- Email: [email protected]
Infection control for the emergency medical technician: Developing an educational program
BRIEF
REPORTS
Infection control for the emergency medical technician: Developing an educational program Marlene Fishman, M.P.H. Deborah Stamp, R.N., CIC Providence
and North Smithfield,
Rhode Island
Most health care providers are routinely educated in the hazards related to the delivery of health care, the infection hazards they impose on patients, and the methods to prevent and control both. However, emergency medical technicians (EMTs), an important group of health care professionals, have not had sufficient opportunity to learn how to protect themselves and their patients from microorganisms. Prevention of nosocomial infections and protection of EMTs from communicable diseases should begin in the pre-hospital phase of health care. There is a slow-moving quest for infection control measures applicable to EMTs. Individual practitioners have educated local EMTs and have conducted traveling workshops.‘, * The emergence of acquired immunodeficiency syndrome (AIDS) sparked attention concerning rescue workers who sought protection with mechanical resuscitators.3 The issue of hepatitis B virus as related to pre-hospital health care providers has also been addressedP Although sporadic infection control lectures may have been offered to EMTs previously, they were not mandated nationally for either newly trained EMTs From the Department of Nosocomial Infection, St. Joseph Hospital, and the Department of Environmental Control, John E. Fogarty Memorial Hospital. Supported by grants and contributions from John R. Casey, Inc.; John E. Fogarty Memorial Hospital; Merck, Sharp & Dohme (Postgraduate Program); Rhode Island Department of Health, Division of Emergency Medical Services; South County Hospital; and Vestal Laboratories, Division of Chemed. Reprint requests: Marlene Fishman, M.P.H., Department of Nosocomial Infection, St. Joseph Hospital, 21 Peace St., Providence, RI 02907.
28
or those currently licensed. Some states do require continuing education credits, but not necessarily for infection control.’ In Rhode Island, the John E. Fogarty Memorial Hospital offered EMTs an infection control seminar in 1978 that emphasized selfprotection from contagious diseases and prevention of nosocomial infections during prehospital care. This program led us to develop an infection control module and to propose that it be included in the state-mandated training program for new EMTs. Once licensed, EMTs may obtain updated information at continuing education seminars. Current efforts to reorganize training programs for recertification may include addition of an infection control module. This article presents detailed steps that infection control practitioners (ICPs) can follow in developing their own educational programs. Examples and data are taken from the 1983 Rhode Island Infection Control Pilot Project for EMTs. This program provided participants with the same lectures, handouts, and slide presentations that were proposed for the EMT core curriculum. The Pilot Project verified the need for infection control and established an interest that warranted the addition of a module in the core curriculum. METHODS Needs assessment
A literature search was conducted to determine the extent of existing EMT programs nationally and in Rhode Island. Capsulized stateof-the-art reports for Rhode Island were provided by individual EMTs, chiefs of rescue units, educators, and State Health Department
Volume
14 Number
February,
1986
1
personnel. In this small state, the individual summaries were sufficient to characterize existing programs and requirements for Rhode Island EMTs. Nationally, EMTs are generally recognized at two or three levels? 1. EMT-ambulance (EMT-A) has a minimum of 81 hours of training 2. EMT-intermediate (EMT-I) receives the EMT-A program plus 25 additional hours of training 3. EMT-paramedic (EMT-P) has 480 hours of training and experience above the EMT-A level The minimum curricula established by the Department of Transportation include 81 hours for the EMT-A and 480 hours for the EMT-P. In Rhode Island, an additional classification, the EMT-cardiac (EMT-C), was created in 1973. Its 120 hours of training correspond to part of the modules established by the Department of Transportation for the paramedic course.’ Infection control did not comprise a separate module in current Rhode Island programs. Minimum infection control practices were integrated into the pediatric module of the total curriculum. After the literature search was completed and the core curriculum for EMT-As in Rhode Island was reviewed, site visits and interviews were conducted with EMTs from a volunteer fire department, a municipal fire department, and a private ambulance company in Rhode Island. Three ambulances and two rescue vehicles were inspected. Ambulances are manned by EMT-As and are used mainly for transporting patients. Rescue vehicles are staffed by EMTs who are educated in emergency pre-hospital patient care. Some vehicles are equipped with sinks, metal decks, enclosed cabinets, and exhaust fans. Supplies include clean or sterile airways, dressing supplies, alcohol, green soap, ammonia, drug box, trauma box, respiratory box, and telemetry monitor, depending on the vehicle classification. Not all vehicles are stocked with gowns, masks, or gloves. Many supplies are routinely replenished at hospitals and may include linens, disinfectants, and airways. Techniques investigated included needle disposal, linen handling, cleaning and disinfection, handwash-
Infection
control
for the EMT
29
Table 1. EMT infection control module objectives At the completion of the module, the participants will be able to: 1.
