Columns, Training

Cleaning the Rig’s Invisible Enemies

Issue 10 and Volume 39.

When I was in EMT school in 1988, my instructor was a captain from the Poway (Calif.) Fire Department. He had a great teaching style and was an excellent instructor. The biggest lesson I learned from him was that nothing in our rigs was clean enough. We used wooden backboards then, and they were difficult to sterilize. How many different body fluids from how many different people were on those boards at any given time? My instructor scraped a sample and sent it to a lab for testing. Needless to say, he was horrified and began cleaning them with bleach afterward.

Fast-forward to present day: A friend is taking a microbiology course and needs to take a sample she can grow for an assignment. Being in EMS, she goes straight to the back of the rig. What gets touched on every call, isn’t involved with direct patient care, and is usually overlooked when cleaning the rig? The radio. My friend scraped the radio mic and added it to a petri dish containing beef broth.

After several days of incubation at room temperature, things were definitely growing: two fungi and eight bacteria, including staph, strep and pneumonia. My friend was told not to open the sample due to liability. She destroyed it, and got an A for her work.

With backboards that could crawl away on their own and radios that could be deemed a hazmat incident, we must ask, “Are we cleaning our rigs well enough?” We should worry about what our patients could possibly be exposed to, but also what we ourselves are being exposed to.

Different viruses and bacteria have different life spans: Hepatitis can survive anywhere from 16 hours to a week, and Staphylococcus aureus can conceivably survive for weeks. See where I’m going with this? It’s gross!

How do we fight these invisible enemies? We have all sorts of disinfecting cleaners, sprays and mists, but we must examine what’s actually in them. If you read the labels for these products you’ll be amazed at the warnings. The first ingredient in my agency-provided cleaning product is diisobutylphenoxyethoxyethyl dimethyl benzyl ammonium chloride. Material safety data sheets give this warning: “Harmful if absorbed through the skin. Inhalation of concentrated vapors may cause irritation of the eyes, nose and throat and dizziness and drowsiness. Prolonged overexposure to ethylene glycol monobutyl ether may affect liver, kidneys, blood, lymphatic system or central nervous system … If on the skin, take off contaminated clothing. Rinse skin immediately with plenty of water for 15–20 minutes. Call a poison control center or doctor for treatment advice.”

That wouldn’t be a pretty picture in a hospital parking lot.

I try to routinely clean our gurney and equipment after every call. While it isn’t always the practice, it should be the standard. Come to find out, many of these commercial cleaning products need to stay wet on the surface for two minutes for virucidal effects and three minutes for disinfectant effects.

Many of our patients could be immunocompromised. However, the risk of health issues from the chemicals used is slight in comparison to the diseases we’re potentially incubating in the back of our ambulance.

A friend of mine starts each shift with having his intern wipe down the whole back of the ambulance with commercial virucidal towelettes, starting with his station chair. This should be the global standard for all crews. The rig should be disinfected and ready for a newborn baby at any point in your shift. If it isn’t to that level, why are you putting yourself back there?