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By Dave Konig
At the beginning of my first ambulance shift, my crew chief told me, “The cleanest part of the ambulance should be the ceiling in the patient compartment.”
His reason was the ceiling is what the patients see the most of in the ambulance. Initially, this made sense, but as time passed and patient upon patient journeyed through the back of the rig, I began to question his wisdom and came to realize the ceiling is the least important part of the ambulance to keep clean.
This isn’t to say it shouldn’t be cleaned, but the transmission of germs and bacteria to the EMS provider and the patient through the ceiling is slim to none. The areas in the back of the ambulance where actual contact is made are truly the most important parts of an ambulance to keep clean.
3 options for ambulance decontamination
When it’s time to decontaminate the ambulance, there are three main categories: sanitizers, disinfectants and cleaners.
Sanitizers reduce germs on the surfaces where they are applied, however sanitizers do not eliminate all pathogens. Hand-washing with soap and water remains the most effective method of eliminating germs.
Disinfectants neutralize or eliminate germs. Unfortunately, disinfectants fall short in removing dirt and organic matter. Leaving behind material offers an environment for the microbes to latch onto and foster their growth.
Cleaners remove dirt, organic material and germs. Using cleaners is a two-step process. The cleaner lifts or loosens the grime from surfaces so it can be rinsed away with water. This process removes the dangerous microbes and the material it uses to fester and grow. Cleaners should not be left on equipment or surfaces to dry for EMS provider health and equipment-care reasons.
Making decontamination part of the process
It is common for EMS crews to divide the duties associated with responding and transporting a patient. Whether this division is a formal process outlined by the agency or an informal agreement between partners, decontamination needs to be included even for the most mundane runs.
Managers and supervisors should make sure EMS crews are including this task in their daily run routine. A formal process serves as a reminder and sets the expectation for the cleanliness of the vehicle, especially the patient care compartment.
Making decontamination part of the daily run routine also supports providers who want to safeguard their personal health and the health of their loved ones, but are partnered with providers not as cognizant. In many agencies, doing a proper decontamination, or asking that it be done, can make a concerned provider the target of ridicule for being conscious of the threat that the microbes actually represent.
4 tips for infection control and decontamination
Ensure all surfaces that come into contact with EMS providers and patients are cleaned. It is also important to focus on what providers come into contact with. Even if the patient does not directly contact the surface, this does not mean it is not possibly contaminated through droplets or other materials. Here are four tips to improve the safety of the ambulance for EMS providers through better infection control and decontamination.
1. Universal precautions is more than gloves
Far too often, EMS providers think putting on a pair of gloves is adequate protection. True universal precautions include the use of gowns, respirators and eye protection where appropriate.
2. Wear PPE while decontaminating
Donning new PPE while decontaminating the ambulance is an important aspect of the process that is too often neglected. Using the same PPE you used while in contact with the patient re-contaminates the areas you are trying to clean.
3. Change cot linens after every patient
Cloth linen is a porous material that allows microbes through to the surface of the cot mattress. Even double-wrapping a patient will not prevent this. Before applying a new cot sheet, wipe down the mattress with a disinfectant.
4. Mix bleach solution daily
A household bleach solution, diluted between 1:10 and 1:100 with water, is appropriate for the decontamination of items and surfaces that have been contaminated with blood or other potentially infectious material. Mix a fresh bleach solution on a daily basis to ensure the potency. Allow one cup of bleach in a gallon of water, prepared at the beginning of a shift, to set for at least 30 minutes before dividing it into smaller spray bottle containers for each ambulance.
Field supervisors, as part of their regular interactions with field personnel, need to ensure their providers are following recommended infection control guidelines and ambulance decontamination processes. Part of that role includes passing along, correcting or busting myths about which surfaces are most critical for decontamination.
About the author
Dave Konig is a New York City-based EMS provider working in the field since 1994. He has worked in the private sector, as a 911 provider and as a volunteer. He blogs about EMS, social media and event medical services at TheSocialMedic.net and maintains DavidKonig.com for other writings including updates on the books he authors.