2. 3. 4. 5.
6.
7. 8. 9.
Give two examples of the impact of the history of infection control on the delivery of modern health care Summarize the common growth requirements of three groups of microorganisms Name all six components of the chain of infection and relate them to the infection control effort List infection control measures used in three clean and sterile techniques Define the mode of transmission for the following: gastroenteritis, viral hepatitis, herpesviruses (chickenpox, shingles), meningitis, pediculosis (lice), scabies, tuberculosis Outline protective measures to be used when delivering emergency patient care to potentialty contagious patients or patients with suspected or confirmed communicable diseases Specify four sanitation techniques that prevent the spread of infection Identify the communicable diseases to which EMTs should be immune List infection control resources including both literature and persons
ing, isolation, and checking expiration dates of supplies. EMTs were interviewed at all three levels (ambulance, intermediate, and cardiac). They voiced an interest in learning the following: symptoms of infectious diseases, rationale for infection control practices, transmission of infection, potential hazards from exposures to contagious disease, prophylaxis before and after exposure to disease, protective attire, and disinfection of equipment and vehicles. Official
support
The authors met with the Educational Standards Committee of the Rhode Island Ambulance Service Coordinating Board and subsequently with the full board, which is authorized to set statewide minimum standards for all levels of pre-hospital care.6 Interest in infection control had already been generated from the 1978 infection control program for EMTs, EMT publications on infectious diseases, media attention to AIDS, our recent site visits to ambulance companies, and an awareness of the lack of essential infection control education for EMTs.
American
30
Fishman
and Stamp
A liaison between ICPs and the Department of Health (the governing body for EMTs) is crucial to provide an impetus in introducing the program. In our case this function was fulfilled by an individual” who was committed both to EMT education and to the EMT’s role in infection control. In September 1983, we formally proposed that a 2-hour module be included in the EMTA training course required for licensure in Rhode Island. The purpose of the module was to assist participants in developing a knowledge of infection control concepts and practices, thereby protecting patients, themselves, and innocent victims from the hazards of infection and communicable diseases. The objectives listed in Table 1 were submitted with the proposal to the Rhode Island Ambulance Service Coordinating Board. After reviewing the proposal, the board approved a Pilot Project for existing licensed EMTs that would provide the participants with the same information that a future EMT would receive in his training program. Results of this Pilot Project were presented at the December, 1983, Rhode Island Ambulance Service Coordinating Board meeting as the basis for a decision regarding the permanent incorporation of this program into the EMT-A curriculum. Program
content
The content of the Pilot Project was designed to cover areas of concern to EMTs and is summarized in this article. Topics for the first hour included an introduction, the history of infection control, basic microbiology, the infection process, and infection control practices. Handouts for this section included an outline of program content and a diagram of the infection process. Topics for the second section included communicable diseases, isolation and sanitation techniques, and infection control resources. Transmission, immunity, prophylaxis, and disinfection were addressed in detail for each disease. Handouts included the outline, guidelines for care of contaminated clothing, a ‘Robert Picard, R.N., EMT-C, Administrator of Emergency Services at John E. Fogarty Memorial Hospital, who was a member of the Ambulance Service Coordinating Board.
