20 Hygiene in the emergency medical services (EMS) calls for attention

Aim Contaminated environmental surfaces are known to provide an important potential source for transmission of healthcare associated pathogens 1 and prehospital treatment appears related to increased risk of infection. 2 Nevertheless, few studies present and discuss prehospital hygiene, resulting in limited knowledge and understanding of related challenges. Our aim was to assess microbial contamination and influencing factors. Methods A nationwide, semi-blinded, cross-sectional study conducted in Denmark from August to November 2016. Using a combined swab/agar method, samples from environment, equipment and personnel were randomly collected from 80 ambulances and crew, in-between patient courses, after cleaning. Focus was colony forming units (cfu) and healthcare associated pathogens. In addition, explanatory variables e.g. hours from last thorough cleaning, area of service (rural/city) and number of patient courses within the shift, were collected and used in bivariate analyses. Results 800 sites, showed an average of 11.3 cfu/cm 2 (environmental sites 5.01 cfu/cm 2 , hands 11.1 cfu/cm 2 and uniforms 30.6 cfu/cm 2 ). Staphylococcus aureus, Enterococcus and Enterobacteriaceae were found on 10, 3.4 and 0.5% of the imprints, respectively. One imprint was MRSA, two were VRE but none was ESBL, and we found no correlation between the explanatory variables and the degree of microbial burden. Conclusion Microbial contamination and related challenges in the EMS calls for further attention. Several sites were contaminated with healthcare associated pathogens, but neither time from cleaning, number of patients nor area of service were of influence on the degree of contamination. Future research on hygienic challenges and routes of transmission is recommended. References Dancer SJ. Controlling hospital-acquired infection: focus on the role of the ?environment and new technologies for decontamination. Clinical microbiology reviews. 2014;27(4):665–90. Alter SM, Merlin MA. Nosocomial and community-acquired infection rates of patients treated by prehospital advanced life support compared with other admitted patients. The American journal of emergency medicine. 2011;29(1):57–64. Conflict of interest H. S. Vikke and M. Giebner, is employed by Falck Denmark A/S H. J. Kolmos has no conflicts of interest Funding The project is partly fundet by Falck A/S and Innovation fund DK