Skip to content

Archives for ambulanc-cleaning

See all posts in the network tagged with ambulanc-cleaning

EMS: Is what you do the Best You Can Do?

11 comments

Not too long ago I was reading an article in Entrepreneur Magazine when I came across an article speaking on negotiating tactics. I wish I could find it, but unfortunately it was long enough ago that I’ve disposed of the printed issue (I subscribe) and cannot find it on the web. It was a good article and it taught me some words that I’ve since used quite a bit in my own life:

“Is that the best you can do?”

From the time our parent’s first put us out there in the world most of us have probably been told to “Do our Best” when we try to do something. No matter if we win or lose, we’ve been told that it’s ok as long as we “do the best we can” while trying. We seem to feel better at the outcome of almost anything if we feel that we’ve “Given our best shot” when we try to accomplish what we’ve set out to do. We all like to do our “best” and we hope that our “best” will be good enough.

This begs the question… is what you’re doing today in EMS “the best you can do?” Career wise, operationally, with your service’s treatments, with your own personal training and education, and with your own attitude… is this really “the best you can do?”

I would like to think that I “try my best” in my own EMS career and paramedic practice. I would also like to think that I work for an EMS organization that is trying to do the best it can for its people and its collective patients. However, there are quite a few situations where I have felt that I have not done or have been prevented from doing my best for a number of reasons. Some are reasonable and others are not. I’d think that all of us would give the answer that we always want to provide every patient with our “best” possible care. However, I’d also guess that everyone reading this can think back to any number of situations where they feel that they didn’t give it. Sometimes this reason comes down to the skill set of the individual provider. This could be a situation where the provider didn’t have the best possible information or knowledge available to them. They may have provided an ineffective or even harmful treatment modality or might have failed to act upon a missed assessment finding, such as by giving a medication for which a patient has a documented allergy because the provider didn’t know or simply forgot that the patient had the allergy. Sometimes the actions of others in the organization can prevent a provider from rendering the best possible care. This could be by failing to check, clean, or restock a needed piece of equipment or by providing inadequate care prior to a provider assuming patient care such as in the case of a first-responder crew failing to place a patient in full c-spine precautions when indicated prior to moving a patient to the transporting ambulance and the transporting EMT not having enough manpower to safely immobilize the patient. Sometimes the organization can hinder an EMS provider from doing his or her best by doing things such as providing inadequate equipment or medical protocols, or by mandating that a provider regularly work past exhaustion-level hours.

People inherently want to do well at whatever they choose to do for their careers as well as at other tasks where they feel strongly about the outcome. I may have accepted that I’ll never be as good of a basketball player as Michael Jordan, nor the same-level of cartoonist as Scott Adams, nor the best noodler in the world… but I’m certainly going to try to be the best paramedic I can be.

THIS guy, however, may be The Best Noodler In the World

Sometimes our own personal biases prevent us from doing the best we can do and for this I’m not talking about bias regarding any protected classes or topic, rather I’m talking about our own version of the status quo. A personal example of this would be my ALS Quick Response Vehicle at work. We went a solid week without having the proper forms available for the daily equipment checks and I didn’t have the computer access to print more off. During that week, I got in the habit of not using the forms and simply checked the truck based upon my knowledge of what was supposed to be in there and what was supposed to be checked. The way it played out, I ended up continuing to not use the check sheets when checking the vehicle, even though the forms had been replenished. A few weeks later, someone found that there was equipment missing in the vehicle that had gone unnoticed for some time. At that point, I realized that I had developed my own bias against using the forms for a reason that is even unbeknownst to me. I had gotten in the rhythm of not using the forms, and that caused me to miss that the infrequently-used piece of equipment was missing. I had developed a personal mental bias that prevented me from “doing my best” and thoroughly checking the truck.

Another preventer of best practices can be organizational politics, both internal and external. As a paramedic who regularly responds to other ambulance services to provide “ALS Intercepts”, I have observed that the politics between the services we work with can affect patient care for both the negative and the positive. While I am not saying that any of these arrangements result in inadequate patient care, I can say that the services with whom I interface most frequently and most pleasantly get a better provider out of me than do the services with whom my relations are less frequent or are strained due to political turmoil. When I respond to a request for an ALS intercept, I am being called to the “house” of another group of providers. While I am the highest level of care on the scene, I’m also a guest in their house. They have their own internal biases and I have mine. Sometimes the synergy in our working relationship can be strained, which results in a palpable difference in the flow of the scene and the teamwork exhibited at it. While I will ensure that I “do my best”, it’s easier to do it when I work well with the team I’m working with.