INFECTION
Journal
of
CONTROL
communicable diseases chart, and an infection control resource list. Audiovisual aids for each faculty member included original slides, some taken during interviews and fire station site visits. Grant
application
and industrial
support
Financial support was required in order to facilitate the Pilot Project. It should be noted that many EMTs volunteer their services to the community and have no means of reimbursement for educational programs in which they participate. Hence, it was decided that registration fees would be waived. Budget was projected to cover faculty expenses, secretarial services, audiovisual aids, travel, printing, folders, refreshments, and facilities. These costs were minimized by the generous underwriting of the two hospitals hosting the Pilot Project seminars: The John E. Fogarty Memorial Hospital and South County Hospital. Seven companies were approached in October for support of the proposed educational program. The companies were chosen because the authors determined that their products (disinfectants, handwashing agents, vaccines) could be used by EMTs. Each company received a written proposal that included background information, the number of EMTs in Rhode Island (more than 3000), the content and objectives of the program, projected costs, suggested faculty, and authorization for product exhibits. Four companies responded (57%) and three committed financial aid for the project. (Ideally, companies should be solicited during the beginning of their fiscal year when monies are still available.) After solicitation of the drug and chemical companies, a training grant application was made to the Chief of Emergency Medical Services at the Rhode Island Health Department. Background information was provided to define the need for this program, to present the recommendation of the Rhode Island Ambulance Service Coordinating Board, and to elaborate on the purposes and objectives of the Pilot Project. Budget proposal, curricula vitae of faculty, and methodology were presented. The items summarized under methodology included faculty, secretarial support, teaching aids, pro-
Volume
14 Number
February,
1986
1
Infection
gram schedule and sites, brochure content and distribution, handouts, and a proposed evaluation tool. The grant application was approved in just 10 days. Program
coordination
Mailing of brochures to EMT training officers was coordinated by the Rhode Island Health Department. The seminar sites were selected according to the Rhode Island Health Department’s geographic considerations, that is, one in northern Rhode Island and one in southern Rhode Island. Secretarial duties included registration of program participants and assistance with company product exhibits. Audiovisual equipment and refreshments were prearranged. Program
evaluation
The evaluation form designed for the Pilot Project was specific to this EMT program and elicited constructive comments (Fig. 1). RESULTS
Fifty-five EMTs registered to attend the seminar. Because of government scheduling changes, only 15 of 32 registrants attended the Friday evening session in southern Rhode Island at South County Hospital. Seventeen of 24 (71%) attended the Saturday morning session held at the John E. Fogarty Memorial Hospital in northern Rhode Island. Thirty participants (94%) returned completed evaluation forms. Responses and training levels are summarized in Fig. 1. Eighty percent of the evaluations (24 of 30) included comments that reiterated the need for EMTs to learn infection control techniques. Some are noted below: “Material covered was about situations encountered on a weekly basis.” “This session made me realize more so than I know how open we really are to these different diseases; it also did a lot to tell us how we can lower our risks of catching diseases from our patients or us giving them to our patients.” “I think too many [EMTs] become apathetic and don’t see how infection control relates to them.” “In order to prevent infection in both the
control
for the EMT
31
patient and EMT, I believe more information would be helpful and would like to see it presented to all rescue units.” “Keep us up-to-date on future infection control seminars; anytime something new develops in this field I believe it is imperative that we in the rescue field learn right away.” “This program would be especially important to new EMTs--I feel this should have been included all along, I am shocked that it’s taken over 10 years to get this in the program.” “Should be in recertification program. Every EMT should know.” “Should be mandated at state and national level for all EMTs.” “One of the best educational programs I have been fortunate to attend.”
Some participants suggested that additional infection control seminars be held to further discuss AIDS, herpesviruses, hepatitis B virus, and disinfection. Main concepts learned by participants can be categorized as self-protection (29%), importance of infection control (29%), and aseptic techniques (41%). Some of these are quoted below: “There is a real possibility of my being exposed to an infectious situation and I should be prepared to do something about it.” “The reality of how disastrous a nosocomial infection can be as well as awareness of how to stop the transmission cycle.” “The realization that infection control goes both ways: protection of the patient and protection of self and ways to prevent infection.” “Sanitation. Cleanliness. Self-responsibility.” “Importance of taking the time to put on gloves, re-stressed the importance of handwashing.” DISCUSSION
We provided written feedback to the administrators of the host hospitals and to the companies providing financial support. The companies with exhibits were informed in writing of the participants’ reactions to their products. The evaluation summary was presented in December 1983, to the Rhode Island Ambulance Service Coordinating Board. The board
American
32
Fishman
and Stamp
INFECTION
EMT INFECTION 1.
CONTROL
MODULE
Journal
of
CONTROL
EVALUATION
What is your overall reaction to the session? 53% (16)
Outstanding, I learned a great deal
40% (12)
Well done, I learned a good deal
7% (2)
Adequate, it had average learning value
0
Fair, I learned a few things
0
Poor, I learned little or nothing
2. Did you receive the knowledge you anticipated? 50% (15)
Yes, very much so
43% (13)
Yes, to
7% (2) 0
a large extent
To some extent No, not at all
Comments:
3. Was the speaker well-prepared and effective? Speaker No. 1
Speaker No. 2
93% (27)
90% (27)
7% (2)
10% (3)
To some extent
0
0
No, not at all
0
0
Yes, very much so Yes, to a large extent
4. Were the handouts and/or audiovisuals effective? Handouts
Audiovisuals
Yes
90% (27)
Adequate
10% (3)
93% (28) 7% (2)
0
0
No Comments:
5. Will the material covered be of direct value to you? 63% (19) 34% (10) 3% (1) 0
Yes, very much so Yes, to a large extent To some extent No, not at all
Fig. 1. Evaluation form designed seminar participants.
