Is MRSA Lurking in Your Ambulance?

Review of: Roline CE, Crumpecker C, Dunn TM: Can methicillin-resistant staphylococcus aureus be found in an ambulance fleet? Prehospital Emergency Care. 11(2):241-244, 2007.

The Science

This was a cross-sectional study of Methicillin-Resistant Staph Aureus (MRSA) contamination in an ambulance fleet operating in the western U.S. in June 2006. Five specific areas within each of 21 ambulances (n = 105) were tested for MRSA contamination. The 21 ambulances, representing approximately two thirds of the total fleet, were tested on the basis of their availability at the two main company stations. Eleven ambulances were tested at station A and 10 ambulances were tested at station B. A total of 16 ALS, three BLS, and two critical care transport (CCT) ambulances were tested between the two facilities.

The areas tested included the steering wheel, left patient stretcher handrail, patient stretcher cushion, the work area to the right of the patient and the Yankauer suction tip.

Of the 21 ambulances screened for MRSA contamination, 10 (47.6%) were positive at 96 hours. Of the total samples collected (n = 105), 13 (12.4%) exhibited MRSA-positive growth. Results from each specific area of the 21 ambulances after 96 hours of growth were as follows: steering wheel: one (4.8%); left patient stretcher handrail: two (9.6%); patient stretcher cushion: two (9.6%); work area to right of patient: seven (33.3%); Yankauer suction tip: 1 (4.8%).

The Science

If this study doesn t scare you, I don t know what will. We have become immune to the fear of contagion while, at the same time, we scream bloody murder when the nursing homes don t tell us our patients have MRSA. A patient transported by this service would have a 50/50 chance of taking a ride in a contaminated ambulance!

More importantly, we need to look at the fact that the contamination was primarily discovered not in areas touched by the patient, but in areas utilized by the crew. The countertop on the patient s right side is where we place the monitor, the blood pressure cuff and just about anything else we use during the transport. And the Yankauer suction tip? Makes you want to keep that sucker wrapped up until you need it, doesn t it?

This is a major source for concern. While these numbers are alarming, we don t have any industry standards to compare them to. Perhaps this should become a quality improvement benchmark for every service, though I m sure the cost of performing the test is not cheap. A rapid reagent test would be very useful. While MRSA is a clear threat, there are increasing reports of Vancomycin resistant Staf Aureus, which is even worse than MRSA.

Based on this study s findings, we, the rescuers, may represent a greater threat to our patients than they do to us.

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