BEFORE DECONTAMINATION

To limit the number of people exposed to potentially contaminated materials, the vehicle operator and patient care provider may be responsible for decontamination and disinfection of the transport unit. However, a separate team may also be used to do this.

All waste, including Personal Protection Equipment (PPE), drapes, and wipes, should be considered Category A infectious substance, and should be packaged appropriately for disposal.

Two people in Personal Protection Equipment (PPE) should decontaminate and disinfect. A third person should be available to document the decontamination and be available for other assistance as needed. Personal Protection Equipment (PPE) should be donned and doffed according to organizational protocols. Personal Protection Equipment (PPE) selection should consider worker protection for biological exposures and potential chemical exposures based on the disinfectant used.

DURING DECONTAMINATION

Disinfect the outside of any prepositioned but unused medical equipment (still inside the protective bags they were placed in) and pass it to the warm zone. If the equipment was removed from a protective bag in transit, assess the equipment to determine if it can be properly decontaminated and disinfected, or disposed of.

Any areas that are visibly contaminated with the patient’s body fluids should be decontaminated first with an approved EPA-registered disinfectant for the appropriate contact time before soaking up the fluid with absorbent materials.

If the interior of the ambulance was draped prior to transport, remove the draping by rolling the drapes down outside in, from the ceiling to the floor of the unit starting at the front of the compartment and moving to the rear.

Roll flooring drapes from the front to rear of the compartment, rolling drapes outside in.

Roll flooring drapes from the front to rear of the compartment, rolling drapes outside in.

It is important that all drape materials are in sections that are small enough to facilitate the insertion of the biohazard bags into an autoclave or pre-determined Category A infectious substance packaging for disposal.

Two people in Personal Protection Equipment (PPE) should manually disinfect the interior of the patient care compartment with particular detail for high-touch surfaces such as door handles and steps using care to limit mechanically generated aerosols and using the surface wipe method to disinfect.

Disinfect the interior as a team so that the team members can talk each other through the process and expedite the decontamination process.

Disinfect the interior as a team so that the team members can talk each other through the process and expedite the decontamination process.

Manually wipe down the ambulance’s exterior patient loading doors and handles, and any areas that may have been contaminated, with disinfectant. The exterior of the ambulance does not require a full disinfectant wipe down.

Once the outside of all surfaces (including waste bags) have been wiped with disinfectant, then doffing can occur. Medical Transport Units.

AFTER DECONTAMINATION

A third person who has been in the cold zone should supervise doffing, which should be performed according to organization protocols.

Dispose of all waste according to organization protocols as well as local and federal regulations for Category A infectious diseases and substances.

Additional cleaning methods can also be used. While not required, this may provide additional assurance to personnel and public prior return-ing the vehicle to service.

Ultraviolet germicidal irradiation, chlorine dioxide gas, or hydrogen peroxide vapor can be used for an additional disinfection step. How-ever, these should not replace the manual disinfection, as their effica-cy against organisms in body fluids has not been fully established and these methods may require specialized equipment and Personal Pro-tection Equipment (PPE)

ZONES

HOT ZONE

The hot zone is considered an area that is known or suspected to be contam-inated and has a high risk of exposure. It should only be entered with full Personal Protection Equipment (PPE). In ambulance decontamination, this would be the vehicle and an area about a meter beyond the ambulance.

WARM ZONE

The warm zone can be considered a transitional area between the hot and cold zones that has no known contamination but has a moderate risk of ex-posure. It should only be entered when wearing full PPE. This is also the ar-ea where one begins the initial portion of the doffing process (following a full suit wipe down within the hot zone) when leaving the hot zone. For am-bulance decontamination, the warm zone can also be the place where waste barrels are pre-positioned so that the waste bags can be placed directly into the containers without entering the hot zone.

COLD ZONE

The cold zone is considered an area that has no contamination and no poten-tial risk for exposure. The individuals in this area are not required to wear Personal Protection Equipment (PPE), although the cold zone will often also serve as the Personal Protection Equipment (PPE) donning area.

SURFACE DISINFECTIONS AND DECONTAMINATIONS

  • The effective use of disinfectants is part of a multi-barrier strategy to prevent associated infections. Surfaces are considered noncritical items because they contact intact skin. Use of noncritical items or contact with noncritical surfaces carries little risk of causing an infec-tion in patients or staff. Thus, the routine use of germicidal chemicals to disinfect.
  • Environmental surfaces (e.g., equipment, faucet and toilet, handles, bedside tables) also could potentially contribute to cross-transmission by contamination of personnel from hand contact with contaminated spaces, surfaces, equipment, patients, or patrons.
  • Some disinfectants should not be diluted; those that are diluted must be prepared correctly to achieve the manufacturers’ recommended use-dilution.
  • Second, infection-control professionals must learn from the literature what inappropriate activities result in extrinsic contamination (i.e., at the point of use) of germicides and train users to prevent recurrence. .
  • Common sources of extrinsic contamination of germicides in the re-viewed literature are the water to make working dilutions, contami-nated containers, and general contamination of the hospital areas where the germicides are prepared and/or used.

Note: All disinfection should use a U.S. Environmental Protection Agency (EPA)-registered hospital disinfectant with a label claim for a non-enveloped virus (norovirus, rotavirus, adenovirus, poliovirus) to disinfect environmental surfaces at appropriate concentration and contact time.

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The Next Generation To Superbugs Elimination

1221 Bowers St. • Ste 789 • Birmingham, MI 48012

3800 Greenfield Rd. • Ste 191 • Dearborn, MI 48121

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