for Pilot Project
subsequently recommended that the Educational Standards Committee incorporate this program into future state-approved EMT-A courses. The final outcome of the Rhode Island Pilot Project depended on the decision of this committee. Until contracts were signed, individual rescue squads, private ambulance com-
shows summary
of responses
from
panies, and coordinators of the State EMT-A Course could request this state-approved infection control module on an individual basis. The state provided a mechanism to fund some of these programs. In June 1984, the Ambulance Service Coordinating Board voted to include this program
Volume February.
14 Number
1
Infection
1986
control
for the EMT
33
6. How does this program compare with other educational programs you’ve attended? 43% (13)
One of the best
16% (5)
Better than others
34% (10)
As good as others
0 7% (2)
It was worse This is my first program
7. The material presented was 83% (25)
New learning
23% (7)
Helpful review, not new Not helpful
Comments:
8. Do you want more information on infection control? Yes 93% (28) No 7% (2) FEEL FREE TO COMMENT ON ANY ASPECT OF THIS PROGRAM:
9. Any suggestions for content of future infection control seminars?
10. What is the main concept you learned?
11. Please describe your training 27% (8) Ambulance/Basic
43% (13) Intermediate
30% (9) Cardiac
12. Please comment on the types of products that interest you
13. Were the exhibits informative? 93% (28) Yes
Fig.
in the EMT curriculum. The program content, as we established it, is now a permanent 3-hour module mandated for all persons seeking EMT licensure in the State of Rhode Island. The board also mandated that the module be taught by an ICP. The positive reaction to this Pilot Project re-
7% (2) No
1, cont’d
sulted not only from the pertinent program content, but also from the professional manner in which the program was coordinated. ICPs should first assess the needs of their target audience in order to determine which issues are actually pertinent. An effective method for developing program content for the EMT is to be-
American
34
Fishman
and
Stamp
INFECTION
come familiar with his work setting, to observe his practice in different municipalities, volunteer units, or private companies, and to encourage the EMT to verbalize his concerns. Professional and financial support alike must be obtained before a program can be coordinated. In order to integrate a permanent infection control program as part of a state licensure procedure, ICPs should work within the state hierarchy. For promoting the Pilot Project, we thank Robert Picard, Administrator of Emergency Services at John E. Fogarty Memorial Hospital and Chairman of the Educational Standards Committee of the Rhode Island Ambulance Service Coordinating Board; Glenn Mitchell, former Medical Director of Emergency Medical Services (EMS), Rhode Island Department of Health; and Harold Pace, Chief of EMS,
Bound
volumes
available
Journal
of
CONTROL
Rhode Island Department of Health. All were members of the Rhode Island Ambulance Service Coordinating Board (1983-1984). We also thank Maria Nicotra for clerical assistance and Janice Hardy for both clerical assistance and registration at the Pilot Project.
References 1. ICPs can be resources for emergency paramedics. Hosp Infect Control 10(5):66-67, 1983. 2. Michaels J: Infection control policies and practices for paramedical personnel. APIC 1984 Poster session, Board 17. 3. Smith B: Infection control: EMS reacts-and overreacts-to the AIDS panic. J Emerg Med Serv 8(8):24-29, 1983. 4. Moss WD: Hepatitis B. Emerg Med Serv 12(5):48,50, 1983. 5. York DK: Basic emergency medical care: Proposed legislation. J Iowa Med Sot 73:100-102, 1983. 6. Mitchell GW: Emergency medical technicians in Rhode Island: An- overview. RI Med J 65:463-466, 1982.
to subscribers
Bound volumes of AMERICAN JOURNAL OF INFECTION CONTROL are available to subscribers (only) for the 1986 issues from the Publisher, at a cost of $24.00 ($30.00 international) for Vol. 14 (January-December). Shipping charges are included. Each bound volume contains a subject and author index and all advertising is removed. The binding is durable buckram with the journal name, volume number, and year stamped in gold on the spine. Payment must accompany all orders. Contact The C. V. Mosby Company, Circulation Department, 11830 Westline Industrial Drive, St. Louis, Missouri 63146 USA; phone 800-325-4177, ext. 351. Subscriptions must be in force to qualify. Bound volumes are not available in place of a regular journal subscription.
