Infection Control for Paramedic Practice – Comprehensive Study Notes

Learning Objectives & Standards

• Aligns with CQU PMSC11002 LOs & National Safety and Quality Health Service Standards (NSQHSS)
  • Fitness to practice, quality health care & cultural competence ➔ direct impact on patient outcomes.
  • Safe clinical approach: assessments, skills & medication use.
  • NSQHSS pillars addressed:
  • Clinical Governance
  • Comprehensive Care
  • Preventing & Controlling Infections
• Specific session goals
  • Describe infection-prevention principles in out-of-hospital care.
  • Explain critical role of hand hygiene & PPE.
  • Identify common sources/modes of transmission in paramedic work.
  • Recognise challenges of IPC in unpredictable, high-pressure scenes.
  • Demonstrate standard precautions & control techniques during scenarios/simulations.

Occupational Risk for Paramedics

• Heightened exposure because of:
  • Unpredictable environments (homes, roadsides, public venues).
  • Frequent inter-facility interactions with varied health-care settings.
  • Routine contact with blood, body fluids & contagious patients.
  • Expanding scope → advanced & invasive procedures where life-saving urgency can eclipse protocol adherence.
• Consequences of poor IPC
  • Harm to patients, clinicians, family members & community.
  • Potential workforce shortages due to illness or furlough.
  • Legal & professional accountability under clinical-governance frameworks.

Importance of Infection Control (Global Perspective)

• Infectious diseases ⟶ approximately $25\%$ of the $57\text{ million}$ deaths/year worldwide.
• Leading cause of death in people < $50$ years.
• Continuous emergence of novel pathogens → initial population has minimal immunity.

Infectious & Communicable Diseases: Key Agents

• Bacteria
• Viruses
• Parasites
• Fungi
• Notifiable-disease data (Australia $2023$):
  • > $1.5\text{ million}$ notifications to NNDSS.
  • COVID-19 = $54\%$ of all notifications.
• After COVID-19, six most-notified diseases (list provided in lecture; recall for exam).
• Communicability
  • Direct transmission: blood & body-fluid contact.
  • Indirect: contaminated food, water, air, surfaces.
  • Vector-borne: mosquitoes, ticks, etc.

Chain of Infection (6 Links)

• Infectious Agent
• Reservoir
• Portal of Exit
• Mode of Transmission
• Portal of Entry
• Susceptible Host

Mechanism

1. Agent must enter host in sufficient numbers to overcome defences.
2. Host succumbs → infection established.
3. Agent exits & is transmitted to next host.

Breaking the Chain: Paramedic-Controllable "Kinks"

• Eliminate/neutralise agent
  • Appropriate antibiotics/antivirals (per scope & protocols).
  • Disinfection/sterilisation of environment & equipment.
• Stop reservoir growth
  • Routine cleaning, surface sterilisation, equipment decontamination.
• Block portals of exit
  • Respiratory hygiene/cough etiquette.
  • Covering bleeding wounds & body-fluid spills.
• Interrupt transmission
  • Adequate ventilation in ambulance.
  • Standard & transmission-based precautions.
  • Correct PPE selection & use.
• Protect portals of entry
  • Intact skin & mucous membrane protection (gloves, masks, eye wear, gowns).
• Increase host defences
  • Vaccination (hepatitis B, influenza, COVID-19, etc.).
  • Post-exposure prophylaxis when indicated.
  • Personal wellness: adequate rest, nutrition & stress management.

Standard Precautions (Apply to ALL Patients)

• Core components
  • Hand hygiene (before/after every patient contact; when visibly soiled use soap & water).
  • PPE proportional to exposure risk (gloves, masks, eye wear, gowns).
  • Safe handling & disposal of sharps.
  • Respiratory hygiene/cough etiquette.
  • Routine cleaning & disinfection of environment/equipment.
• Rationale: many patients are asymptomatic carriers; standardisation reduces cognitive load & error.

Hand Hygiene

• Evidence: >70\% ethanol-based hand-rubs effective against enveloped viruses & most bacteria.
• WHO “Five Moments”
  1. Before touching a patient.
  2. Before a procedure.
  3. After a procedure or body-fluid exposure risk.
  4. After touching a patient.
  5. After touching patient surroundings.
• Operational reminders
  • Pre/post shift & as per service policy.
  • Remove jewellery; keep nails short & clean.
  • Dry hands completely → residual moisture increases microbial transfer.

