, county fire department providing fire and EMS response in Florida.  A one-page survey was delivered to 387 personnel at 21 fire stations.  Participants returned the anonymous surveys through the inter-office mail system.  Data were analyzed and descriptive statistics generated using EpiInfo 6.0.

Results: A total of 228 surveys were completed, representing a 58.9% response rate.  Over 50% (131) of participants indicated they had not received any training on hand hygiene from the fire department during the term of their employment.  In various questions, 90 to 93% of respondents demonstrated a perception of personal risk due to pathogens encountered on the job, as well as the potential negative impact of poor hand hygiene.  Responses to additional comments regarding frequency of hand hygiene revealed important differences between self-reported practices and observations of the practices of others. Respondents identified barriers such as difficulty in finding water or hand gel (11.6%), fatigue (2.7%), belief that wearing gloves was a substitute for hand hygiene (8%), and forgetfulness (28.9%). 

Conclusions: EMS workers in this sample demonstrated an understanding of the importance of and reported consistently practicing hand hygiene, but reported concerns that co-workers were not consistently doing so.  This descriptive study is an important first step in documenting the perceptions and reported practices of EMS providers regarding hand hygiene, providing a foundation for future interventions to improve methods, rates, and consistency of hand hygiene in this sample. Additional efforts should aim to understand the practices, attitudes, and beliefs of EMS personnel regarding hand hygiene in a variety of practice settings.