Paramedic knowledge of infectious disease aetiology and transmission in an Australian Emergency Medical System

Introduction Paramedics and other emergency health workers are exposed to infectious disease particularly when undertaking exposure-prone procedures as a component of their everyday practice. This study examined paramedic knowledge of infectious disease aetiology and transmission in the pre-hospital care environment. Methods A mail survey of paramedics from an Australian ambulance service (n=2274) was conducted. Results With a response rate of 55.3% (1258/2274), the study demonstrated that paramedic knowledge of infectious disease aetiology and modes of transmission was poor. Of the 25 infectious diseases included in the survey, only three aetiological agents were correctly identified by at least 80% of respondents. The most accurate responses for aetiology of individual infectious diseases were for HIV/AIDS (91.4%), influenza (87.4%), and hepatitis B (85.7%). Poorest results were observed for pertussis, infectious mononucleosis, leprosy, dengue fever, Japanese B encephalitis and vancomycin resistant enterococcus (VRE), all with less than half the sample providing a correct response. Modes of transmission of significant infectious diseases were also assessed. Most accurate responses were found for HIV/AIDS (85.8%), salmonella (81.9%) and influenza (80.1%). Poorest results were observed for infectious mononucleosis, diphtheria, shigella, Japanese B encephalitis, vancomycin resistant enterococcus, meningococcal meningitis, rubella and infectious mononucleosis, with less than a third of the sample providing a correct response. Conclusions Results suggest that knowledge of aetiology and transmission of infectious disease is generally poor amongst paramedics. A comprehensive in-service education infection control programs for paramedics with emphasis on infectious disease aetiology and transmission is recommended. 1 Shaban et al.: Paramedic knowledge of infectious disease aetiology and transmiss Produced by The Berkeley Electronic Press, 2003 Journal of Emergency Primary Health Care (JEPHC), Vol.1, Issue3-4, 2003 Author(s): Shaban et al. INTRODUCTION Infection control is an essential part of health care. The changing epidemiology of disease, widening scope of practice of health care providers and increased occupational risks associated with provision of health care have precipitated a review of infection control in Australia. Evidence-based infection control practice across nursing, medicine and dentistry is evolving. However, there is limited infection control research in the prehospital care environment. Shaban [1] identified the need to review ambulance paramedic infection control guidelines as a result of changing patterns of health care in the pre-hospital environment, new disease epidemiology and a lack of sound, specific research into pre-hospital infection control. This study aimed to establish baseline data on knowledge and reported practice in the pre-hospital context. In particular, this research examined levels of paramedic knowledge of infectious disease aetiology and modes of transmission in the pre-hospital environment. A thorough literature search failed to locate any research that examined paramedic knowledge of the aetiology and transmission of infectious disease in ambulance care specific to the Australian setting. The literature review located a large body of research in the nursing, medical and dental disciplines. Isolated studies have been conducted in the United States examining Emergency Medical Technicians’ (EMTs) knowledge of infection control and infectious diseases. Mencl et al. [2] surveyed 425 EMTs on knowledge of transmission of four infectious diseases, human immunodeficiency virus (HIV), hepatitis, meningitis and tuberculosis. Questions about knowledge of universal precautions, transmission routes and postexposure actions, and items examining personal concerns about infectious diseases were surveyed. Mencl et al. [2] found poor knowledge of universal precautions, transmission routes and postexposure action and argued for further continuing EMT education in these areas focusing on routes of transmission, risk of exposure, appropriate use of postexposure prophylaxis and requirements for follow-up testing. In another study in the US, Eutis [3] reported poor compliance with recommendations for universal precautions among prehospital providers. Inadequate knowledge and prevention of occupational exposure of HIV and AIDS among pre-hospital personnel was reported by Gellert et al. [4]. They recommended the introduction of additional education and training programs for pre-hospital emergency staff. Cydulka et al. [4] assessed the knowledge base of 420 paramedics on knowledge of AIDS and hepatitis B after conducting an education seminar in a large metropolitan US fire department and reported an improvement. No study has, however, examined knowledge of infectious disease aetiology and transmission, or indeed infection control practices in general, in the Australian pre-hospital context. Infection control research to date has been discipline, context and location specific. This study sought to examine paramedics in an Australian setting in terms of regards to standards of infection control, specifically standard and additional precautions as 2 Journal of Emergency Primary Health Care, Vol. 1 [2003], Iss. 3, Art. 10 http://ro.ecu.edu.au/jephc/vol1/iss3/10 Journal of Emergency Primary Health Care (JEPHC), Vol.1, Issue3-4, 2003 Author(s): Shaban et al. defined by the National Health and Medical Research Council (NHMRC) [5] and paramedics’ knowledge of infectious diseases. METHODS This study used survey methodology to examine paramedic knowledge of infectious disease aetiology and transmission in an Australian EMS. All clinical staff personnel (n=2274) in one State-wide service were eligible to participate in the study. An anonymous survey consisting of thirty-seven questions was constructed in consultation with an infection control and ambulance expert-working group (EWG). The content was in accordance with the NHMRC [6] infection control standards. The survey format was designed in three sections. Section one of the survey focused on the collection of demographic data. Questions used to assess knowledge of infection control were grouped in section two, and addressed a variety of infection control areas as determined by the EWG. Assessments of reported infection control practices were grouped in section three. The survey tool, information sheet and consent form were piloted. As a result of the pilot testing, minor editorial changes were made to questions in order to enhance clarity. Ethics approval was obtained from Griffith University Human Research Ethics Committee (HREC). Surveys were sent to all eligible paramedic staff. The criterion for inclusion in this study was that the participant held a clinical or clinically related position, or a position that directly affected clinical outcomes of paramedic care.