REPORTS
Infection control for the emergency medical technician: Developing an educational program Marlene Fishman, M.P.H. Deborah Stamp, R.N., CIC Providence
and North Smithfield,
Rhode Island
Most health care providers are routinely educated in the hazards related to the delivery of health care, the infection hazards they impose on patients, and the methods to prevent and control both. However, emergency medical technicians (EMTs), an important group of health care professionals, have not had sufficient opportunity to learn how to protect themselves and their patients from microorganisms. Prevention of nosocomial infections and protection of EMTs from communicable diseases should begin in the pre-hospital phase of health care. There is a slow-moving quest for infection control measures applicable to EMTs. Individual practitioners have educated local EMTs and have conducted traveling workshops.‘, * The emergence of acquired immunodeficiency syndrome (AIDS) sparked attention concerning rescue workers who sought protection with mechanical resuscitators.3 The issue of hepatitis B virus as related to pre-hospital health care providers has also been addressedP Although sporadic infection control lectures may have been offered to EMTs previously, they were not mandated nationally for either newly trained EMTs From the Department of Nosocomial Infection, St. Joseph Hospital, and the Department of Environmental Control, John E. Fogarty Memorial Hospital. Supported by grants and contributions from John R. Casey, Inc.; John E. Fogarty Memorial Hospital; Merck, Sharp & Dohme (Postgraduate Program); Rhode Island Department of Health, Division of Emergency Medical Services; South County Hospital; and Vestal Laboratories, Division of Chemed. Reprint requests: Marlene Fishman, M.P.H., Department of Nosocomial Infection, St. Joseph Hospital, 21 Peace St., Providence, RI 02907.
28
or those currently licensed. Some states do require continuing education credits, but not necessarily for infection control.’ In Rhode Island, the John E. Fogarty Memorial Hospital offered EMTs an infection control seminar in 1978 that emphasized selfprotection from contagious diseases and prevention of nosocomial infections during prehospital care. This program led us to develop an infection control module and to propose that it be included in the state-mandated training program for new EMTs. Once licensed, EMTs may obtain updated information at continuing education seminars. Current efforts to reorganize training programs for recertification may include addition of an infection control module. This article presents detailed steps that infection control practitioners (ICPs) can follow in developing their own educational programs. Examples and data are taken from the 1983 Rhode Island Infection Control Pilot Project for EMTs. This program provided participants with the same lectures, handouts, and slide presentations that were proposed for the EMT core curriculum. The Pilot Project verified the need for infection control and established an interest that warranted the addition of a module in the core curriculum. METHODS Needs assessment
A literature search was conducted to determine the extent of existing EMT programs nationally and in Rhode Island. Capsulized stateof-the-art reports for Rhode Island were provided by individual EMTs, chiefs of rescue units, educators, and State Health Department
Volume
14 Number
February,
1986
1
personnel. In this small state, the individual summaries were sufficient to characterize existing programs and requirements for Rhode Island EMTs. Nationally, EMTs are generally recognized at two or three levels? 1. EMT-ambulance (EMT-A) has a minimum of 81 hours of training 2. EMT-intermediate (EMT-I) receives the EMT-A program plus 25 additional hours of training 3. EMT-paramedic (EMT-P) has 480 hours of training and experience above the EMT-A level The minimum curricula established by the Department of Transportation include 81 hours for the EMT-A and 480 hours for the EMT-P. In Rhode Island, an additional classification, the EMT-cardiac (EMT-C), was created in 1973. Its 120 hours of training correspond to part of the modules established by the Department of Transportation for the paramedic course.’ Infection control did not comprise a separate module in current Rhode Island programs. Minimum infection control practices were integrated into the pediatric module of the total curriculum. After the literature search was completed and the core curriculum for EMT-As in Rhode Island was reviewed, site visits and interviews were conducted with EMTs from a volunteer fire department, a municipal fire department, and a private ambulance company in Rhode Island. Three ambulances and two rescue vehicles were inspected. Ambulances are manned by EMT-As and are used mainly for transporting patients. Rescue vehicles are staffed by EMTs who are educated in emergency pre-hospital patient care. Some vehicles are equipped with sinks, metal decks, enclosed cabinets, and exhaust fans. Supplies include clean or sterile airways, dressing supplies, alcohol, green soap, ammonia, drug box, trauma box, respiratory box, and telemetry monitor, depending on the vehicle classification. Not all vehicles are stocked with gowns, masks, or gloves. Many supplies are routinely replenished at hospitals and may include linens, disinfectants, and airways. Techniques investigated included needle disposal, linen handling, cleaning and disinfection, handwash-
Infection
control
for the EMT
29
Table 1. EMT infection control module objectives At the completion of the module, the participants will be able to: 1.
