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November 2019, Perth Occupational cleanliness of emergency ambulances: a prospective study ACIPC Conference Perth 2019 Dr Paul Simpson, Liz Thyer, Kate Hispley, Tanya Somani, David Morris
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Occupational cleanliness of emergency ambulances: a ...

Feb 08, 2022

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Page 1: Occupational cleanliness of emergency ambulances: a ...

November 2019, Perth

Occupational cleanliness of emergency

ambulances: a prospective study

ACIPC Conference

Perth 2019

Dr Paul Simpson, Liz Thyer, Kate Hispley, Tanya Somani, David Morris

Page 2: Occupational cleanliness of emergency ambulances: a ...

HAI’s: What are we doing about them?

Page 3: Occupational cleanliness of emergency ambulances: a ...

Operational environment

➢ NSW Ambulance responds to an

emergency 000 call every 28

seconds

➢ NSW Ambulance responses

309,282 in the last quarter

➢ 4985 paramedics and clinical

staff state-wide

Page 4: Occupational cleanliness of emergency ambulances: a ...

Standard cleaning model often resulted in..

The IDIL

method

and

I’ll

Do

It

Later

Page 5: Occupational cleanliness of emergency ambulances: a ...

Standard cleaning model (SCM)

▪ Ad-hoc practices

▪ Variation of cleans

▪ Poor surveillance

Opportunities for improvement!

Page 6: Occupational cleanliness of emergency ambulances: a ...

Our ‘LHD’ is 235 stations!

Page 7: Occupational cleanliness of emergency ambulances: a ...

Dedicated cleaning and logistics servicing of ambulances by HealthShare NSW

➢ Scheduled environmental cleans

➢ Correct product use

➢ Surveillance of cleans

➢ Over 150,000 items removed from

ambulances

What is Make Ready Model?

Page 8: Occupational cleanliness of emergency ambulances: a ...

Make Ready Model Environmental Cleaning

➢ Scheduled cleaning

➢ Auditing of cleaning

➢ ATP and visual

➢ 139 fleet inducted

into the system

81,000 cleans

to date!

Page 9: Occupational cleanliness of emergency ambulances: a ...

6 types of cleaning interactions/ levels:

1 - Induction of vehicle into MRM service

2 - Detailed clean - every 6 weeks

3 - Specific clean as required- organism dependant

4 - Post shift daily clean

5 - Hot swap

6 - No clean

Make Ready Model Environmental Cleaning

Page 10: Occupational cleanliness of emergency ambulances: a ...

Standard cleaning

model vs. Make

Ready Model

environmental

cleaning of

ambulances?

The golden question?

Page 11: Occupational cleanliness of emergency ambulances: a ...

The research question?

“In frontline emergency ambulances, does the ‘make

ready model’ operational ambulance service model,

compared to the standard operational model, result in

improved environmental cleanliness evidenced by

reduced surface bioburden measured using

(ATP) bioluminescence testing?”

Page 12: Occupational cleanliness of emergency ambulances: a ...

The ‘make ready

model’ operational

ambulance service

model will improve

environmental

cleanliness by reducing

overall bioburden in a

transport ambulance

Primary research hypothesis

Page 13: Occupational cleanliness of emergency ambulances: a ...

➢ ATP testing of 68 ambulances in

metropolitan areas

➢ 36 from make ready model

➢ 32 from standard cleaning model

➢ Testing occurred over a 2 week

period using a convenience

sampling approach

Methods of data collection

Page 14: Occupational cleanliness of emergency ambulances: a ...

Methods of data collection

➢ Samples were only taken from

ambulances that were not being

used ‘on shift’ at the time of

sampling. They had been used

and cleaned (either MRM or

SCM)

➢ Testing occurred between 4-9am

on 4 random mornings

➢ Staff given no warning of testing

Page 15: Occupational cleanliness of emergency ambulances: a ...

Research design and analysis

➢ Ambulance workload was

identified as a potential

confounder

➢ Number of transports

undertaken by an

ambulance in the 14 days

preceding data collection

Page 16: Occupational cleanliness of emergency ambulances: a ...

What was tested?

Page 17: Occupational cleanliness of emergency ambulances: a ...

Individual test points for MRM vs SCM

➢ There was a limited statistical difference in individual

bioburden levels across 5 of the 6 high touch area test points

➢ There was a significant difference in bioburden on the

steering wheel touch point (SCM 1578 v MRM 702; p=0.0012

Page 18: Occupational cleanliness of emergency ambulances: a ...

Primary results- overall bioburden

➢ When compared to SCM, the MRM cleaning model

was associated with adjusted decrease in overall

bioburden of 38%

Page 19: Occupational cleanliness of emergency ambulances: a ...

Results- primary outcome

The MRM produced a 38% reduction in

overall bioburden

compared

to the SCM

Page 20: Occupational cleanliness of emergency ambulances: a ...

Implications

➢ We know an end-of-

shift cleaning model

such as MRM can

achieve major

reductions in bioburden

➢Rigorous objective data providing a baseline for RLU’s

in ambulances; however no RLU-based standard exists

➢Rigorous objective data describing the magnitude of

difference a standardised cleaning model has in

emergency ambulances

Page 21: Occupational cleanliness of emergency ambulances: a ...

Implications

➢ We don’t know whether the 38% difference

achieved by the MRM is reconciled from a health

economic perspective

➢ Will 38% result in a clinically significant difference

in HAI’s?

Page 22: Occupational cleanliness of emergency ambulances: a ...

Limitations

➢ The convenience sampling

approach opens the study up

to potential bias

➢ A future study using a more

systematic sampling

approach is recommended,

but was beyond the scope

and feasibility of the current

project

Page 23: Occupational cleanliness of emergency ambulances: a ...

Where to next?

➢Impact of reduction in

bioburden on patient

outcomes

➢Does a cleaner

ambulance actually

result in decreased

HAI’s?

➢ This data can inform and contribute towards

the development of a ambulance-specific

bioburden parameters

Page 24: Occupational cleanliness of emergency ambulances: a ...

Remember…

‘HAIs are a potentially preventable adverse

event rather than an unpredictable

complication in health….Patients, visitors

and staff - regardless of location or position -

all play a role in the reduction of HAIs.’

Clinical Excellence Commission

Page 25: Occupational cleanliness of emergency ambulances: a ...

Acknowledgements

Western Sydney University- Dr. Paul Simpson,

Dr. Kingsley Agho, Ms. Liz Thyer

Western Sydney University- Students from the

Undergraduate Paramedic Student Research

Engagement Academy (‘UPSTREAM), who played an

integral role in the conception, design, data collection

and analysis of the data

HealthShare who provide the Make Ready Model

service

NSW Ambulance- Kate Hipsley and Michelle Fernandez

3M for donating the equipment and technical expertise