So how do we change things? We’re all human and we all have things that prevent our “best shot” from being the only thing that we “give it” in our EMS careers. This may be consciously, as in the case of internal politics; Subconsciously, as in the case of my not using the check sheet; or Involuntary, as in our service not providing us with needed equipment or our coworkers failing to replace an item in the ambulance that we did not have an opportunity to check. As in most things, the easiest thing for us to change is ourselves. Changing ourselves is a great place to start and will make serving as an example to others your main tool to use to try and get the best out of them.

Most situations can be made better and almost all of us can try harder. The secret is to attempt to do our “best” at all times and to try and ingrain our own best practices into our daily routines. This can be as simple as always trying to check the truck in the most thorough way possible or by making sure that you always check and recheck things to ensure that they’re done right. It helps to continuously seek out and recognize one’s own personal biases, (remember my check sheet?) to make sure that our own preferences and routines aren’t leading to suboptimal performance. Consistently ask yourself if what you’re doing is the “best you can do” and then ask yourself what you can do to make it your best. Mentally prepare yourself for your shifts with adequate rest when possible, manage your stress level so you can keep your thoughts focused on your care, and train hard. Ingrain your best efforts into the systematic way you do things and make your best way your normal way of doing things. We can’t change everyone around us in an instant, but our quiet positive efforts can pay large dividends in how people around us think, feel, and act. Our best may in turn get the best out of our partner, which may in turn get the best out of the next crew, and so forth. Soon enough… deciding to give our best may change your organization, our industry, or our profession.

And I assure you, doing your best will indeed make the difference in someone’s life. It’s just what we do, Folks.

“Is that the best you can do??

————————————————

For more on doing your best in EMS and in getting the best out of your EMS people read:  “The Shine Factor”

Posted by on August 19, 2010 • Filed under: Administration & Leadership, ALS Intercept, Ambulance cleaning, Command & Leadership, edemse, Emergency Medical Services, EMS, EMS ethics, EMS Topics, EMS training, Fire Rescue Topics, Firefighter, Management, Paramedic, Patient Management, politics, pride, profession, professionalism, Training & Development, training-fire-rescue-topics, Uncategorized

Education vs Training: The “Professional Ambulance Cleaner”

22 comments

Imagine if you will this hypothetical scenario:

You and your roommate have just graduated EMT school together and go to work at competing ambulance companies in the same city. He works for HIS ambulance service, and you work for YOUR ambulance service. Both services have similar fleets, similar deployment patterns, and similar call-volumes. In fact, there’s really no way to tell them apart other than the fact that the HIS ambulance service uniforms are sickly green jumpsuits, and YOUR ambulance uniforms are Macho Blue Shirts with navy blue pants.

You both go off for your first day on the job which understandably includes several hours of training on company policies. For both of you, the whole day turns out to be a long class on how to clean the inside of ambulances.

Here’s the differences, though. At YOUR ambulance, you learn about the biological functions of bacteria and viruses. You learn their strengths, their weaknesses, how they reproduce on inanimate environmental surfaces, how they create biofilms to increase their reproductive capabilities and life span, and how pervasive they are in randomized samples from real-life ambulances. You learn how grime collects in the ambulances, how it adheres to the surfaces that you will be cleaning, and what the various types of substances are that you will most commonly find in real-world applications. The whole first day is spent on nothing but learning about dirt, grime, and germs and how they contaminate ambulance interiors. They even threw in the types of materials that the ambulance interior is made from and what the specific dirt-holding and germ-breeding properties of each material are. You see samples and scenarios pertaining to germ and dirt proliferation on ambulance interiors.

Not only that, there’s homework, reading material, and a report due the next day.