2. 3. 4. 5.
6.
7. 8. 9.
Give two examples of the impact of the history of infection control on the delivery of modern health care Summarize the common growth requirements of three groups of microorganisms Name all six components of the chain of infection and relate them to the infection control effort List infection control measures used in three clean and sterile techniques Define the mode of transmission for the following: gastroenteritis, viral hepatitis, herpesviruses (chickenpox, shingles), meningitis, pediculosis (lice), scabies, tuberculosis Outline protective measures to be used when delivering emergency patient care to potentialty contagious patients or patients with suspected or confirmed communicable diseases Specify four sanitation techniques that prevent the spread of infection Identify the communicable diseases to which EMTs should be immune List infection control resources including both literature and persons
ing, isolation, and checking expiration dates of supplies. EMTs were interviewed at all three levels (ambulance, intermediate, and cardiac). They voiced an interest in learning the following: symptoms of infectious diseases, rationale for infection control practices, transmission of infection, potential hazards from exposures to contagious disease, prophylaxis before and after exposure to disease, protective attire, and disinfection of equipment and vehicles. Official
support
The authors met with the Educational Standards Committee of the Rhode Island Ambulance Service Coordinating Board and subsequently with the full board, which is authorized to set statewide minimum standards for all levels of pre-hospital care.6 Interest in infection control had already been generated from the 1978 infection control program for EMTs, EMT publications on infectious diseases, media attention to AIDS, our recent site visits to ambulance companies, and an awareness of the lack of essential infection control education for EMTs.
American
30
Fishman
and Stamp
A liaison between ICPs and the Department of Health (the governing body for EMTs) is crucial to provide an impetus in introducing the program. In our case this function was fulfilled by an individual” who was committed both to EMT education and to the EMT’s role in infection control. In September 1983, we formally proposed that a 2-hour module be included in the EMTA training course required for licensure in Rhode Island. The purpose of the module was to assist participants in developing a knowledge of infection control concepts and practices, thereby protecting patients, themselves, and innocent victims from the hazards of infection and communicable diseases. The objectives listed in Table 1 were submitted with the proposal to the Rhode Island Ambulance Service Coordinating Board. After reviewing the proposal, the board approved a Pilot Project for existing licensed EMTs that would provide the participants with the same information that a future EMT would receive in his training program. Results of this Pilot Project were presented at the December, 1983, Rhode Island Ambulance Service Coordinating Board meeting as the basis for a decision regarding the permanent incorporation of this program into the EMT-A curriculum. Program
content
The content of the Pilot Project was designed to cover areas of concern to EMTs and is summarized in this article. Topics for the first hour included an introduction, the history of infection control, basic microbiology, the infection process, and infection control practices. Handouts for this section included an outline of program content and a diagram of the infection process. Topics for the second section included communicable diseases, isolation and sanitation techniques, and infection control resources. Transmission, immunity, prophylaxis, and disinfection were addressed in detail for each disease. Handouts included the outline, guidelines for care of contaminated clothing, a ‘Robert Picard, R.N., EMT-C, Administrator of Emergency Services at John E. Fogarty Memorial Hospital, who was a member of the Ambulance Service Coordinating Board.
