Much discussion and many studies about infection control focus on hospitals and their procedures. But the chain of infection control begins before a patient arrives when it involves first responders. Some studies clearly show that those transported by ambulance can be put at risk before even arriving at a primary care facility. And they are not alone. The emergency services personnel can be exposed to a variety of infectious diseases because the vehicles are contaminated even when seemingly clean. At least one study indicates that cleaning protocol based on fumigation with a hydrogen peroxide system is insufficient.
Emergency medical services need to address infection control better for all concerned. First responders are at risk, as well as their patients. They all must deal with fomites, airborne infection and hand hygiene practices. Poor hand hygiene in hospitals is well noted, but the problem isn’t contained within hospital walls. The high prevalence of MRSA in Ohio EMS personnel is both an occupational hazard and patient safety concern. Implementing methods to reinforce CDC guidelines for proper hygiene could decrease MRSA found in the EMS setting. Previous literature suggests that a reduction in MRSA colonization can lead to decreases in transmission and improved health for both patients and personnel.
The risk of airborne infection is always present for our first responders. Particles on surfaces can be and are aerosolized, and patients are shedding both bacteria and viruses in the presence of first-responders. Risk Assessment towards Droplet and Airborne Infections among Ambulance Personnel in a Province of Northeastern Thailand is an enlightening study on droplet and droplet nuclei. The study “supported that ambulance personnel were at moderate to high risk for droplet and airborne infections while working. To reduce the occupational risk, standard precaution practices should be strengthened, and the air ventilation in an ambulance should be improved.”
We recently swabbed an ambulance in the Northern Virginia area. The contamination numbers were very elevated in the “clean” ambulance. These folks are a huge part of our pandemic defense force, and we need to take steps to get a much better handle on infection control.