Challenges faced by ambulance services

Nigel Barr 1

University of the Sunshine Coast (USC), School of Nursing, Midwifery and Paramedicine.



Australian paramedic-led healthcare occurs in a diverse range of community settings and is unscheduled in nature, which presents challenges for compliance with recommended infection prevention and control (IPC) practices.  This presentation reports on the findings of a national study into the self-reported IPC practices and perceptions of Australian paramedics and discusses the challenges faced by ambulance services.


An online survey (n=417; 17% response rate) and two focus group interviews (n=6 per group) were conducted with members of Paramedics Australasia in 2013 and 2015. Ethical clearance was obtained from the USC HREC (S/10/252 and S/14/719).


Participants perceived that IPC was important in paramedic-led healthcare. However, participants reported poor compliance with hand hygiene, environmental hygiene, aseptic techniques and reporting of breaches in IPC. Nearly two-thirds of the survey participants did not change their gloves until after the completion of a case, suggesting most hand-hygiene opportunities were missed. Factors associated with better compliance with hand-hygiene prior to IV insertion included: female gender (P=0.031), receiving competency based training (P=0.002), registration as a nurse (P<0.001), increasing time post-qualification (P=0.006), and state or territory of employment (P=0.008). Analysis of textual data found challenges for IPC were associated with lack of training, poor access to cleaning products, difficulty in changing gloves, perceived operational pressure and perceived case acuity.


Paramedic IPC practices require substantial improvement in order to lower potential transmission of pathogens and improve patient safety in clinical care. There is also a need for a coordinated national approach to contextualise the national IPC guidance to paramedic-led healthcare and improve compliance.

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