Infection Control in Pre-Hospital Settings Falls on EMS Personnel

The task of infection prevention and control can begin even before a hospital admission, in the case of emergency transport. During that time, it is the responsibility of emergency medical services (EMS) personnel to ensure hygienic and safe patient care.

Investigators with the Los Angeles Department of Public Health sought to assess EMS infection control policies and practices between 2016 and 2017. The team presented their results in an oral abstract session at the Association for Professionals in Infection Control and Epidemiology (APIC 2019) annual meeting.

To assess practices and policies, Department of Public Health and Emergency Medical Services Agency nurses performed ride-alongs in Los Angeles in >2 ambulances per 14 providers included in the study.

Of the 14 providers included, 11 had a designated infection control officer, 13 had written infection control policies, 12 reviewed and updated the policies annually, 12 had written policies for cleaning/disinfection, and all 14 required infection control training for new staff. However, only 59% assessed skills after the training, and only 31% audited across 4 infection control topics.

Twelve of the 14 providers required staff to receive an influenza vaccination, but the median vaccination rate was only 55% (range 1-99%).

The study found that EMS practiced hand hygiene before patient contact in just 7% of assessments but wore gloves in 100% of observed interactions. Personnel practiced hand hygiene after glove use in 79% of cases assessed. High-touch surfaces in ambulances were cleaned after each patient encounter 79% of the time and replaced disinfectants and cleaners 89% of the time.

“EMS providers are an important part of the health care system as they transport patients in and out of hospitals and other health care facilities,” investigators concluded. “Overall, findings were encouraging, but ensuring up-to-date policies for all areas of infection control, monitoring competencies, and observing practices to assess adherence may improve infection control.”

The study, “The State of Infection Control Among Los Angeles County (LAC) Emergency Medical Services (EMS) Providers,” was presented on Wednesday, June 12, 2019 at APIC 2019 in Philadelphia, Pennsylvania.