The second day that you report to YOUR ambulance service, you learn all about different types of cleaning products, tools, and disinfectants. You learn how to properly choose the detergent needed for optimum dirt-dissolving power on what type of surfaces you may have to clean; You learn the proper disinfectant to choose for each type of commonly encountered bacteria, virus, and fungi spore; and you learn the proper contact times to leave each product on for optimal disinfection and/or dirt dissolving power. Then you learn about every different type of sponge, mop, rag, fabric, and tool used to clean the ambulances. You spend a few hours in the laboratory they have testing out the material and performing experiments in the name of learning.

Oh, and after that day too, there’s a lot of homework and reading material.

Your roommate, on the other hand, went to work and found out that he too had to learn about ambulance cleaning. He learned that they also expect clean ambulances, however his choices and training are much simpler. He is told to clean the ambulance using two bottles: One marked “Cleaner” and the other marked “Germ Killer”. He is given ten rags and is told to clean the ambulance for inspection by the owner of the company using the tools given in the time allowed. He does so and is told “Good, now do it again tomorrow”. The next day, he again cleans the ambulances using the tools and training provided, and is again told “You did a good job”

In the above scenario, the first ambulance service, “YOUR Ambulance, uses a form of advanced education to teach their people how properly to clean the ambulances to their specifications. The education is rigorous and in-depth.

At “HIS Ambulance” they use training, and vocational experience to teach their employees how to properly clean the ambulances.

Here’s some questions I have:

  1. Which ambulance service do you think will have cleaner ambulances in the long run?
  2. Which employee do you think will do an overall better job in cleaning the ambulances?
  3. Which employer, “YOUR Ambulance” or “HIS Ambulance” do you think has the better philosophy?
  4. Which ambulance cleaning class will result in the better, more motivated, happier employee?

Anyone else see the relationship to EMS training/education here? Which one results in a more “Professional Ambulance Cleaner” that is better equipped to handle the job?

Posted by on November 12, 2009 • Filed under: Ambulance cleaning, Ambulance maintenance, disinfection, Emergency Medical Services, ems 2.0, ems education, EMS Management, ems scenario, ems scenario based education, EMS Topics, EMS training, Management, Paramedic, paramedic education, profession, professionalism, sanitize, scenario based training, Training & Development, training-fire-rescue-topics

A Motivational EMS Article Geared towards Newer EMTs

5 comments

The following article is what I submitted to my Fire/Rescue/EMS department’s monthly newsletter for this month’s EMS column. It has a readership of every one of the the 110 or so members of the department, their families, and a good percentage of the 30k or so people in our district. They know me personally as someone who (Imagine this) likes EMS.

If you like this article, feel free to steal it and use it for your purposes. All I ask is that you keep the links intact and give byline credit. Shoot a comment to me too so I can see if it indeed does go anywhere.

Oh, and here’s a thought. If you would like a short EMS related piece to put into your department’s newsletter, shoot me an e-mail at proems1@yahoo.com I’ll be happy to come up with something.

————————————–

It’s well known around the department that I like the ambulances and EMS in general. I do, and I’ve always been proud to be a part of (My Department’s) EMS program. I think that the level of dedication and professionalism in our department is second to none and that our program is certainly one of the best in the region and in the state.

With that said, in EMS there is never a time to slow down and rest on our laurels. The science that drives our brand of medicine is constantly evolving and the only constant is change. In my EMS career, I’ve seen “The Right Thing to Do” for my patients change more times than I thought possible. Continuing education, reinforcing the basics, and studying the latest research is key in keeping oneself in step with how best to care for our patients. As with any community based Emergency Medical Services provider, our citizens are our families, neighbors, and friends. We have the responsibility of being the first line of defense against the very worst times in peoples’ lives and it is our duty to be at our best when we are called to make a difference. The people we care about most are depending on us.

Just as in firefighting, in EMS, the little things make the biggest difference. It really is the Basic Life Support care that makes everything else work and our calls run the smoothest. Patients do not necessarily perceive the skillful application of Advanced Techniques or medications given to them, but they certainly appreciate the attention given to treatment of their ABCs, their comfort on the cot, pain relief and stabilization through proper splinting techniques, the compassion of the care providers, and the cleanliness of our ambulances and equipment. It has been said that “Perception is Reality”, meaning that the way someone perceives you or your organization affects their own reality. In EMS, good perception actually has been shown to provide for better patient outcomes. Really, if you have more confidence in the skill or effectiveness of your medical provider or a technique, you’re statistically more likely to have a better outcome.

