Lethbridge iGEM 2016

Human Practices (Silver)

Introduction, Interviews, Literature Review

Introduction

Our human practices story began when our local Fire and EMS Department contacted us about wanting to about the efficacy of their cleaning standards for their ambulances. In addition, they also wanted to find out about what microorganisms are found in the EMS vehicles and a way that they can detect any pathogens in a real time detection system.

Interviews

To have more of an understanding of the issues the Fire and EMS Department were facing, we interviewed Ward Eggli, the Fire and EMS Resource Officer who initially contacted us, and four first responders.

In order to get opinions from a variety paramedics about their feelings on current cleaning standards, an unregulated survey was sent out to them. 32 first responders answered. Most responded with wanting to see a more standardized method of cleaning implemented. There was almost a 50/50 split in responses on whether or not the risk of infection would impact how the paramedic handled the call. The majority of respondents feel like risk of infection affects their family or social life because they are uncertain as to what exactly they are coming into contact with.

Literature Reviews

After being contacted by EMS, we conducted a literature search on previous practices in detecting pathogens in EMS vehicles. We discovered that no study has been conducted in Canada and sparsely in the United States and Europe. Below are tables summarizing what we found in the 8 papers we found.

Table 1. Overview of the sample sizes (where n= the number of ambulances), number of samples taken, and the sampling techniques used in each paper.

First author, reference	Sample size (n=ambulances)	Number of samples taken	Sampling techniques
Alrazeeni, D. (2014)	10	60	Swabs followed by culturing
Alves, D.W. (2008)	4	20	cotton swabs with saline solution, agar plate cultures
Luksamijarulkul, P. (2015)	30	544	Air samples, surface swabs followed by culturing
Makiela, S. (2016)	2 helicopters	360	Swabs followed by culturing
Nigam, Y. (2003)	6	164	Swabs with saline solution, blood agar plate cultures
Roline, C.E. (2007)	21	105	Swabs followed by culturing
Vikke, H.S. (2016)	60	50	Swabs followed by culturing
Wepler, M. (2015)	150	2136	Swabs followed by culturing

The number of ambulances and amount of samples taken varied greatly between the papers examined. The sampling techniques used were all based on cell culturing methods.

Table 2. Overview of sampling locations, study lengths, methods of disinfection, and pathogens found in the ambulances sampled in each paper.

First author, reference	Target locations	Length of study	Disinfection techniques used	Pathogens found
Alrazeeni, D. (2014)	Stretcher handle, oxygen flowmeter knob, interior handle of the rear door	2 months	Fumigation with 6% hydrogen peroxide (H2O2) for 2 hours	Bacillus spp., Staphylococcus spp.
Alves, D.W. (2008)	Oxygen flow regulator knob, seat crack, radio, driver's side door handle, lower track of sliding door	N/A	Ethanol-based sanitizer, quaternary ammonium chloride	Bacillus spp., Staphylococcus spp. Pseudomonas fluorescens
Luksamijarulkul, P. (2015)	Stethoscopes, the adjustment knob of oxygen flows, long spinal boards, stretcher mattresses, and air flow adjustment fins	2 months	Gaseous chlorine dioxide (ClO2)	Staphylococcus spp., Gram negative bacilli, Gram positive bacilli, Fungi, Aspergillus spp., Penicillium spp., Fusarium spp., Septate hypha fungi, Rizopus and Mucor
Makiela, S. (2016)	Blood pressure cuffs, buttons on cardiac monitor, radio handpiece, floor between personnel seats and stretcher, seat-belt buckles of personnel seats	3 months	Helicopter ambulance cleaning protocols.	Methicillin Resistant Staphylococcus aureus (MRSA), Multi-resistant S.aureus (Multi-RSA)
Nigam, Y. (2003)	Stretcher mattress, inside cupboards, steering wheel, entonox mask, inside suction bottle, rails of grid/track or floor	12 months	Phenolic pine disinfectants, Tiket, 10% bleach solutions, Domestos, hypochlorite solutions, alcohol and chlorhexidine wipes	S. epidermidis, Bacillus spp., Coliforms, Corynebacterium, S. aureus, Pseudomonas spp.
Roline, C.E. (2007)	Steering wheel, left patient handrail, stretcher cushion, work area to the right of patient, yankauer suction tip	N/A	None given	MRSA
Vikke, H.S. (2016)	Blood pressure cuffs	2 months	80% ethanol rags, cuffs are made of anti-microbial protection fabric	S. aureus, Enterococcus
Wepler, M. (2015)	Carrying handles, oxygen saturation clip, carrying handle cardiovascular bag, tourniquet, ECG cable, BP cuff, headboard of patient stretcher, carrying handle pharmacists’ cabinet, ECG control panel, carrying chair	N/A	Regular ambulance disinfection protocols in Germany	Micrococci, Staphylococcus spp., Apergillus spp., environmental moulds, Methicillin Resistant Staphylococcus aureus (MRSA)

Most of the studies sampled the oxygen flowmeter knob, a handle located in the ambulance, and a part of the stretcher. While the length of each study was not reported in each paper, most were two months. The most common methods of disinfection involved using alcohol-based wipes. The types of pathogens found varied between each study as some were looking at detecting specific pathogens while others were looking at the general microflora. Variations of Staphylococcus spp. were the most common microorganisms found.

References

Alrazeeni, D., & Al Sufi, M. S. (2014). Nosocomial infections in ambulances and effectiveness of ambulance fumigation techniques in Saudi Arabia: Phase I study. Saudi medical journal, 35(11), 1354.

Alves, D. W., & Bissell, R. A. (2008). Bacterial pathogens in ambulances: results of unannounced sample collection. Prehospital emergency care,12(2), 218-224.

Luksamijarulkul, P., & Pipitsangjan, S. (2015). Microbial air quality and bacterial surface contamination in ambulances during patient services.Oman medical journal, 30(2), 104.

Makiela, S., Taylor-Robinson, A. W., Weber, A., & Maguire, B. J. (2016). A Preliminary Assessment of Contamination of Emergency Service Helicopters with MRSA and Multi-Resistant Staphylococcus aureus. Emergency Medicine: Open Access, 2016.

Nigam, Y., & Cutter, J. (2003). A preliminary investigation into bacterial contamination of Welsh emergency ambulances. Emergency medicine journal, 20(5), 479-482.

Roline, C. E., Crumpecker, C., & Dunn, T. M. (2007). Can methicillin-resistant Staphylococcus aureus be found in an ambulance fleet?.Prehospital emergency care, 11(2), 241-244.

Vikke, H. S., & Giebner, M. (2016). POSAiDA: presence of Staphylococcus aureus/MRSA and Enterococcus/VRE in Danish ambulances. A cross-sectional study. BMC research notes, 9(1), 1.