A two-armed, randomised, controlled exploratory study of adding the AmbuGard cleaning system to normal deep-cleaning procedures in a regional ambulance service

Abstract

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.