It is so important for us as healthcare providers to focus on providing the best care possible for our current patients, but also to keep an eye out for future patients. Start now by making sure that the ambulance is thoroughly cleaned at the start of every day and after every call. Make sure that your equipment is ready to go and that you’re an expert in its use. Read something educational every day to keep yourself in the right mindset and to keep your skills sharp. Pull things out and practice with them. Come up with questions to ask the more experienced providers and don’t be afraid to ask them. It is every EMTs duty to become an expert in prehospital care and you are the only one who can expand your knowledge enough to become one. Study every day.

Here are some resources I use every day, they teach me something every time I use them:

-          Http://www.happymedic.com – A San Francisco Firefighter/Paramedic and his adventures in EMS.

-          Http://www.999medic.com – A British paramedic working EMS with our neighbors across the pond.

-          Http://www.theEMTspot.com – Educational tidbits, tips, and tricks from a Colorado Paramedic.

-          Http://www.EveryDayEmsTips.com – A Social Media, training, and EMS guru with daily tips to improve your care.

-          Http://paramedicine101.blogspot.com – In-Depth Educational Articles for EMS providers.

-          Http://www.LifeUnderTheLights.com – Your’s Truly’s random musings on the EMS.

Of course, getting your hands on a copy of JEMS or EMS Magazine is great too. Learn something every day, take pride in yourself, your service, and the care you provide. Your next patient could be your loved one, make sure they’d get care that you’d be proud to give them.

Posted by on November 3, 2009 • Filed under: Ambulance cleaning, courtesy, Emergency Medical Services, EMS, ems education, EMS Motivation, EMS pep talk, EMS Topics, EMS training, EMT, medicblog999, Patient Management, profession, professionalism, Public relations, technology-communications-ems-topics, Training & Development, volunteer fire department, volunteer firefighter, Your Happy Medic

Clean EMS – Lifesaving practices in Ambulance Cleaning

No comments

Here is a shocking statistic: According to the United States Centers for Disease Control and Prevention (CDC) Nosocomial Infections (or Healthcare Associated Infections – “HAIs”) defined as “… infections which are a result of treatment in a hospital or a healthcare service unit, but secondary to the patient’s original condition” are the 4th leading cause of death in the United States. The CDC estimates that nosocomial infections sicken 1.7million patients and are responsible for 99,000 associated deaths each year in US hospitals alone.

Let me repeat those above statements. HAIs KILL almost 100,000 people and make around 1.7 MILLION patients sick and/or sicker PER YEAR in the US. If you don’t believe me, here is the page from the CDC website where I got those facts. I’m inclined to believe the CDC, however I question how many people are weakened from their newly acquired HAI which allows their original condition to worsen and kill them? This means that in the United States of America, healthcare people kill all of those patients every year because we’re not doing things like washing our hands well enough?

My grandmother always told me that a hospital is no place for sick people, looks like she might be right.

Every person spews bacteria, viruses, fungi, and a host of other things everywhere they go. Our skin crawls with Staphylococcus Aureus, microscopic mites, cold and flu viruses, and hosts of other microbes that flake off with our skin and hair. Our fecal matter is full of E. Coli which gets on our hands when we *ahem* clean ourselves. Our coughs and sneezes spew droplets full of germs in a wide radius. Pretty much every time we touch anything our hands pick up thousands (if not millions) of germs that spread to everything else we touch. We are walking, talking Petri dishes being used by all kinds of nasty germs as unwitting patsies to help them breed, move, spread, and infect. Put a bunch of people together and you have an infection control problem. Put a bunch of sick people together and throw in people with all kinds of weakened immune systems and virulent infections and you have a healthcare organization.

Now imagine that every movement inside that organization collects, incubates, breeds, and spreads bacteria. You’re in the hospital and the dietary tray comes by? It left germs. The nurse comes in and holds your hand? She left germs. You take a pen from the registration person? You spread germs. You sneeze? You spread airborne germs. Hospitals are one of the most effective tools that germs have in their arsenal of spreading themselves and causing the diseases that they do and while no exact statistics exist that I’ve been able to find to back up my next statement, Ambulances are probably worse. It makes sense to me because we’re in a smallish enclosed environment that goes all around town to lots of private homes, nursing homes, hospitals, and who knows where collecting various bodily fluids and other types of DNA samples from every person we put in the back (and/or the front). Factor in high call volumes that leave little time for proper decontamination, EMS personnel that have little understanding of proper disinfection practices and that are already overworked, overtired, and under-motivated to properly clean and you have a Mobile Infection Causing Unit (MICU? Cute)

Bottom line: Hour for hour, time spent cleaning your ambulances and your equipment may ultimately save more lives than time spent training.

