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The paramedic work setting in Australia presents challenges for applying recommended infection prevention and control (IPC) practices. Our study had two aims: to describe the guidance provided across a range of documents used by Australian ambulance services; and to explore the views of health experts regarding the adequacy of guidance on IPC practices for Australian paramedics. Methods Content analysis was used to evaluate the degree of alignment between IPC operating procedures from four state ambulance services and the IPC guidelines issued by the National Health and Medical Research Council (NHMRC) in 2010. Semi-structured interviews were conducted to explore perspectives of 14 experts about IPC practices among paramedics and IPC guidance provided to them. Results While the ambulance operating procedures aligned well with the NHMRC IPC guidelines, we identified differences in the nature of advice provided that could lead to differing practices by paramedics across Australia. Experts identified several domains of IPC practices by paramedics that would benefit from closer scrutiny and/or more specific guidance, including hand and environmental hygiene, governance and surveillance, environmental challenges, vehicle design, cultural barriers and communication with state health regulators. Conclusion Our study has further highlighted unique challenges faced by paramedics in adhering to recommended IPC practices while providing healthcare in the mobile primary emergency environment. Two recommendations arise from our research. First, there is a need to adapt the current national risk-based framework for IPC in Australia to paramedicine. Second, that targeted research into staff compliance is required to identify the key barriers and enablers to the uptake of IPC practices in paramedicine.

A qualitative exploration of infection prevention and control guidance for Australian paramedics