Completeness of Cleaning Critical Care Transport Vehicles

Background:  Boston MedFlight (BMF) is a critical care transport service with 3000 calls per year divided between 3 rotor wing , 1 fixed wing, and 2 ground vehicles. Patients may be transported from the scene of an acute traumatic injury (16%) or between hospitals (84%). Environmental contamination of shared medical equipment and high touch surfaces (targets) is believed to play a role in the transmission of various pathogens in hospitals; and there are systems to assess completeness of cleaning (cleaning). Cleaning has not been assessed in critical care transport vehicles where crew are expected to disinfect all potentially contaminated surfaces between each case. BMF crew are taught that disinfection of surfaces between patients are key components of the infection control program and of the safety culture of the organization.

Objective: The goal of this project was to evaluate cleaning of a defined set of targets in the vehicles operated by BMF.

Methods: The infection control officer evaluated cleaning of ten targets common to all transport vehicles using a previously validated method that uses a fluorescent marking dye. Cleaning was considered “complete” if the fluorescent mark was totally removed from the target when assessed 24 hours after marking. Targets were also visually inspected for evidence of gross contamination with blood or body fluids. Targets included wall and portable suction, defibrillator (buttons, touch screen), ventilator (on/off switch, reset buttons), and monitor (BP and EKG recorders, touch screen). Baseline data were collected in March 2009. Review of updated Health Department guidance for Emergency Medical Services regarding disinfection practices was completed in April 2009 in response to the appearance of pandemic Influenza. Follow-up data were collected in April and July.

Results: 2900 standardized environmental targets (10 objects) were assessed. Some targets were cleaned frequently regardless of the vehicle (average for defibrillator screen 65%, ventilator controls 68%, and monitor screen 92% of the time). Other items, such as the BP monitor were cleaned more frequently in ground vehicles than in the aircraft (Z score for comparison of proportions 9.1464, p < 0.0001). Cleaning increased in all vehicles after the April update, but improvements have not been consistently sustained. 

 

Conclusions: This is the first time an objective method has been used to assess cleaning of patient transport vehicles. Although all targets appeared to be clean on visual inspection, an opportunity for improvement was identified. Potential causes of incomplete cleaning include shared responsibility for disinfection (no single crew member assigned), ineffective technique, or competing priorities related to patient management. As a result of this study, crews were re-educated and will be provided with objective real-time feedback both to improve performance and to understand and mitigate barriers to effective cleaning.