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BackgroundAdequate ventilation is an important aspect of cardiopulmonary resuscitation (CPR). Research suggests 80% of caregivers hyperventilate during CPR and that feedback improves compliance with ventilation guidelines. Hyperventilation is associated with increased intrathoracic pressure, impaired haemodynamics and cerebral vasoconstriction and therefore can be deleterious to survival. VANZ aimed to determine if compliance with European Resuscitation Council (ERC) ventilation guidelines could be improved using a real time ventilation feedback deviceMethodsParticipants simulated a two-minute cardiac arrest scenario using a manikin and defibrillator without ventilation feedback. Researchers demonstrated the ventilation feedback device and participants practiced using it. The two-minute scenario was then repeated with ventilation feedback. The ventilation rate, volume and CPR quality were recorded during each scenario. The primary outcome was based on achieving ≥50% compliance with ERC ventilation guidelines of ventilating at 8-12 breaths per minute and 500-600ml per breath. Following the study participants were asked to complete a short survey on the ventilation feedback deviceResultsDuring September 2020 106 participants (58% male, mean age 42, 74% paramedics) completed the study. The primary outcome showed a significant improvement from 9% of participants achieving ≥50% compliance without feedback to 91% of participants achieving ≥50% compliance with feedback (McNemars test p<0.0001). Survey data from participants was overwhelmingly positive about the ventilation feedback device.ConclusionsUse of real time ventilation feedback during CPR significantly improved participants ability to deliver ventilations compliant with ERC guidelines in a simulated scenario. The fact that this was a manikin study is a limitation but the low rate of compliance with ventilation guidelines without feedback raises questions about ventilation quality when CPR is performed on patients. Future research should examine the quality of ventilations performed on patients, the ability of feedback to improve compliance with guidelines and the impact this has on patient outcomes.

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Background: Ambulance services transport patients with infections and diseases, and could pose a cross-transmission risk to patients and staff through environmental contamination. The literature suggests that environmental pathogens are present in ambulances, cleaning is inconsistent and patient/staff impact is difficult to quantify. Eco-Mist developed a dry misting decontamination system for ambulance use called AmbuGard, which works in < 30 minutes and is 99.9999% effective against common pathogens. The research question is: ‘What pathogens are present in North East Ambulance Service ambulances and what impact does adding AmbuGard to the deep-cleaning process make?’.Methods: A two-armed, randomised controlled trial enrolled 14 ambulances during their regular 24-week deep clean, which were 1:1 randomised to deep cleaning (control arm) or deep cleaning plus AmbuGard (intervention arm). Polywipe swabs were taken before and after cleaning from five locations selected for high rates of contact (steering wheel, shelf, side-door grab rail, patient seat armrest, rear door handle/grab rail). Microbiology culture methods identified the presence and amount of bacterial organisms present, including the selected pathogens: Enterococcus spp.; Enterobacter spp.; Klebsiella spp.; Staphylococcus aureus; Acinetobacter spp.; Pseudomonas spp.; Clostridium difficile; coagulase-negative staphylococci (CoNS). The researcher taking the swabs and the laboratory were blinded to the trial arm.Results: Pathogens of interest were found in 10 (71%) vehicles. CoNS were found in all vehicles. Pathogens were found on all locations swabbed. Normal deep cleaning was effective at eliminating pathogens and the addition of AmbuGard showed no obvious improvement in effectiveness.Conclusion: Pathogens associated with healthcare-acquired infections were found throughout all ambulances. Normal deep cleaning was effective, and adding AmbuGard showed no obvious improvement. This was a small study at a single point in time. Further research is needed into temporal trends, how to reduce pathogens during normal clinical duties and patient/staff impact.

BackgroundAmbulance services transport patients with infections and diseases and could pose a cross transmission risk to patients and staff through environmental contamination. The literature suggests that environmental pathogens are present on ambulances, cleaning is inconsistent and patient/staff impact is difficult to quantify. Eco-Mist developed a dry misting decontamination system for ambulance use called AmbuGard which works in <30 minutes and is 99.9999% effective against common pathogens. The research question is ‘What pathogens are present on North East Ambulance Service ambulances and what impact does adding the AmbuGard to the deep cleaning process make?’MethodsA two armed, randomised controlled trial enrolled fourteen ambulances during their regular 24 week deep clean which were 1:1 randomised to deep cleaning (control arm) or deep cleaning plus AmbuGard (intervention arm). Polywipe swabs were taken before and after cleaning from five locations selected for high rates of contact (steering wheel, shelf, side door grab rail, patient seat armrest, rear door handle/grab rail). Microbiology culture methods identified the presence and amount of bacterial organisms present including the selected pathogens: Enterococcus spp.; Enterobacter spp.; Klebsiella spp.; Staphylococcus aureus; Acinetobacter spp.; Pseudomonas spp.; Clostridium difficile; coagulase-negative staphylococci (CoNS)). The researcher taking the swabs and the laboratory were blinded to the trial arm.ResultsPathogens of interest were found on 10 (71%) vehicles. CoNS were found on all vehicles. Pathogens were found on all locations swabbed. Normal deep cleaning was effective at eliminating pathogens and the addition of AmbuGard showed no obvious improvement in effectiveness.ConclusionPathogens associated with healthcare acquired infections were found throughout all ambulances. Normal deep cleaning was effective and adding AmbuGard showed no obvious improvement. This was a small study at a single point in time. Further research is needed into temporal trends, how to reduce pathogens during normal clinical duties and patient/staff impact.