Infection Prevention and Control Cleaning in Patient Transport Vehicles
By Adam Murfitt, Specialist Provider of Medical Cleaning and IPC Services, Clear Trace
Any provider of health-related services should have excellent infection prevention and control (IPC) practices culturally ingrained into the workforce. These practices should be underpinned by regular reviews of systems and policies to ensure ongoing compliance. After all, your patient transport vehicles are operating in a range of different situations all with heightened infection risks. Complacency or slack procedures increase the margin of error and then you are one small step away from dealing with serious issues
Legislative, moral and economic reasons to look again
No one should catch an infection while receiving treatment and services related to health, yet every year across the world hundreds of millions do. According to the World Health Organisation (WHO), when done properly, infection prevention and control can decrease healthcare-associated infections by at least 30% (http://www.who. int/infection-prevention/en).
Any organisation related to healthcare should have stringent policies for not just dealing with current infection risks, but also tracking any emerging threats. Infection control is a journey, not a destination. This means that every UK patient transport service needs to constantly review and refine systems and policies to ensure that their vehicles are not just clean, but hygienically clean. This is an era in which regulators, commissioners of services and the public are ever vigilant. If you are inspected by CQC and found to have not reached microbiological sterility, the backlash can be substantial. This includes the sobering thought that putting your patients at risk of infections is commercially reckless.
In a litigious age, non-compliance for any private patient transport businesses could mean not only fines but also compensation levels that could put you out of business.
Visually clean versus microbiologically clean
Ambulances and non-urgent patient transport services may feel they have a rigorous adherence to keeping vehicles and equipment “spotless” when their main control system is visual cleanliness. It’s impossible to be confident of adherence to IPC without applying specialist equipment, chemicals and skills on a regular basis. There are no shortcuts on this topic.
To adhere to best practice, you need six weekly deep cleans, followed by tests to prove their validity. This needs to involve not just simply removing contaminants from surfaces, but also creating a sterile environment on a microbiologic level.
Patient transport clinical governanceHaving auditable and reliable infection prevention and control systems does not simply mean having documented procedures. Nor can responsibility lie entirely with whoever is appointed as lead for IPC. Systems need to be orchestrated effectively by all the management and staff in an ambulance or non-urgent patient transport services. Everyone’s roles and responsibilities should be clear and constantly reaffirmed. Each person has a part to play in delivering infection prevention and control as defined by the Health and Social Care Act 2008.
The CQC may look to the board or senior management to take responsibility for non-compliance, but the managers need to ensure that their teams have the understanding, support and confidence to flag up problems, and to activate deep clean procedures as and when appropriate. For example, where does a crew’s responsibilities start and finish, and at what point do specialist services need to provide a more auditable and microbiological clean?
Can the crew that is asked to clean vehicles and equipment for constant control of pathogens such as MRSA, Clostridium difficile (C-diff), Norovirus and flu, be effective if they have neither the skills nor the time to get to the sufficient level of sanitation that a deep clean provides?
Mapping areas of responsibility against the standards of cleanliness should include any contracted services – such as ambulance preparation teams.They too need to be thoroughly briefed and supported to ensure infection prevention and control is a streamlined and consistent process.
How to have confidence in your IPC systems and policies
If your organisation is confident that it practices the highest possible standards of infection prevention and control, then simply believing that to be true is not sufficient. Even the most rigorous and well managed IPC for an ambulance or patient transport service must be tested and auditable. For that to take place, the best way to test microbiological cleanliness is usually an ATP swab system.
One of the primary advantages of an ATP swab system is that the results are gathered and stored instantly and digitally. This is trackable and shareable information that could prove vital for a CQC visit.
ATP swabs do have their limitations and there may be times when micro swabs are more effective. The two may be needed in tandem in some situations. However, ATP is the measurement system increasingly used in many industry sectors – from container companies to restaurants to dental surgeries. This is because it provides a real-time, accurate method of monitoring your infection prevention and control performance.
Responsive v scheduled IPC
Most organisations sit on a logistical knife-edge, keeping all too few ambulances and non-urgent patient transport vehicles on the road with high demand. The solution for some is to create a working pattern for vehicles that includes regular slots that can facilitate regular deep cleans.
But what if, after exposure to a high-risk situation, your vehicle is used to transport a vulnerable person before the deep clean took place? The solution is to have access to flexible and versatile infection prevention and control services.
One of the mandates of the Care Quality Commission’s guidance on IPC is that care must be “timely to maintain people’s health, safety and welfare.” Getting a balance of planned and reactive deep cleaning is key to that.
Round the clock adherence to IPC regulations
Choosing the right system for IPC adherence should also bring with it lasting benefits for your patient transport vehicle sanitisation. That’s because the best outcome means adding substances to surfaces that continue to shield for as long as scientifically possible. It would be interesting to test your vehicle not just immediately after one of its six weekly deep cleans, but also some days later. Not all cleaning chemicals or delivery systems perform with equal efficiency and effectiveness, and not all of them leave behind residues that add continuing IPC potential.
Clearly, there is a lot more to infection prevention and control than what appears on the surface. To get beneath the issue involves not just systems, but the right level of support.
To discuss this article with Adam:
Email: [email protected]
Tel: 01524 220225
Linkedin: www.linkedin.com/in/adam- murfitt-2a1b3663/