Bug PATROL

     The value of cleaning, decontamination and disinfection in reducing transmission of disease has long been recognized. People used vinegar for disinfection as far back as the 13th century. In the 1970s, it became routine to clean and disinfect medical equipment to protect patients. In the 1980s, efforts focused on protecting healthcare workers from items and surfaces contaminated with bloodborne pathogens such as HIV, hepatitis B and hepatitis C.

     Now, in this new century, as new drug-resistant organisms emerge, cleaning and disinfection are even more important for patients and providers alike. However, without clear written policies and procedures for the care, cleaning, decontamination and disinfection of vehicles and equipment, both groups may face an increased risk, especially for bacterial infections. (Bloodborne pathogens are caused by viruses, which do not survive well outside the human body. Studies have shown that hepatitis B is the only one that can do so for any amount of time.)

     Study after study on handwashing by healthcare providers shows that compliance with this very basic protective measure is poor. So, what about cleaning routines for vehicles and equipment? How well is your department complying with proper procedures for cleaning and disinfecting these? Is it part of compliance monitoring and your exposure-control plan?

     Although the routine culturing of environmental surfaces is not recommended, it can serve as a valuable tool for identifying problems. In a recent study published in the journal Prehospital Emergency Care, one department conducted environmental culturing of its ambulances. Of 21 ambulances, it found that 10 were colonized with methicillin-resistant Staphylococcus aureus (MRSA). This strongly suggests that adequate cleaning and disinfection were not taking place.

KEY DEFINITIONS
     Cleaning involves the physical removal of dust, soil and foreign material from a surface. It usually entails scrubbing and the use of plain soap and hot water. Cleaning must take place before disinfection can be achieved. This is the most important step in the process.

     Decontamination is the removal of disease-producing organisms. This process renders items safe to handle.

     Disinfection refers to the process of destroying disease-producing organisms using a chemical agent.

     Vehicles should be cleaned after each patient transport. Cleaning is an important activity, but not a time-consuming one. New products make surface cleaning easy, requiring only a wipe-and-go approach. In many areas, medical facilities make cleaning space and solutions available for EMS.

     Cleaning post-transport is a commonsense activity and should focus on the items used for care and areas with which the patient was in direct contact. There is no need to put a vehicle out of service or air it out because of a patient's disease status. Environmental surfaces can be cleaned with any cleaner or disinfectant intended for environmental surfaces. The term environmental surface includes floors, woodwork, ambulance seats, countertops, etc. In some vehicles with special flooring, consult the manufacturer's recommendations for a cleaning/disinfection agent. Not following these guidelines can result in damage to the surface and possibly void its warranty. Routine cleaning of the entire inside of the vehicle should be performed at least weekly.