Surface Disinfection: Are You Cleaning As Well As You Could Be?

Karen Swecker, RN, CIC
Exposure Control Liaison, MedFlight

An important part of safety operations is keeping patients safe from easily transmitted bacteria. The aircraft, just like the ambulance, becomes easily contaminated with many different potentially pathogenic bacteria: MRSA, VRE, C. difficile, and all the other multi-drug resistant organisms (MDROs). It is important to decontaminate the aircraft after
each patient transport as well as complete weekly deeper cleans.

Decontamination means the removal of or neutralizing bacteria from surfaces and objects. The decontamination process starts by wiping all surfaces to physically remove any debris. It is important to read the labels to ensure the products used are safe for the surfaces. For example, saline could be used to wipe down surfaces, but it is damaging to instruments.

A surface that isn’t cleaned, but is wiped down with a disinfectant, is not decontaminated.  If a blood glucometer is not cleaned of dried blood and just wiped down with a disinfectant, it can still cause potential infections. Hepatitis B remains infectious in dried blood for at least seven days.  Surfaces must be thoroughly cleaned before any disinfectant is applied.

Have someone observe your process.  Were you wearing gloves to provide patient care and then touched the radio control knobs or control box to give a report?  If so, you have just contaminated the radio with bacteria from the patient.  Gloves, like bare hands, easily transfer pathogens from surface to surface.  After transfer of a patient, make
sure to wipe all surfaces not in direct contact with the patient such as door handles, sled knobs, chin straps and the sides of helmets.

When choosing a disinfectant, make sure to thoroughly read the instructions to ensure you are properly using the product. Labels will list what type of disinfectant is in the product, what type of bacteria is killed and how long it takes to kill. A product listed as tuberculocidal will kill Mycobacterium within the time limit listed. While Mycobacterium is not transmitted from surfaces; these bacteria are very hard to kill.
The standard is if Mycobacteria is killed, all other bacteria will also be eliminated within the same time frame.

The one exception to this is highly transmissible Clostridium difficile (C. diff). Hand sanitizer is not effective; therefore, care providers must wash hands with soap and
water.  A bleach product must be used to effectively kill C. diff on surfaces. Unfortunately, bleach is very corrosive to many surfaces and care should be taken. Check equipment manufacturers before using a bleach product. Bleach products should NOT be used on surfaces in aircraft.  When transporting a patient with diarrhea, make sure to
change gloves frequently and do not touch any surface with gloves used for patient care.

A few resources available for reference:
The Guide to Managing an Emergency Service Infection Control
Program, U.S. Fire Administration
Infection Prevention and Control Guidance for EMS Providers,
Metropolitan Chicago Healthcare Council

Center for Disease Control: