Knowledge, attitudes, and infection prevention practices regarding multidrug-resistant organisms among Emergency Medical Service (EMS) providers
Methods: An electronic survey was sent to a stratified random sample of nationally certified EMS providers between November 2013 and February 2014. The survey included 22 items about hand hygiene, glove use, and environmental disinfection, as well as general knowledge and attitudes pertaining to MDROs. Descriptive statistics were performed.
Results: 5,293 EMS providers received the survey and 516 (9.7%) were returned. Of those, 50.1% were Emergency Medical Technician–Basics (EMT-B) and 34.6% were paramedics. 84.9% reported glove use during patient care. While 95.3% agreed that hand hygiene was necessary regardless of glove use, only 16.1% regularly disinfected their hands prior to glove use and 68.9% did so after glove use. Lack of time, interference with patient care, and low perceived risk of exposure to blood or other body fluids were the most common reasons for non-adherence with hand hygiene. While 85.9% routinely disinfected their medical equipment and stretcher after each patient encounter, less than 60% disinfected the ambulance compartment during a shift, even after visible contamination of the environment. While most had heard of methicillin-resistant Staphylococcus aureus, fewer EMT-Bs compared to paramedics were familiar with vancomycin-resistant Enterococcus, Clostridium difficile, or multidrug-resistant Gram-negative bacteria and how these organisms are transmitted. Providers reported they would be more likely to use gloves (94.6%), perform hand hygiene (91.2%), and thoroughly disinfect their environment (87.3%) if they knew that a patient had a MDRO. Perceived barriers to such awareness included lack of communication among healthcare personnel and lack of clear documentation in the medical record.
Conclusion: Opportunities exist to improve awareness, knowledge, and practices among EMS providers regarding infection prevention and MDROs through further education and standardization of policies. While non-responder bias may have influenced our survey findings, knowledge and practices are likely to be even poorer in non-responders.
Barnes Jewish Hospital Foundation: Investigator, Research grant
B. Froelke, None
R. Crowe, None
M. Bentley, None
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