Before I launch myself into a full-fledged rant on my obsessive-compulsive ambulance cleaning techniques, I think that I should tell you the point of this article. I want to lay out a few simple steps that you can put in to place on your next shift that will keep you, your coworkers, and your patients much healthier and happier. With a little bit of information on proper cleaning practices, you have the potential to make a very large difference in the long-term outcomes of your patients.

Here are some terms you should know:

  • Sterilization: (Also known as Terminal Sterilization): This is a term used to describe the total and complete removal of all forms of microbial life including bacteria, viruses, fungi, and other organisms in all phases of their lifecycle. Sterilization is accomplished by a few methods, two of the most popular being the heat and steam pressure used in an autoclave device and ethylene oxide gas however a long soak in a glutaraldehyde solution may be used. Sterilization is used for “Critical Devices” defined as tools or equipment that come into direct contact with the bloodstream or other normally sterile areas of the body such as IV needles, scalpels, and surgical tools.

  • High-Level Disinfection: This is a term used to describe a very broad-spectrum disinfection process that destroys almost all microbial life but may not completely remove all possible bacteria, viruses, or spores. It is usually accomplished by a prolonged soak in a liquid chemical sterilant but not for the contact time needed for terminal sterilization. This process is used for “semi-critical devices” that come into contact with mucous membranes but for which sterilization is not completely attainable or would damage the equipment. Examples of semi-critical devices in the EMS field include laryngoscope blades, Magill Forceps, and oropharyngeal airways (that thank goodness are now almost always disposable!)

  • Disinfection: This term is used to describe a process in which an environmental surface is first cleaned and then processed in a manner that kills a defined amount of known microbial organisms. There are two further loose classifications of disinfection practices below the above: “Intermediate” which is used for patient care equipment and surfaces such as EKG monitors, Ambulance cots, sphygmomanometers (OMG! I spelled that right the first time!! – It’s a bp cuff), stethoscopes, and other like equipment. “Low” level disinfection would be appropriate for environmental surfaces such as walls, floors, and countertops.

  • Sanitization: This process is defined as a chemical substance or process that kills 99.999% of a specific bacterial sample within 30 seconds but when compared to a normal use concentration a disinfecting agent will kill a broader spectrum of microbial life.

  • Antiseptic agent: This is a term used to describe a process that kills microbial life on living tissue, such as antiseptic soap or alcohol hand sanitizer.

  • Cleaning (or Pre-Cleaning): This is a process used with a detergent and a cloth or other friction-causing device that removes dirt and other gross contaminants from a surface. By removing the gross contaminants, you remove the food that microbes eat, the dirt particles that they hide in, and the biofilms that they create and thrive in. Most disinfectants and sanitizers require a pre-cleaning process in order to be effective.

  • Contact Time: The length of time that a surface must remain saturated with a sanitizer or disinfectant in order to kill the specified number and type of microbes desired.

Why did I go to the lengths that I just did to define such boring terms? Because it gives you an idea of how hard you should work to kill germs in the back of your ambulance. Bacteria and other like microbes grow, adapt, and change in response to various stimuli. There is scientific debate on the next statement but some of these changes may include developing resistance to the chemicals that we use to kill them. Remember, microbes are the ultimate adaptation machines capable of surviving almost anything anywhere. It takes a process to kill them all and to n
ot just kill the slower, weaker members of the microbial “herd”. Think about it, natural selection favors the strong organisms capable of resisting environmental change. Introduce a disinfectant improperly and all you’re really doing is killing the weak microbes and leaving the strong to survive and thrive on the added food source made of the microscopic corpses of their dead comrades.

Eww.

