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May 2016
Summary
Thorough cleaning and disinfection of environmental surfaces is an essential element of any effective infection prevention program, especially in light of the risks and costs associated with hospital acquired infections (HAIs). Recent studies have found that the results of manual cleaning and disinfection practices are often suboptimal and the risk of cross contamination is high. In this study we evaluated the effectiveness of a new method of cleaning and disinfection.
Two South Florida Fire Rescue Agencies supplemented their existing manual cleaning protocols to include an additional step of spray application of EPA approved disinfectants using ByoPlanet’s Technology. Sampling of critical surfaces in the vehicles showed that >95% fewer bacteria were isolated from vehicles treated with the ByoPlanet electrostatic sprayer compared to vehicles that were cleaned and disinfected using standard manual practices.
How clean are EMS vehicles?
Between 2008 and 2013 the National Institute for Occupational Safety and Health (NIOSH) annually reported that the second most common event related to injuries and illness for EMS workers was exposure to potentially infectious material.1 Studies have shown that the bioburden in EMS vehicles remains high, even after manual cleaning and disinfection, which puts EMS personnel and their patients at risk. Infection-causing bacteria isolated in these studies include Enterococci, Staphylococci, Acinetobacter, and Pseudomonas.2,3,4,5
Methicillin-resistant Staphylococcus aureus (MRSA) is of particular concern. This bacteria is resistant to many antibiotics and causes skin infections in the community and more serious infections in healthcare facilities. In one study,
the bacteria was isolated in almost 50% of ambulances6 and in another, 33% of 19 fire stations sampled had at least one positive MRSA sample.7 Additionally, MRSA carriage in EMS personnel has been reported to be as high as 23%, around 20 times higher than in the general population.8 High carriage can increase the risk of transmission between EMS personnel and patients via environmental surfaces if complete disinfection is not achieved.
Given the importance of environmental disinfection in infection prevention, novel technologies which can complement or replace existing manual cleaning practices are needed. This study evaluated the ability of the ByoPlanet system to deliver improved environmental disinfection of EMS vehicles compared to existing manual cleaning methods.
ByoPlanet Induction Charged Technology
Since 2008 ByoPlanet International has pioneered the use of its induction charged technology (ICT) electrostatic sprayers to deliver disinfectants to reduce microorganism contamination and odor in a number of settings. Using the technology, disinfectants are aerosolized and electrically charged, and are attracted to surfaces, enabling even and total coverage - maximizing disinfection efficacy. The technology has been successfully used to decontaminate cruise ships, which are often the high profile setting for norovirus outbreaks.
ByoPlanet International has been working with several fire rescue agencies and healthcare coalitions to find ways to utilize this technology in Fire Rescue Agency EMS vehicles. The goal is to reduce the risk of pathogen transmission to EMS personnel, their patients and hospital staff by providing a more clinically efficacious, cost effective and labor reducing method of disinfection and odor reduction.
ByoPlanet has conducted extensive research to validate the superiority of its induction charged spray delivery system, which provides consistent and uniform coverage with a thin yet effective layer of disinfectant on all surfaces—harder to reach areas might have otherwise been missed when using manual cleaning and disinfection.
Critical aspects of this document are to highlight the importance of education, training, research in applied science/engineering and collaboration efforts to advance this technology from theory to practice.
Study objective
This study was conducted to determine whether bacterial load was lower on surfaces in EMS vehicles after two types of cleaning: 1) using normal cleaning protocols enhanced by the ByoPlanet system and an EPA approved disinfectant and 2) normal manual cleaning/disinfection protocols.
How the study was conducted
The setting for the study was two fire departments in Broward County, Florida. The study utilized two EMS units at each station, which handle the majority of the calls. To measure total bacterial load, a moist fabric swab was rubbed over an area of a pre-determined surface and the swab sent to a microbiology laboratory for culturing. Predetermined locations were the steering wheel, stretcher handle, door handle, bench seat and oxygen meter knob, all of which have been shown by published studies to be locations from which bacteria can be isolated. The study consisted of two phases.
Phase I: Measuring bacterial load after normal cleaning protocol
Sampling was done at the end of a shift, after the normal manual cleaning/disinfecting protocols had been implemented. Vehicles were sampled 16 times – eight at each station, over a three week period.
