Disinfection Procedures

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Simusid

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I'm currently on a kick to read/learn more about how disgusting our ambulances actually are (from a bacterial POV). This thread caught my eye as my son is doing a science fair experiment to culture our two ambulances.

So for today I've got two questions. First, I'd like to hear what you do after each call. I would say that we do a general wipe down of whatever happens to look "dirty" or whatever we know we might have touched. Probably 90% of the "per run" cleaning is done with alcohol wipes and obviously that will miss a lot. I doubt the grab rails are done each time, the monitor, scopes, etc. I'm going to do a better job in the future!

Second, does your service have a written procedure to do periodic disinfection and/or cleaning? I know we do not, but we need to do that. If you have one would you mind sharing?
 
Simusid said:
I'm currently on a kick to read/learn more about how disgusting our ambulances actually are (from a bacterial POV). This thread caught my eye as my son is doing a science fair experiment to culture our two ambulances.

So for today I've got two questions. First, I'd like to hear what you do after each call. I would say that we do a general wipe down of whatever happens to look "dirty" or whatever we know we might have touched. Probably 90% of the "per run" cleaning is done with alcohol wipes and obviously that will miss a lot. I doubt the grab rails are done each time, the monitor, scopes, etc. I'm going to do a better job in the future!

Second, does your service have a written procedure to do periodic disinfection and/or cleaning? I know we do not, but we need to do that. If you have one would you mind sharing?
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Just keep in mind that human beings need bacteria, the goal is not a sterile environment.

As well, bacteria that are suseptable to treatment compete for resources for metabolism with resistant bacteria and other organisms like yeasts and fungi. If you kill all the weak ones, the only thing left are the really nast buggers unapposed

Also be very careful what you use alcohol on. Some senory devices and rubber seals do not like it.
 
I am always a stickler for cleaning all the areas most don't on a religious like basis. Examples... the grab rails, radio mics, radio panel, action areas, seats, stretcher rails, handles on the doors, and interior corners where providers hands always go.

We always use a commercial spray disinfectant solution or you can make your own with water and chlorox. Just make sure you let the solution sit for 30 sec or so before you wipe it off. If using commerical solution the back label will tell you how long to wait before wiping off... most people do not observe this.

There was a hospital study done on disinfection and they found that when the same cloth or towel is used to disinfect multiple surfaces, there is actually a cross contamination and spread of the germs amongst surfaces.
 
I personally don't like those commercial chlorine wipes... They have a strong odor, not to mention your navy blue pants will have permanent red-brown stains if you sit on a surface wiped with these things before it's completely dry.
 
We use a virex type mix to wash the floor of the rigs and use a foaming disinfectant on the cot and bench seat after every call. We also will use a virex soaked rag to clean cabinets and stuff if they get messy during a call.
 
unless there is bodily fluid anywhere or any thing that need to be actually cleaned we just sweep the rig out. after a trauma or code, wiped down wash the floor with pine sol. Yes the rig smells like pine for an hour or 2 but it gets the job done. the only thing that gets done after every call is changing the stretcher linens. keep in mind we do keep our rigs as clean as possible with our spare time on a shift. we like to be presentable.
 
^^^ that is disgusting. sweeping will do nothing to get the stuff that matters, and pine-sol dosnt do much better.

i clean as if i where going to be the next patient, it is the only right thing to do. here is my routine.

Morning: after the check out, the gurney comes out and is cleaned with the foaming disinfectant; mattress, rails, handles, main frame, gurney O2. the floor is moped with either bleach (1 cup in 1gal water) or commercial germicide and allowed to air dry. bench seat, door handles, grab rails are cleaned with the same as the gurney. cabinets are cleaned with wipes. dash/radios/steering wheel/floor (rubber floor) wipes.

each call: gurney is cleaned with foam and new sheets are used. monitor is cleaned. spot cleaning where it is needed.

i know it is probably overkill, but this is how clean i would want it if my family where riding. I am not worried about this knocking out my NF, i am worried about someone else's NF.
 
I gave a tour of our trucks to a friend of mine who is a PhD biochemical engineer for a drug company. He's the mentor for my son's sci fair project.

