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
Proper cleaning and disinfection of an ambulance and patient care equipment is necessary to protect EMS providers and patients. Many new products can provide safer, more effective and more efficient cleaning and disinfection for ambulances and equipment.
Consider these five factors when purchasing a disinfecting system for the ambulances in your EMS agency fleet:
1. Ease of use
Look for a system that your staff will be able to use easily with the proper initial training and without having to consult the owner’s manual each time. The easier the system is to use, the greater the likelihood that personnel will consistently use the system.
Conduct an evaluation during the purchasing process. Bring in several disinfecting systems and have staff give those systems a hands-on trial. This will go a long way toward buying a system that your people will use regularly and correctly.
2. Cost per use
The initial purchase cost of a disinfecting system is just one financial factor to consider. Operating costs for consumable supplies (such as disinfectant solutions, batteries and bulbs) and the replacement of system components due to normal wear and tear also need to be factored into the purchasing decision.
Combine the projected costs of the initial system purchase, consumable supplies and replacement parts. Divide the total cost of the system by the projected number of times the system will be used to calculate the cost per use.
Determine the denominator (number of uses) by asking EMS crews to conduct an ambulance and equipment decontamination census for a week. If this shows that those crews would have used a disinfecting system 100 times during the week, then you have the number of times the system would be used annually – 52 x 100 or 5,200 times per year per ambulance.
3. Turnaround time for decontamination
The turnaround time for the decontamination of an ambulance and its equipment must also be considered when evaluating disinfecting systems for purchase. Conduct a time and task analysis of your agency’s current decontamination process.
Time-and-task analysis scenarios should start at the time an ambulance is taken out of service for decontamination and include all preparation tasks necessary to prepare the ambulance and its equipment for decontamination, plus the actual decontamination tasks and the tasks necessary to make the ambulance available for service following decontamination.
4. Effectiveness at eliminating pathogens
Disinfectant agent potency, particularly liquid agents, against Mycobacterium tuberculosis has been recognized as a substantial benchmark. Keep in mind, however, that tuberculosis is airborne, not transmitted via environmental surfaces, so the use of such products on environmental surfaces plays no role in preventing the spread of tuberculosis.
However, because mycobacteria, like the TB bacteria, are the top dog in the hierarchy of germs, any germicide or decontamination device with a tuberculocidal claim on the label is considered capable of inactivating a broad spectrum of pathogens.
It is this broad-spectrum capability against less-resistant organisms such as bloodborne pathogens like the hepatitis virus (B and C) and HIV/AIDS – rather than the product’s ability to knock out the TB bacteria – that is the basis for protocols and regulations dictating use of tuberculocidal chemicals for most surface disinfection.
5. Shortcomings or limitations
Seek out references from other customers of the decontamination system to determine any implementation or performance shortcomings. Any decontamination system and protocol is only as effective as its ability to reach all surfaces. Don’t forget the ambulance’s front compartment or equipment that is stowed or hidden from the vapors or UV light, such as blood pressure cuffs, mobile data terminal surfaces or consumable EMS supplies.
In addition, keep in mind that a decontamination system doesn’t correct deficiencies in handwashing hygiene by EMS personnel or address pathogens potentially transferred to a patient from an EMS provider’s uniform, stethoscope, pen or smartphone.
Regular and effective decontamination of the ambulance’s patient care compartment’s surfaces, patient care assessment and treatment equipment and provider’s hands and uniforms is a critical component in preventing infectious disease transmission. Purchasing, implementing and maintaining a decontamination system is a responsibility of EMS leaders to improve workplace and call safety for field personnel, patients and bystanders.
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.
