Columns, Patient Care

Study Reveals EMS MRSA Infection Risks

Issue 1 and Volume 41.

WASH UP

Orellana RC, Hoet AE, Bell C, et al. Methicillin-resistant Staphylococcus aureus in Ohio EMS providers: A statewide cross-sectional study. Prehosp Emerg Care. Oct. 30, 2015. [Epub ahead of print.]

We in EMS are involved in a risky business. The hazards involved in emergency driving, physical violence and lifting people are risks we take every day in the service of others. But what about the risks we can’t see?

Exposure to microscopic superbugs like methicillin-resistant Staphylococcus aureus (MRSA) go undetected in our daily work and can be responsible for prolonged hospitalization, amputations and severe organ damage.

A new study from the department of epidemiology at the Ohio State University may offer some insight as to the prevalence of this bad bug.

Methods: Orellana and his team performed a first-of-its-kind study on 280 randomly chosen EMS personnel from 84 EMS agencies in the state of Ohio. Participants were asked about handwashing frequency, glove usage and the presence of open wounds. Confounding factors such as the use of antibiotics or a history of staph infections were also documented.

BOTTOM LINE

What we already know: The rate of MRSA infection is a growing concern in healthcare.

What this study adds: EMS providers have 10 times the risk of carrying MRSA if they don’t wash their hands after removing gloves.

Results: Study participants had samples from their anterior nares gathered with a sterile swab. The samples were then transported to a lab for further testing. Of the 280 EMTs and paramedics, 13 (4.6%) tested positive for MRSA colonies. Further, providers who didn’t practice regular hand washing after removing their gloves saw a 10-fold increase in the risk of MRSA infection (odds ratio: 10.51). EMS workers with an open wound were nearly seven times more likely to carry MRSA colonies in their nasal passages.

FLASHBACK: DIRTY HANDS

Ho JD, Ansari RK, Page D. Hand sanitization rates in an urban emergency medical services system. J Emerg Med. 2014;47(2):163–168.

Do you remember this study performed in 2005? In this blinded six-month observational study, paramedics washed their hands 62% of the time after patient care activities—but only 1% before and 3% during care of the patient. Gloves weren’t worn 12% of the time and hand sanitation only occurred 19% of the time before the crew had a meal.

Discussion: MRSA prevention is a major focus of healthcare organizations, but it appears we fall short in EMS. So-called superbugs like MRSA aren’t going away anytime soon. This study sampled providers in every EMS region of Ohio, which means this isn’t a problem that can be isolated to a single service. The presence of MRSA colonies provides a risk to the patients we treat, not to mention ourselves and our fellow EMTs and paramedics.

It’s time to go back to basics. Simple hand washing is a critical process before and after taking care of patients, and wearing gloves makes all the difference.

EMS Today conference

Learn more from David Page at the EMS Today Conference & Expo, Feb. 25–27, in Baltimore, Md. EMSToday.com

Visit www.pcrfpodcast.org for audio commentary.

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