INFECTION
Journal
of
CONTROL
communicable diseases chart, and an infection control resource list. Audiovisual aids for each faculty member included original slides, some taken during interviews and fire station site visits. Grant
application
and industrial
support
Financial support was required in order to facilitate the Pilot Project. It should be noted that many EMTs volunteer their services to the community and have no means of reimbursement for educational programs in which they participate. Hence, it was decided that registration fees would be waived. Budget was projected to cover faculty expenses, secretarial services, audiovisual aids, travel, printing, folders, refreshments, and facilities. These costs were minimized by the generous underwriting of the two hospitals hosting the Pilot Project seminars: The John E. Fogarty Memorial Hospital and South County Hospital. Seven companies were approached in October for support of the proposed educational program. The companies were chosen because the authors determined that their products (disinfectants, handwashing agents, vaccines) could be used by EMTs. Each company received a written proposal that included background information, the number of EMTs in Rhode Island (more than 3000), the content and objectives of the program, projected costs, suggested faculty, and authorization for product exhibits. Four companies responded (57%) and three committed financial aid for the project. (Ideally, companies should be solicited during the beginning of their fiscal year when monies are still available.) After solicitation of the drug and chemical companies, a training grant application was made to the Chief of Emergency Medical Services at the Rhode Island Health Department. Background information was provided to define the need for this program, to present the recommendation of the Rhode Island Ambulance Service Coordinating Board, and to elaborate on the purposes and objectives of the Pilot Project. Budget proposal, curricula vitae of faculty, and methodology were presented. The items summarized under methodology included faculty, secretarial support, teaching aids, pro-
Volume
14 Number
February,
1986
1
Infection
gram schedule and sites, brochure content and distribution, handouts, and a proposed evaluation tool. The grant application was approved in just 10 days. Program
coordination
Mailing of brochures to EMT training officers was coordinated by the Rhode Island Health Department. The seminar sites were selected according to the Rhode Island Health Department’s geographic considerations, that is, one in northern Rhode Island and one in southern Rhode Island. Secretarial duties included registration of program participants and assistance with company product exhibits. Audiovisual equipment and refreshments were prearranged. Program
evaluation
The evaluation form designed for the Pilot Project was specific to this EMT program and elicited constructive comments (Fig. 1). RESULTS
Fifty-five EMTs registered to attend the seminar. Because of government scheduling changes, only 15 of 32 registrants attended the Friday evening session in southern Rhode Island at South County Hospital. Seventeen of 24 (71%) attended the Saturday morning session held at the John E. Fogarty Memorial Hospital in northern Rhode Island. Thirty participants (94%) returned completed evaluation forms. Responses and training levels are summarized in Fig. 1. Eighty percent of the evaluations (24 of 30) included comments that reiterated the need for EMTs to learn infection control techniques. Some are noted below: “Material covered was about situations encountered on a weekly basis.” “This session made me realize more so than I know how open we really are to these different diseases; it also did a lot to tell us how we can lower our risks of catching diseases from our patients or us giving them to our patients.” “I think too many [EMTs] become apathetic and don’t see how infection control relates to them.” “In order to prevent infection in both the
control
for the EMT
31
patient and EMT, I believe more information would be helpful and would like to see it presented to all rescue units.” “Keep us up-to-date on future infection control seminars; anytime something new develops in this field I believe it is imperative that we in the rescue field learn right away.” “This program would be especially important to new EMTs--I feel this should have been included all along, I am shocked that it’s taken over 10 years to get this in the program.” “Should be in recertification program. Every EMT should know.” “Should be mandated at state and national level for all EMTs.” “One of the best educational programs I have been fortunate to attend.”
Some participants suggested that additional infection control seminars be held to further discuss AIDS, herpesviruses, hepatitis B virus, and disinfection. Main concepts learned by participants can be categorized as self-protection (29%), importance of infection control (29%), and aseptic techniques (41%). Some of these are quoted below: “There is a real possibility of my being exposed to an infectious situation and I should be prepared to do something about it.” “The reality of how disastrous a nosocomial infection can be as well as awareness of how to stop the transmission cycle.” “The realization that infection control goes both ways: protection of the patient and protection of self and ways to prevent infection.” “Sanitation. Cleanliness. Self-responsibility.” “Importance of taking the time to put on gloves, re-stressed the importance of handwashing.” DISCUSSION
We provided written feedback to the administrators of the host hospitals and to the companies providing financial support. The companies with exhibits were informed in writing of the participants’ reactions to their products. The evaluation summary was presented in December 1983, to the Rhode Island Ambulance Service Coordinating Board. The board
American
32
Fishman
and Stamp
INFECTION
EMT INFECTION 1.
CONTROL
MODULE
Journal
of
CONTROL
EVALUATION
What is your overall reaction to the session? 53% (16)
Outstanding, I learned a great deal
40% (12)
Well done, I learned a good deal
7% (2)
Adequate, it had average learning value
0
Fair, I learned a few things
0
Poor, I learned little or nothing
2. Did you receive the knowledge you anticipated? 50% (15)
Yes, very much so
43% (13)
Yes, to
7% (2) 0
a large extent
To some extent No, not at all
Comments:
3. Was the speaker well-prepared and effective? Speaker No. 1
Speaker No. 2
93% (27)
90% (27)
7% (2)
10% (3)
To some extent
0
0
No, not at all
0
0
Yes, very much so Yes, to a large extent
4. Were the handouts and/or audiovisuals effective? Handouts
Audiovisuals
Yes
90% (27)
Adequate
10% (3)
93% (28) 7% (2)
0
0
No Comments:
5. Will the material covered be of direct value to you? 63% (19) 34% (10) 3% (1) 0
Yes, very much so Yes, to a large extent To some extent No, not at all
Fig. 1. Evaluation form designed seminar participants.
