Hygiene Knowledge and Digital Health Literacy in Emergency Medical Services in Germany: A Cross-Sectional Study of EMS Personnel and Emergency Physicians with Relevance for the Development of Training Programmes.

Background: Effective hygiene and infection prevention are essential for patient and staff safety in EMS. This study assessed hygiene and infection prevention knowledge among EMS personnel and emergency physicians in Thuringia, Germany. Specifically, it examined knowledge of WHO recommendations on hand hygiene, standard infection prevention measures, appropriate use of personal protective equipment (PPE), and the management of patients with confirmed multidrug-resistant organisms (MDROs). In addition, associations with digital health literacy, job satisfaction, teamwork, and patient safety were explored to inform future training needs in EMS. Methods: A quantitative cross-sectional study was conducted using an online questionnaire between June and September 2025. A total of 72 EMS personnel and emergency physicians participated. The survey included the Digital Health Literacy Instrument (DHLI), the WHO questionnaire on hand hygiene knowledge, a knowledge test on standard infection prevention measures, PPE use, and MDRO management, the short questionnaire on general and facet-specific job satisfaction (KAFA), and the German version of the questionnaire on teamwork and patient safety (FTPS/SAQ). Group comparisons were performed using Fisher's exact test or t-tests, as appropriate, and associations were examined using correlation analyses. Results: WHO-based hand hygiene knowledge was predominantly moderate (59.5%). Emergency physicians demonstrated higher levels of knowledge than EMS personnel (57.1% vs. 28.6%) and were more likely to answer basic questions on transmission routes correctly. In the extended hygiene knowledge test on basic hygiene measures, PPE use, and MDRO management, most participants showed low (43.1%) or moderate knowledge (45.1%), while only 11.8% achieved a good level. Digital health literacy was generally high, particularly for basic application skills. Respondents reported a high level of job satisfaction. Teamwork and patient safety were also perceived positively overall; however, communication was rated less positively by emergency physicians than by EMS personnel (p = 0.005; d = 0.81). Conclusions: Relevant gaps in hygiene and infection prevention knowledge were identified in the EMS setting, particularly regarding standard infection prevention measures, PPE use, and MDRO management. Future EMS training should therefore address both knowledge gaps and implementation-relevant factors such as communication, teamwork, and digital competencies. This study should be regarded as an exploratory pilot study.