I may be nuts, but I clean hard. When I do my dishes at home by hand because on a medic’s pay I can’t afford a dishwasher (actually I’m just too lazy to install one) I thoroughly rinse my dish sponge, saturate it with water, and then microwave it for two minutes. I do this because a sponge is the perfect environment for bacteria to survive. It’s wet, dark, and warm. The heat and radiation generated by the microwave kill most of the bacteria that grow inside the sponge. Otherwise, all I’m doing is spreading new germs on my dishes. The same goes for cleaning my kitchen counters. Actual scientific studies (That I’ve learned about by reading this awesome column by Dave Barry) state that people who regularly clean their kitchens actually have more bacteria in them than people who don’t clean them much at all. It makes sense. With all of the wiping of surfaces and ineffective disinfection practices done in the home, microbes simply hitch a ride on the sponge or the cloth being used to “clean” and redeposit and breed on another surface. I’m sure they appreciate it.

Unfortunately, what happens in your kitchen also happens in your ambulance. Even more unfortunate for us and our patients, is that your kitchen usually isn’t exposed to MRSA, C. Diff, or Tuberculosis… or HIV, or Hepatitis B, or VRE… or hundreds more other microbes that I can’t spell properly. Start spreading those around and you’ve got yourself a rather deadly situation.

Needless to say, pretty much no matter how good you think you are cleaning your ambulance now you could be doing better. First of all, you should spend some time selecting the proper product for the job and pay attention to how it’s properly used. Fortunately, the good bureaucrats at the EPA, CDC, and a whole alphabet soup bowl of organizations have left you a trail. Always read the product label and instructions and look for the sentence that says “Using this product in a manner not consistent with its label instructions is a violation of federal law”. This is because it is the job of the Environmental Protection Agency (EPA) to regulate and test “Hospital-level Disinfectants” which are appropriate for use in EMS. The EPA tests these disinfectants which contain a wide variety of chemicals or combination of chemicals of varied efficacy against known bacterial cultures. It then measures the length of time that it takes the chemical(s) to kill specific organisms and the amount of the sample that is killed. It is important to remember that the disinfecting agent is only proven to be effective in specific concentrations in specific lengths of time. Any less than that and who knows what will or will not be killed. Also important to remember is that in the lab, they’re testing bacterial cultures without the presence of any dirt, proteins, or any other soil. Microbes hide in the pores of dirt particles, hide under proteins, and create “biofilms” that protect them against noxious stimuli. They’re the ultimate survivors, remember? Heck, even cockroaches get the sniffles.

So how do we translate this little bit of microbiology class into EMS? More importantly, how do we protect our patients’ and our own health by integrating proper cleaning and disinfection procedures into our shifts while still getting time for lunch? By arming yourself with a little more knowledge, and taking the steps that I’m putting forth below, that’s how. Proper ambulance disinfection doesn’t have to be a daunting task. It just has to be done properly. We also need to look over the volumes of cleaning and disinfecting products available as well and learn how to deploy them properly against our pathogenic enemies.

I can’t recommend any one cleaning product. (Although I would review them if they sent me a free case and paid me a lot of money to do so! Proems1@yahoo.com) However I have used a lot of them. My EMT textbook recommended bleach back when I went through my initial training. While common household bleach, which is a solution of the oxidizing agent sodium hypochlorite and some inert ingredients, is very effective in 1:10 bleach/water concentrations as a hospital disinfectant and in 1:30 concentrations as a sanitizer, it is fairly uncomfortable to use in the back of an ambulance. It can damage equipment and clothing and also can cause severe mucous membrane irritation and damage in humans. Bleach solutions are particularly affected by the presence of organic soil and require very thorough pre-cleaning for proper effect. I prefer to use commercially available hospital-level disinfectants that have a short-to-medium contact time against most pathogenic bacteria, viruses, pseudomonas, and fungi and also contain a detergent that can be used in the pre-cleaning steps. It is important to look at the contact time that it takes for the disinfecting agent to work against the microbes it is able to kill. Some products will advertise claims such as “Kills 99.999% of germs in 30seconds!” which is the definition of a sanitizer. However, if you look at the label directions, it kills 2 or 3 germs in 30 seconds but takes a full 10 minutes to be effective against HIV, Hep C, and pneumonia. Look for a chemical that is easy to apply, thoroughly wets the surfaces you’re disinfecting, and doesn’t dry too quickly in your environment. Lysol IC spray®, a popular commercial product, contains isopropyl alcohol and a benzyamoniumchloride compound. The isopropyl alcohol makes up the majority of the formulation and can sometimes dry too quickly to maintain effective saturation of the surface and therefore effective disinfection. If the disinfection product your agency uses dries too quickly, you should reapply it to keep up the proper contact time, or switch products.

