A close family member recently entered a hospital with a cardiac illness. Within a few days, he contracted an infection called Methicillin-Resistant Staphylococcus Aureus (MRSA).
MRSA is caused by a strain of staph bacteria resistant to antibiotics. It starts with a skin puncture, is highly contagious, and spreads through skin contact, which I now know was from the IV given to my family member.
History of EMS Infection Control
As a young paramedic in 1977, I learned that infection control consists of: (1) mopping the ambulance floor with the same mop used on the fire station floor, (2) practicing good hand washing and then (3) large doses of disinfectant sprayed into the ambulance. Many times I watched with ungloved hands my patient’s blood circle down the hospital sink. The possibility of an infection was not a consideration.
In 1979 to 1981, rare types of pneumonia, cancer, and other illnesses were being reported in Los Angeles and New York among a number of male patients. These conditions were not usually found in people with healthy immune systems.
In 1982, public health officials began to use the term “Acquired Immunodeficiency Syndrome” or AIDS, to describe the occurrences of these opportunistic infections. Formal surveillance of AIDS cases began that year in the United States.
The Dallas Fire Rescue Department in 1981 issued gloves to its EMTs and paramedics. This was the first real attempt at infection control other than cleaning and washing hands.
Universal precautions were introduced in 1985 which included the practice of avoiding contact with patients’ bodily fluids by wearing of nonporous medical gloves, goggles and face shields. Today we have new options.
Infection Control Studies
A number of recent hospital studies show a significantly higher chance of contracting the same infection after admission to a room vacated by an infected patient. This “prior occupant risk” has been linked to a four-fold increase in infection risk, linking a patient’s risk for a hospital acquired infection (HAI) to the room in which they are admitted.
Are emergency patients linked simply by the ambulance or clinic used? This risk represents and demonstrates that the environment is a significant contributor to spreading disease. The stakes seem higher with new resistant organisms like Ebola, New Delhi virus, Acinetobacter baumanni and others joining the list of already troubling organisms such as MRSA, VRE and Norovirus.
Ineffectiveness of Current Decontamination
Procedures Medical and scientific literature show traditional cleaning methods are up to 50 percent ineffective. This potential risk remains unacceptable, especially when no-touch technologies are available that can greatly diminish the potential for human error.
This adds a critical layer of extra protection for patient and provider safety. Handwashing Effectiveness Achieving and maintaining a high percentage of hand hygiene compliance is standard operating procedure of every EMS organization.
However, hand hygiene alone is not enough.
Engineering controls are OSHA’s primary means of control, meaning available technology is mandatory. Because we cannot eliminate blood, UV lighting technology is the engineering control of choice. Administrative procedures and training employees are also mandatory.
EMS decontamination (decon) procedures will not change drastically. Personal Protective Equipment (PPE) and decontamination of the ambulance, clinic and equipment are crucial. Once the ambulance/clinic and equipment are decontaminated, the UVC light completes the process. This keeps personnel and patients healthy and free of infections, illnesses and downtime.
Not only is it difficult to maintain a high compliance rate (typical compliance rates seems to hover between 40 percent and 60 percent), it is also difficult to keep hands clean. Studies now show that hands become contaminated as quickly from surfaces and objects as they do from touching patients. Hands are only as clean as the surfaces with which they come in contact.
Hospitals are beginning to adopt a “No-Touch Disinfection System” also known as “area disinfection.” Area disinfection means disinfecting an enclosed space. Are ambulances and clinics a confined space? These cutting technologies are the next big change for EMS.
Area disinfection can be achieved using either ultraviolet light (UV) or hydrogen peroxide vapor (HPV). Both devices are placed in the ambulance or clinic while it is unoccupied. The device runs for a specified time called the disinfection cycle.
Ultraviolet disinfection is common in everything from laboratories to vacuum cleaners. Using a variety of methods, high-energy ultraviolet light in the area of the spectrum known as UVC is produced by either mercury or xenon gas. Xenon gas is reported to be 10 times faster than traditional mercury UV lamps.
How does it work?
UVC energy passes through the cell walls of bacteria, viruses, and bacterial spores. Once the UVC energy is inside the microorganism, it is absorbed by the DNA, RNA and proteins.
One of the primary mechanisms of damage created by UVC is the fusing of the strands of DNA creating what is known as “thymine dimers.” Once the DNA is fused, the organism can no longer replicate and is no longer infectious. This is radiation, but the technical term for this is “deactivation.” UVC light is fast acting and sometimes as short as eight minutes.
Ultraviolet light technology has also been found to reduce air (airborne) and environmental contamination in healthcare setting.
UVC lighting is available from Amazon to Walmart, but getting this technology retrofit to the ambulance/ clinic is the next change. There are a variety of companies producing these devices. UVC light is proving effective in deactivating today’s multi-drug-resistant organisms and infections, but it requires change.
It is now time to plan for these changes when budget planning and purchasing new equipment. This is good change for healthcare providers.
Hydrogen Peroxide Vapor (HPV)
Hydrogen peroxide vapor systems use chemical reactions to produce a vapor of hydrogen peroxide that disperses throughout the area to be disinfected. The oxygen in the hydrogen peroxide vapor reacts with the cell walls of microorganisms, leading to cell death.
HPV systems have been used as instrument sterilizers for some time. The basic concept is to fill the room with a mist containing (depending on the formulation) a percentage of hydrogen peroxide that coats the surfaces in the room. HPV systems, for example, take multiple hours to achieve their disinfection level. Time constraints limit the viability for EMS.
Depending on the technology, the duration of the disinfection cycle can be between eight and 240 minutes. EMS organizations would need the short acting device.
OSHA controls outline a hierarchy for controlling hazards which include: (1) elimination or substitution, (2) engineering controls; (3) administrative rules and training programs, (4) Personal Protective Equipment.
Engineering controls are OSHA’s primary means of control, meaning available technology is mandatory.