Phase II: Measuring bacterial load after normal cleaning + ByoPlanet Spray disinfection protocol
Sampling was done after the implementation of both the normal end of shift after cleaning disinfection protocols and disinfection using the ByoPlanet Sprayer. Phase II was initiated one week after the completion of Phase I and 40 vehicles (20 per station) were sampled over a five week period.
In both phases, ambulance crews were not notified about the study to ensure that they did not alter their normal cleaning/disinfection routines.
ByoPlanet’s BP-515 ICT model was used as the disinfectant delivery system at both stations. A ready to use, health care grade, hydrogen peroxide cleaner disinfectant was used with the ICT sprayer at one station, and a dilutible quaternary ammonium all-purpose cleaner and disinfectant (DQA) at the second station.
Study findings
After Phase I cleaning and disinfection using normal manual fire station protocols, locations in EMS vehicles were contaminated with an average bacterial load of 100-424 colony forming units/inch2 (CFU/inch2). After Phase II cleaning and disinfection, which includes in normal manual clean combined with the ByoPlanet electrostatic spray, the bacterial load on each of the same locations was less than 5 CFU/inch2. The findings showed 95% fewer isolated bacteria after disinfection in Phase II compared to Phase I. The reductions in CFU/inch2 at each location were the same for Phase I and Phase II, regardless of the disinfectants used.
Figure 1: Average bacterial load in CFUs/in2 at each of five locations after Phase I (manual cleaning/disinfection) and Phase II (manual + electrospray cleaning/disinfection)
Implications for fire departments
This study showed that after cleaning and disinfection using normal manual fire station protocols, relatively high bacterial loads were found on critical surfaces in EMS vehicles.
However, when disinfection using ByoPlanet’s ICT with either of two EPA approved disinfectants was carried out in addition to the normal manual cleaning and disinfection, >95% fewer bacteria were isolated on these surfaces.
In a healthcare world where multi-drug resistant organisms and emerging pathogens are ever-present threats, effective environmental disinfection is an important strategy to prevent their spread.
This study demonstrated that disinfects delivered using the ByoPlanet sprayer effectively covers every surface resulting in improved efficacy.
Future studies are planned to determine whether similar results can be achieved following the application of EPA approved disinfectants through ByoPlanet’s technology in all other areas of healthcare.
Dr. Keri Lestage
VP of Product Development
ByoPlanet
klestage@byoplanet.com
Consulted on this particular study.
ByoPlanet’s long term goal is to better protect all first responders and their patients from the spread of debilitating pathogens and the threats of cross contamination.
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1 - National Institute of Occupational Safety and Health. Emergency Medical Services Workers. Injury and Illness data 2008-2013. Accessed May 4, 2016, from Center of Disease Control: http://www.cdc.gov/niosh/topics/ems/data.html
2 - Alrazeeni D, Al Sufi MS. Nosocomial infections in ambulances and effectiveness of ambulance fumigation techniques in Saudi Arabia. Saudi Medical journal, 2014;35(11):1354-1360.
3 - Alves DW, Bissell RA. Bacterial Pathogens in ambulances: results of unannounced sample collection. Prehospital Emergency Care, 2008; 12(2):218-224.
4 - Kober P, Labes H, Möller H, Hülsse C, Kramer A. Hygiene status of ambulances and equipment in rescue services. Anasthesiol Intensivmed Notfallmed Schmerzther, 2001; 36(1):25-30.
5 - Nigam Y, Cutter J. A preliminary investigation into bacterial contamination of Welsh emergency ambulances. Emergency Medicine Journal, 2003; 27(5):479-482.
6 - Roline CE, Crumpecker C, Dunn TM. Can Methicil lin-Resistant Staphylococcus aureus be found in an ambulance fleet? Prehospital Emergency Care, 2007; 11(2):241-244
7 - Roberts MC, No DB. Environment surface sampling in 33 Washington State fire stations for methicillin-resistant and methicillin-susceptible Staphylococcus aureus. Am J Infect Control. 2014;42(6):591-6.
8 - Orellana R, Hoet AE, Bell C, Kelley C, Lu B, Anderson SE, Stevenson KB. (2016). Methicillin-resistant Staphylococcus aureus in Ohio EMS Providers: A Statewide Cross-sectional Study. Prehospital Emergency Care, 2016; 20(2):184-190.