Personal Protective Equipment (PPE)

• Gloves: non-sterile (routine exposure), sterile (invasive/maternity/surgical).
• Masks/Respirators: surgical, N95/P2 as dictated by aerosol-generating procedures (AGPs).
• Eye protection: goggles or face shields for splash/spray risk.
• Gowns/Aprons: protect clothing/skin during procedures with anticipated fluid contact.
• Key principles
  • Correct donning order: gown → mask/respirator → goggles/face shield → gloves.
  • Correct doffing order to avoid self-contamination: gloves → goggles/face shield → gown → mask.
  • Dispose or reprocess according to organisational policy.

Sharps Safety & Routine Environmental Cleaning

• Person creating the sharp is responsible for safe disposal.
• Minimisation:
  • Use safety-engineered devices where available.
  • Never recap, bend or break needles.
• Disposal:
  • Immediately into approved sharps container (puncture & leak-proof, marked biohazard).
• Cleaning Protocols
  • High-touch surfaces disinfected between every patient.
  • Scheduled deep cleaning of vehicle/clinical areas.
  • Use approved hospital-grade disinfectants (contact time adherence critical).

Donning & Doffing Medical Gloves

Indications

• Non-sterile
  • Visible/anticipated blood or body fluids.
  • Symptomatic infectious patient.
  • Cytotoxic drug handling.
  • Use of cleaning chemicals/wipes.
• Sterile
  • Surgical procedures, vaginal birth, bimanual compression, other invasive maternity tasks.

Contraindications

• No visual/assessed risk & asymptomatic patient.

Potential Complications

• Glove/field contamination.
• Contact dermatitis; latex or chemical allergies.

Non-Sterile Glove Procedure (Condensed)

• Donning
  • Grasp cuff only; avoid palm/finger contact.
  • Glove first hand; use gloved fingers under cuff of second glove.
• Doffing
  • Pinch & invert first glove; hold in gloved hand.
  • Slide ungloved fingers inside second glove cuff; invert & encase first glove.
  • Discard; perform hand hygiene.

Sterile Glove Procedure (Key Steps)

• Hand hygiene → inspect packaging integrity.
• Open sterile inner pack on clean, dry surface.
• Slip first hand into glove without touching outside surface.
• Slide gloved fingers under cuff of second glove; don second glove.
• Unfold cuffs; adjust fit.
• Doffing mirrors non-sterile process, ensuring only glove-to-glove & skin-to-skin contact.

Additional Principles

• Never apply hand-rub to gloves.
• Double-gloving not permitted under QAS guidelines.
• One pair of gloves = one patient contact.
• Replace compromised glove immediately & perform hand hygiene.

Challenges Specific to Pre-hospital Environment

• Space constraints → difficult aseptic fields.
• Environmental extremes (rain, poor lighting) hinder glove donning, surface disinfection.
• Limited water access for soap-and-water washing when hands visibly soiled.
• High-pressure decision making may tempt omission of PPE.
• Scene safety risks (traffic, violence) compete for attention.

Ethical & Professional Implications

• Duty of care: protect patient & public from harm (non-maleficence).
• Self-protection preserves workforce capacity – beneficence towards colleagues & system.
• Cultural competence: acknowledge patient beliefs about infection & PPE (e.g., mask anxiety, religious dress).
• Documentation: accurate recording of IPC measures demonstrates governance compliance.

Key Takeaways for Exam & Practice

• Memorise the six links of the Chain of Infection & at least two interventions for each.
• WHO Five Moments & correct glove doffing sequence are high-yield OSCE items.
• Cite current statistics (e.g., $54\%$ of $1.5\text{ million}$ NNDSS $2023$ notifications = COVID-19) to emphasise contemporary relevance.
• Standard precautions are minimum expectation; transmission-based precautions add layers for known/suspected pathogens.
• Fit testing of N95/P2 respirators & immunisations are part of personal readiness (fitness to practice under NSQHSS Clinical Governance).

References (Condensed – full citations in slide deck)

• Australian Commission on Safety and Quality in Health Care – IPC guidelines.
• CDC – National Notifiable Diseases Surveillance System.
• Queensland Ambulance Service – Clinical Practice Procedures: Donning & Doffing Gloves ($2024$).
• WHO – Five Moments for Hand Hygiene ($2021$).

In every call, every shift, every patient contact—protect yourself to protect others.