for Pilot Project
subsequently recommended that the Educational Standards Committee incorporate this program into future state-approved EMT-A courses. The final outcome of the Rhode Island Pilot Project depended on the decision of this committee. Until contracts were signed, individual rescue squads, private ambulance com-
shows summary
of responses
from
panies, and coordinators of the State EMT-A Course could request this state-approved infection control module on an individual basis. The state provided a mechanism to fund some of these programs. In June 1984, the Ambulance Service Coordinating Board voted to include this program
Volume February.
14 Number
1
Infection
1986
control
for the EMT
33
6. How does this program compare with other educational programs you’ve attended? 43% (13)
One of the best
16% (5)
Better than others
34% (10)
As good as others
0 7% (2)
It was worse This is my first program
7. The material presented was 83% (25)
New learning
23% (7)
Helpful review, not new Not helpful
Comments:
8. Do you want more information on infection control? Yes 93% (28) No 7% (2) FEEL FREE TO COMMENT ON ANY ASPECT OF THIS PROGRAM:
9. Any suggestions for content of future infection control seminars?
10. What is the main concept you learned?
11. Please describe your training 27% (8) Ambulance/Basic
43% (13) Intermediate
30% (9) Cardiac
12. Please comment on the types of products that interest you
13. Were the exhibits informative? 93% (28) Yes
Fig.
in the EMT curriculum. The program content, as we established it, is now a permanent 3-hour module mandated for all persons seeking EMT licensure in the State of Rhode Island. The board also mandated that the module be taught by an ICP. The positive reaction to this Pilot Project re-
7% (2) No
1, cont’d
sulted not only from the pertinent program content, but also from the professional manner in which the program was coordinated. ICPs should first assess the needs of their target audience in order to determine which issues are actually pertinent. An effective method for developing program content for the EMT is to be-
American
34
Fishman
and
Stamp
INFECTION
come familiar with his work setting, to observe his practice in different municipalities, volunteer units, or private companies, and to encourage the EMT to verbalize his concerns. Professional and financial support alike must be obtained before a program can be coordinated. In order to integrate a permanent infection control program as part of a state licensure procedure, ICPs should work within the state hierarchy. For promoting the Pilot Project, we thank Robert Picard, Administrator of Emergency Services at John E. Fogarty Memorial Hospital and Chairman of the Educational Standards Committee of the Rhode Island Ambulance Service Coordinating Board; Glenn Mitchell, former Medical Director of Emergency Medical Services (EMS), Rhode Island Department of Health; and Harold Pace, Chief of EMS,
Bound
volumes
available
Journal
of
CONTROL
Rhode Island Department of Health. All were members of the Rhode Island Ambulance Service Coordinating Board (1983-1984). We also thank Maria Nicotra for clerical assistance and Janice Hardy for both clerical assistance and registration at the Pilot Project.
References 1. ICPs can be resources for emergency paramedics. Hosp Infect Control 10(5):66-67, 1983. 2. Michaels J: Infection control policies and practices for paramedical personnel. APIC 1984 Poster session, Board 17. 3. Smith B: Infection control: EMS reacts-and overreacts-to the AIDS panic. J Emerg Med Serv 8(8):24-29, 1983. 4. Moss WD: Hepatitis B. Emerg Med Serv 12(5):48,50, 1983. 5. York DK: Basic emergency medical care: Proposed legislation. J Iowa Med Sot 73:100-102, 1983. 6. Mitchell GW: Emergency medical technicians in Rhode Island: An- overview. RI Med J 65:463-466, 1982.
to subscribers
Bound volumes of AMERICAN JOURNAL OF INFECTION CONTROL are available to subscribers (only) for the 1986 issues from the Publisher, at a cost of $24.00 ($30.00 international) for Vol. 14 (January-December). Shipping charges are included. Each bound volume contains a subject and author index and all advertising is removed. The binding is durable buckram with the journal name, volume number, and year stamped in gold on the spine. Payment must accompany all orders. Contact The C. V. Mosby Company, Circulation Department, 11830 Westline Industrial Drive, St. Louis, Missouri 63146 USA; phone 800-325-4177, ext. 351. Subscriptions must be in force to qualify. Bound volumes are not available in place of a regular journal subscription.