EMS Equipment and Transport Vehicle Cleaning and Disinfection: Challenges & Best Practices

Emergency medical systems teams are constantly faced with challenges of preventing infection transmission. The emergence of antimicrobial-resistant microbes (e.g., healthcare-acquired and community-acquired methicillin-resistant Staphylococcus aureus [MRSA], vancomycin-resistant Enterococcus [VRE] and multidrug-resistant Gram-negative bacilli), along with growing concern regarding the spread of Clostridia difficile bacteria are problems facing all healthcare providers. A major challenge for EMS is the broad range of potentially transmissible infections, including the above pathogens and others that may be recognized or unrecognized when transporting patients.

Meeting best practices for cleaning and disinfection of environmental surfaces and patient care equipment constitutes an important factor in preventing the spread of infections. Environmental surfaces and patient care equipment can serve as reservoirs for pathogenic microorganisms, and, without clear written policies and procedures for the care, cleaning and disinfection of transport vehicles and equipment, patients and EMS teams are at increased risk. The most common means of infection transmission occurs when gloved or ungloved hands come in contact with a contaminated surface and/or there is patient contact with contaminated surfaces or medical equipment.1,2

Published studies focusing on transmission to surfaces and medical equipment in healthcare facilities have proven that contamination of the environment has likely contributed to the spread of resistant pathogens (MRSA and VRE).1,2 A nationwide research performed in Europe showed that traditional cleaning and disinfection practices had little effect in removing bacterial contamination (specifically MRSA) in ambulances, thus leaving crews and patients potentially at risk.3

OSHA Bloodborne Pathogen Standard
In December 1991, the Occupational Safety and Health Administration (OSHA) issued a standard titled "Occupational Exposure to Bloodborne Pathogens."4 The OSHA BBP rule applies to all persons occupationally exposed to blood and other potentially infectious materials. One of the requirements under the standard is ensuring that each place of employment be kept clean and sanitary. This involves development and implementation of protocols and procedures addressing work practices for employees that include cleaning schedules and appropriate methods of decontamination and disinfection. All equipment and environmental working surfaces must be cleaned and decontaminated with an appropriate disinfectant after contact with blood and other potentially infectious materials.

While the OSHA standard does not specify the type of disinfectant or procedure, the original compliance document suggested that a germicide used to clean a blood spill must be tuberculocidal to kill the hepatitis B virus (HBV);5 however, in February 1997, OSHA amended its policy and stated that EPA-registered disinfectants that are labeled as effective against HIV and HBV would be considered appropriate disinfectants.6 When bloodborne pathogens other than HBV or HIV are of concern, OSHA continues to require the use of EPA-registered tuberculocidal disinfectants or hypochlorite solution (bleach diluted 1:10 or 1:100 with water).7

Classification Approach to Cleaning and Disinfection
In infection prevention and control practice, cleaning and disinfecting (or sterilization) of reusable equipment is based on a classification system. A critical device is a device or item that enters sterile tissue or the vascular system and therefore should be sterile, i.e. IV catheter. Semi-critical devices are items that come in contact with mucous membranes and require high-level disinfection between uses, i.e., laryngoscope blades, oxygen masks, resuscitation bags.