The trash in our truck is a small plastic bin that pulls out from under one of the seats. It includes two smallish sharps boxes. He said you can do whatever you want in the rest of the truck but it won't matter unless you get the trash container and the inside of the drawer very clean. I noticed a small puff of air as you close the drawer, he said it inoculates the rest of the box every time you close it.

Unfortunately, the trash is NOT emptied after every run. We will be concentrating the cleaning and culturing on that drawer area.
 
^^^have not thought too much about that. we usually only empty the trash in the AM. we don't generate much trash but this may be somewhere i look in the future. on a side note, nothing that has contacted the Pt goes in my trash it is mostly just cannula wrappers. we do have a bio-hazard trash on the back door which gets emptied every trip if there are any nastys.
 
Every time I see these threads I always wonder how many of you actually practice what you preach.

My real life experience with multiple services is far different than what you're reporting. It seems like the norm to not clean the rig between calls and to only disinfect the rig/equipment after the messy calls. I won't even tell you where the trash is emptied.

I can't remember ever seeing a rig undergo a thorough cleaning, no matter what service I was with. It's good to know that there are some diligent medics out there!
 
MMiz said:
My real life experience with multiple services is far different than what you're reporting. It seems like the norm to not clean the rig between calls and to only disinfect the rig/equipment after the messy calls. I won't even tell you where the trash is emptied.
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If there's no biohazard in the trash, then any trash will do. This holds true whether you're talking about basic trash out of the ambulance vs basic trash outside of hospitals and clinics. Does, in my experience, EMS need to do a better job at properly disposing of biohazard trash? Sure, but even soiled trash isn't necessarily a biohazard, otherwise anyone who's thrown a soiled diaper into the trash is equally at fault.


I can't remember ever seeing a rig undergo a thorough cleaning, no matter what service I was with. It's good to know that there are some diligent medics out there!
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I try to wipe and mop all of the surfaces down every shift and I try to do a basic wipe down after every call. However I will admit that I've never really gone through and pulled everything out of the cabinets, wiped down the cabinets, and then returned the supplies. It was a running joke at my last company that when I left the rigs weren't going to be washed anymore because if the ambulance was dirty, I washed it top to bottom in addition to wiping down the back without being asked. The rig reflects the crew and if I have the opportunity, I will not be associated with a dirty ambulance.
 
I can honestly say I practice what I preach. The thought of ambulances not being disinfected is quite disgusting. I have a personal thing for cleanliness so I guess it carries over to the ambulance.
 
Ok here's the status of my son's project. We've got a stack of petri dishes (commercially prepared) and he swabs three different locations in the back of the truck. First the counter surface, second the grab bars and third the trash area. He took control samples on one truck (no additional cleaning) and he takes samples from the second truck one day after wiping with a germicide wipe followed by a 1:100 bleach/water spray.

Preliminary conclusions right now are:

1) The "dirtiest" surface, as judged qualitatively with the most general growth and the most types of colonies was the counter.

2) The "cleanest" surface was actually the trash!

3) The surface that was most affected by an additional cleaning was the grab rail. Pretty bad in the control, almost no growth when cleaned

I'll post a few pictures if anyone is interested. I've had a lot of fun helping him with this :)
 
Rigs are supposed to get wiped down completely once per shift. I personally will wipe down anything that I believe may have been contaminated during the course of a call. This meaning, if we are transporting a little old lady with a little chest pain, I am probably not cleaning much after we drop her off at the hospital, however if its a sweaty man or someone with an active bleed, some interior surfaces, as well as all contacted stretcher surfaces get cleaned.
 
Simusid,

Thanks for following up with us. I'd love to see the pictures!
 
This is the control culture from the overhead grab bar on the truck that had no additional cleaning
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This is the culture of the same location on the other truck after an additional cleaning and bleach spray.
A1.JPG


He didn't clean and then culture right away. He cleaned and waited about 24 hours and then took the swab. I think the first picture is 5 days old and the second one is 4 days old. Neither one changed much over the next few days.

I think it tells me that a quick disinfection is really worth it. The bleach spray takes less than 30 seconds to do the whole back of the truck.
 
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