Detection of potentially pathogenic bacteria on emergency care personnel's safety protective footwear and evaluation of infection, prevention, and control procedures in the uMgungundlovu district of KwaZulu-Natal

Abstract

Emergency Care Personnel (ECP) within KwaZulu-Natal Emergency Medical Services (KZN EMS) consistently respond to medical, trauma, and disaster emergencies. Emergency care personnel often serve as primary responders responsible for providing specialised care and life-saving interventions, which may increase their risk of exposure to healthcare-associated infections. Emergency care personnel are equipped with official attire and Safety Protective Footwear (SPF), which are part of their Personal Protective Equipment (PPE) for duty. Working in the pre-hospital setting presents challenges due to the lack of patient history provided to ECPs’ upon initial contact, increasing the risk of Healthcare-Associated Infections (HAIs). Emergency care personnel may unintentionally facilitate transmission of diseases. In the pre hospital setting, there is a scarcity of information regarding disease transmission. Emergency care personnel are restricted in their ability to sanitise and disinfect their vehicles and SPF because of high-priority cases and limited turnaround times. In the absence of an Infection Prevention and Control (IPC) policy regarding cleaning procedures for EMS personnel, there is a potential risk of HAIs. KZN EMS does not possess an adequate IPC system, in contrast to hospitals. The purpose of this study was to evaluate ECPs' SPF for the presence of microorganisms related to bacterial infections and to determine whether EMS KwaZulu-Natal uMgungundlovu district has any infection prevention and control procedures or policies. This study employed a prospective cross-sectional quantitative approach and was conducted in two phases. The initial phase involved swabbing of 53 selected ECPs’ SPF at the EMS Grey’s Hospital base to identify bacterial contamination. This was followed by data collection using a questionnaire distributed to all EMS bases in the uMgungundlovu District, aimed at assessing ECP's ICP awareness and practices among 165 staff members. After distributing the questionnaire to all bases in the uMgungundlovu district, a total of 303 participants were surveyed, with 165 (54%) responding. A considerable proportion of participants were uninformed of EMS policies and practices due to the absence of an EMS IPC policy. Inadequate ICP awareness, insufficient disinfection practices, unavailable PPE, and inaccessible cleaning supplies were all prevalent issues. The study employed an aerobic culture-based method consisting of 53 samples. The bacterial analysis revealed six pathogens (11.3%) in seven (13.2%) SPF samples. Pasteurella canis, Enterococcus faecium, Enterococcus casseliflavus, Escherichia coli, Pantoea agglomerans, and Acinetobacter radioresistens were all identified as potential pathogenic organisms. This study demonstrated the prevalence of microbial contamination on ECPs’ SPF, which may act as a reservoir for transmitting potential infections to patients and healthcare personnel. Emergency medical service personnel showed significant non compliance in cleaning and disinfecting practices. KwaZulu-Natal EMS uMgungundlovu District lacks an effective cleaning protocol for decontaminating SPF. Further research is necessary to determine whether contaminated SPF contributes to the transmission of infectious pathogens in pre-hospital settings. Additionally, KZN EMS must address the insufficient supply of cleaning materials, inadequate IPC training, and poor procedural guidelines.