How to decontaminate and clean the ambulance properly?
The ambulance is an essential vehicle to provide emergency medical assistance in pre-hospital care scenarios. That’s the vehicle on which paramedics and EMTs yearly save millions of people all over the world. But as they prodigate to save people’s life, they are well aware of how important is to decontaminate and to clean the ambulance, especially in case of a virus outbreaks.
Medical practitioners know very well how to provide care to patients, at the same time they must take care of their ambulance, too. Not only does an ambulance transport people to medical facilities, but it also must allow medical care on board. That’s why it is very important to decontaminate and to clean the ambulance, in order to guarantee safety to both patients and practitioners.
In many countries, there are protocols and guidelines which follow precise steps to follow to clean and decontaminate the ambulance. In this article, we will mention some countries rules, but we will give universal advice which can be followed by any practitioner around the world.
1. Before cleaning the interior…beware of the exterior!
The first advice is to first clean the exterior. Use sponges drenched with soap and water, then brush, to cover the entire body of the ambulance. Make sure that the tires are free of mud and dirt. In case they need to be cleaned, you can use extra cleaner, like a degreaser. Do not be afraid of energetically brushing the tires, scrubbing with a brush. Good behaviour is to wash the tires each time the body of the ambulance is washed.
2. Decontaminate and clean the ambulance: inside the cab
Inside the cab of the ambulance, you have to make sure that both seats and the floor are decontaminated and cleaned. You can see that they are externally clean, but you know that it does not mean that they are decontaminated and cleaned. Wipeout both the floor and seats with a cleaner and wear the gloves to do this operation.
Keep always with you a trash bag, so you can get rid of used disposable tools and other rubbish. Regarding the decontamination of the console, use a disinfectant but be careful: do not spray the disinfectant directly on the dashboard, console, radio, or any other electronic equipment. Instead, spray directly on the rag and then wipe down. Your attention must go particularly to door handles, and radio microphone.
They are the most touched by paramedics and EMTs. They speak on to the radio microphones, that’s why is so important to clean them. Take into consideration the correct cleaning of the stretchers which everyday transport patients. They deserve the highest cleaning. Stretcher linens must be new and clean after each dispatch, in case of patient transportation. No patient should ever be placed on used linens. Make sure also that stretcher straps are cleaned correctly after each use.
Then, wipe the mattress down removing it from the frame, to be sure that you are cleaning it properly. Wipe down the handrails and the frame of the cot even the undercarriage. Ambulance door glasses, if in plexiglass, must be cleaned with a glass cleaner, not a disinfectant.
Then, check the harps container. If it is close to being full, change it immediately or make sure to change it after your next visit to the hospital.
3. Last, but not least: decontaminate and clean the ambulance floor and items
Decontaminate and clean the ambulance on the floor by sweeping out dirt or debris. Spray the floor with disinfectant and let it sit for a few minutes. Then mop with clean water.
Be careful when you clean Monitor or Defibrillator. Make sure that you wipe down the lead cables, the pulse ox probe and the face of the monitor. Clean out the Oxygen caddy and wipe down the regulator, the backboards, head blocks, stethoscope bell and earpieces, the BB cuff and let them dry before placing back on the ambulance.
These are routine steps to clean an ambulance and its equipment, but if you are facing a particular illness or virus which is affecting a specific area of your country, then you must take further behaviour. These days we are all leaving with SARSCOV2. It’s an enemy difficult to defeat, that’s why it is very important to pay attention to decontamination.
4. Suspected virus patient: Ebola and SARSCOV2
The CDC (Centers for Disease Control and Prevention) explains how to decontaminate and clean the ambulance in case of virus affected patient transportation, especially ebola patients. This process is designed for a 3-person team. Two people will be donned in PPE and perform the decontamination. A third person, not donned in PPE, will be available to document the decontamination and for other assistance.
- Select an appropriate site for ambulance decontamination: it must protect the vehicle and the team from weather elements.
- Establish a secure perimeter for the safety of the public and decontamination personnel.
- Climate control is beneficial.
- Define and mark hot, warm, and cold zones of contamination around the ambulance that require PPE to enter.
Decontaminate and clean the ambulance
- Limit the number of people exposed to potentially contaminated materials
- All waste, including PPE, drapes, and wipes, should be considered Category A infectious substance and should be packaged appropriately for disposal.
- PPE should be donned and doffed according to organizational protocols.
- PPE selection should consider worker protection for biological exposures and potential chemical exposures based on the disinfectant used.
- Disinfect the outside of any prepositioned but unused medical equipment (still inside the protective bags they were placed in) and pass it to the warm zone. If the equipment was removed from a protective bag in transit, assess the equipment to determine if it can be properly decontaminated and disinfected, or disposed of.
- Any areas that are visibly contaminated with the patient’s body fluids should be decontaminated first with an approved EPA-registered disinfectant for the appropriate contact time before soaking up the fluid with absorbent materials.
- If the interior of the ambulance was draped prior to transport, remove the draping by rolling the drapes down outside in, from the ceiling to the floor of the unit starting at the front of the compartment and moving to the rear.
- Roll flooring drapes from the front to rear of the compartment, rolling drapes outside in.
- To facilitate packaging and transport, drapes can be gently cut into segments. It is important that all drape materials are in sections that are small enough to facilitate the insertion of the biohazard bags into an autoclave or pre-determined Category A infectious substance packaging for disposal.
- Two people in PPE should manually disinfect the interior of the patient care compartment with particular detail for high-touch surfaces such as door handles and steps using care to limit mechanically generated aerosols and using the surface wipe method to disinfect.
- Disinfect the interior as a team so that the team members can talk to each other through the process and expedite the decontamination process.
- Once the manual interior wipes down has been completed, collect and package all waste as Category A waste.
- Manually wipe down the ambulance’s exterior patient loading doors and handles, and any areas that may have been contaminated, with disinfectant. The exterior of the ambulance does not require a full disinfectant wipe down.
- Once the outside of all surfaces (including waste bags) have been wiped with disinfectant, then doffing can occur.
- A third person who has been in the cold zone should supervise doffing, which should be performed according to organization doffing protocols.
- Dispose of all waste according to organization protocols as well as local and federal regulations for Category A infectious substances.
- Additional cleaning methods can also be used. While not required, this may provide additional assurance to personnel and public prior to returning the vehicle to service. Ultraviolet germicidal irradiation, chlorine dioxide gas, or hydrogen peroxide vapour can be used for an additional disinfection step. However, these should not replace the manual disinfection, as their efficacy against organisms in body fluids has not been fully established and these methods may require specialized equipment and PPE.
- The ambulance can then be returned to service.