This feature is part of our Paramedic Chief Digital Edition, a regular supplement to EMS1.com that brings a sharpened focus to some of the most challenging topics facing paramedic chiefs and EMS leaders everywhere. To read all of the articles included in the Winter 2016 issue, click here.
By Robert Avsec
There is an unseen but very real threat to the health of EMS providers and the patients they serve in their ambulances. The threat comes from the worldwide spread of infectious pathogens, such as MRSA, C. difficile, hepatitis and tuberculosis. Recent outbreaks involving the Ebola and Zika viruses have gained worldwide attention and increased concern for and interest in ambulance decontamination among EMS leaders.
In addition to threats from bloodborne and airborne pathogens, many EMS agencies are busier than ever before, and handling that increased workload with the same or less staffing creates a time crunch. The proper cleaning and disinfection of an ambulance and the equipment used to provide patient care is a critical task that can frequently be overlooked or not done properly. This poses a threat to EMS providers and their patients during subsequent patient care encounters.
While manual decontamination practices can be effective and should be done, paramedic chiefs should consider an increasing number of technologies that can provide safer, more effective and more efficient cleaning and disinfection for ambulances and equipment.
Better manual decontamination
While the most common methodology for cleaning and decontaminating surfaces in the patient care compartment and EMS equipment involves manually cleaning those surfaces with EPA-approved disinfecting solutions, manual cleaning does have shortcomings.
Manual cleaning of cot rails and buckles, seats, action counters, door handles and other frequently touched surfaces is time-consuming. A thorough cleaning of every surface is also often impractical for EMS crews facing pressure to rapidly return to service for their next patient call. The miss rate of manual cleaning practices may be over 50 percent, according to one decontamination equipment vendor.
Vapor-based decontamination equipment
The AeroClave ADS is a decontamination system that can be directly integrated into a new or existing ambulance. The ADS utilizes an EPA-approved hospital disinfectant to decontaminate surfaces in the patient care compartment and equipment after every patient transport.
The ADS is a convenient, hands-off solution for decontaminating an ambulance’s patient care compartment. A nozzle, installed inside the patient care compartment, disperses a mist of disinfectant solution that is designed to meet OSHA and NFPA specifications.
Zimek’s Z-vac Micro-Particle Evacuator uses disinfectant misting technology to decontaminate an ambulance’s interior and the equipment carried aboard the ambulance. When connected to the vehicle and activated using a window overlay, an installed port or window insert, the system automatically disperses a disinfectant vapor throughout the vehicle’s interior. Upon completion of a decontamination cycle, any remaining mist is removed using the company’s Z-vac Vehicle Adapter.
The Bioquell BQ-EMS uses hydrogen peroxide vapor to eradicate pathogens from exposed surfaces in the ambulance, including patient care equipment, controls for on-board electronics and the stretcher. A decontamination cycle can be done within a sealed vehicle by placing the hydrogen peroxide vapor generator and the aerators in the patient care compartment of the ambulance.
A wireless control panel is used to start and stop the process. The vehicle’s contents need to be prepared before system activation to ensure decontamination of exposed surfaces.
The Ambustat atomizes Actril Cold Sterilant, a disinfectant with peracetic acid and hydrogen peroxide, into small droplets — fog, mist or spray— by shearing them in a highly turbulent section of the nozzle. A blower in the power head supplies air to create the turbulence, and the flow rate can be adjusted for desired droplet size.
Combination approach
The Klenitise ambulance cleaning and disinfection system uses a three-step process that employs both manual disinfection and vapor disinfection technologies. The first step in the process is to scan surfaces in the ambulance using a handheld UV light to highlight areas that have been in contact with patients and where surface residues are present. Visually identifying contaminated surfaces allows the EMS provider to manually decontaminate those surfaces with a disinfectant spray and towels. The ambulance can then be completely decontaminated using a fogger system.
Ultraviolet germicidal irradiation
Ultraviolet germicidal irradiation for disinfection has been used primarily in medical sanitation and sterile work facilities. In recent years UVGI has found renewed application in air and surface sanitization in medical care settings such as hospitals, clinics and laboratories.
“Ultraviolet germicidal irradiation (UVGI) is an established means of disinfection and can be used to prevent the spread of certain infectious diseases. Low-pressure mercury (Hg) discharge lamps are commonly used in UVGI applications and emit shortwave ultraviolet-C (UV-C, 100–280 nanometer [nm]) radiation, primarily at 254 nm. UV-C radiation kills or inactivates microbes by damaging their deoxyribonucleic acid (DNA).”
The History of Ultraviolet Germicidal Irradiation for Air Disinfection
MRSA-UV has produced several products that use UVGI for safer, more effective and more efficient decontamination of ambulances and equipment. The Turbo-UV is a compact unit (22 x 8 x 8 inches) that can be placed in the closed patient compartment of an ambulance for as little as 15 minutes. The Turbo-UV is compact enough that it can also be used for decontaminating EMS station sleeping rooms, EMS equipment and personal protective gear that may have been exposed to infectious pathogens.
The EMS-UV air sanitizer employs UVGI to circulate and clean the interior air of an ambulance to reduce airborne viruses, bacteria, mold, allergens and odors. The EMS-UV can be mounted on a wall in the patient care compartment and allowed to run continuously. The UV-C bulb inside the unit requires minimal electricity and annual replacement.
The Rapid Razor-UV is a handheld, rechargeable UVGI device designed for decontamination of surfaces inside the ambulance. The user simply passes the device closely over the contaminated surface area, allowing the energy from the high-output UVC Emitter to rapidly decontaminate surfaces. The unit includes an internal pacer that sets the scan speed to ensure a complete and accurate scan. A recessed safety shield prevents direct exposure to UVC energy while also adding reflectance that increases its effectiveness.
Ambulance decontamination is necessary to protect EMS personnel and patients. Consider the practices and products listed above to fully eliminate dangerous pathogens from the ambulances in your fleet.
About the author
Battalion Chief Robert Avsec (Ret.) served with the Chesterfield (Va.) Fire & EMS Department for 26 years beginning as a firefighter/EMT; During his career, he was an active instructor, beginning as an EMT Instructor, who later became an instructor for fire, hazardous materials, and leadership courses at the local, state, and federal levels, which included more than 10 years as a contract instructor with the National Fire Academy.