My research in to the effectiveness of the popular pre-moistened disinfecting towelettes makes me cringe to think that they’re commonly used as the only cleaning and disinfecting procedure in a lot of places I’ve been to. I have yet to find one of these products that are soil tolerant enough to not require a pre-cleaning step prior to disinfection and I’ve never seen one that leaves behind enough moist product to maintain saturation to the contact time without drying too early. This may be an effective way to pre-clean and maybe sanitize, but I’ve not found one that can be an effective disinfectant with the ineffective contact time. They simply don’t do a good enough job as a disinfectant. However, their big advantage is that by using multiple towlettes on multiple surfaces you’re preventing cross contamination by simply throwing away a dry towlette and using a new wet one on the new surface. It’s the same principle as the people who don’t clean their kitchens often having less infected surfaces than those who continuously spread the germs around. Be careful though, how many times have you seen someone in the ER give the bed a quick wipe, not even wet 100% of the surface area, and then hastily throw on another sheet so they can get another body on the cart?

In the ambulance, I recommend bringing good cloth towels. Use at least 6 or 8 of them. You have to do a pre-cleaning step to remove gross contamination and eliminate the soils that will cause whatever disinfectant you use to lose effectiveness. If you use a combination cleaner/disinfectant you can use it for both a pre-cleaning and then a thorough wetting soak. However for the cost conscious I recommend using a good regular detergent for pre-cleaning because they tend to be cheaper and more effective at dissolving grease and removing soils. Be sure
to change towels often and use proper Body-Substance-Isolation (BSI) to protect yourself from the germs back there. After pre-cleaning, thoroughly saturate each surface in the ambulance with a proper hospital-level disinfectant and watch to make sure that each surface stays thoroughly saturated for the full contact time. Reapply it if necessary. Remember, if you’re not leaving the product on there to do its job, you’re not really doing anything but making the microbes angry. Pay special attention to commonly touched surfaces in the ambulance, such as door handles, radio microphones, the handles on the ceiling, o2 connections, drawer and cabinet handles, and the steering wheel. I even disinfect the handle that’s on our hand sanitizer dispenser. It gets touched a lot with filthy hands. My biggest tip? Take a vacuum into the back of the rig with you to suck the big garbage and dust out of the cracks and crevasses before you pre-clean. It works great and makes it simple to do a great job.

Patient care equipment should be disinfected after every use. Remember to clean and sanitize monitor cables, stethoscopes, BP cuffs, splints, backboards, head blocks, spider straps, cot straps, and anything and everything else we use. Your patients’ lives depend on it. So could yours.

Remember: Be sure to take the time to wait for the disinfectant to do its job. Pay attention to contact time. Always remember a pre-cleaning step. While some minimal soil can be ok, anything that is visibly dirty or that hasn’t been cleaned all shift should probably be pre-cleaned.

Whew! This was a long one. If you got this far, be proud. Remember. Plumbers have saved countless more lives than doctors. Doctors treat disease, plumbers carry it away to prevent it altogether. Next time you see an “Environmental Services” person in the hospital, thank them for being the life savers that they are. Every bit helps.

———————————————-

Related Posts:

“The Shine Factor” – One of my first, and best, articles.

Reference Material:

http://en.wikipedia.org/wiki/Disinfection, http://www.wcponline.com/column.cfm?T=T&ID=1482&AT=T, http://firechief.com/ems/ambulance_transports_0301/, http://en.wikipedia.org/wiki/Nosocomial_infection, http://www.opticide.com/tb111503.htm, http://www.cdc.gov/ncidod/dhqp/hai.html, http://www.futurehealthcareus.com/?mc=appropriate-selection%20&page=ps-viewresearch, http://www.miamiherald.com/living/columnists/dave-barry/story/861087.html

Posted by on May 22, 2009 • Filed under: Ambulance, Ambulance cleaning, CDC, disinfection, EMS, EMT, Fire department, infection control, Paramedic, sanitize, swine flu
Random Pages Created By Best Accountant Services