Emergency medical services oxygen equipment: a fomite for transmission of MRSA?

Abstract

ObjectivesThe primary purpose of this study was to determine if methicillin-resistant Staphylococcus aureus (MRSA) was present on the surface of oxygen cylinders and regulators used in the prehospital setting and secondarily to assess other surfaces for MRSA within the ambulance compartment, as a comparison.MethodsOn 17 March 2018, the surface of oxygen cylinders and regulators located in ambulances at an emergency medical services (EMS) station in North Alabama (n=9) and at an offsite oxygen cylinder storage area (n=70) were swabbed using sterile cotton-tipped applicators saturated in an 0.9% NaCl solution. These cotton-tipped applicators were then streaked across the surface of HardyCHROM MRSA plates, followed by incubation at 36°C for 24 hours. The growth of pink or magenta colonies was considered a positive indication for the presence of MRSA. The motivation for assessing oxygen cylinders at the offsite storage area was to outline the persistence of MRSA on stored oxygen cylinders.ResultsOf nine oxygen cylinders tested in the ambulances, nine had MRSA colonisation (100%). MRSA was also present on 67 of 70 oxygen cylinders (96%) tested at the offsite oxygen cylinder storage area.ConclusionOxygen cylinders appear to act as a fomite for MRSA. The development of universal disinfection protocols for oxygen equipment could help reduce the risk of patient infection due to cross-contamination.

Microbial contamination on ambulance surfaces: a systematic literature review

“…While 10 studies included additional areas and surfaces outside of the patient care compartment (e.g., fire station living quarters, EMS personnel, EMS clothing, and the driver's cabin), they were included as part of this review for having also researched the patient care compartment of the ambulance [6,7,[15][16][17][18][19][20][21][22]. Eight studies specifically targeted MRSA contamination [7,16,[19][20][21][23][24][25] while others targeted S. aureus [15], general bacterial contamination [6,18,22,26,27], any organism associated with HAIs [28], and gram-negative multi-drug resistant organisms (MDRO) [17]. The majority of studies utilised swabs for sample collection [6, 15-20, 22-24, 26, 27], two used contact plates only [25,28], one used a combination of contact plates and swabs [7], and one used a combination of dip slides and swabs [21].…”

Control of Methicillin-Resistant Staphylococcus aureus Strains Associated With a Hospital Outbreak Involving Contamination From Anesthesia Equipment Using UV-C

“…The relevance of MRSA in the hospital has been related to infections associated with health care, such as pneumonia, bacteremia, and wound infections (Rago et al, 2012;De la Rosa-Zamboni et al, 2018;Friedrich, 2019;Gibson, 2019). The cross-contamination by hospital equipment confined to specific surgical areas with MRSA strains residing in the nasopharynx by health staff has not been extensively studied in hospitals in Mexico.…”

Bacteria Associated with Healthcare-Associated Infections on Environmental Samples Obtained from Two Fire Departments

“…Gram -Nosocomial transmission [40,41] E. coli Gram -Contaminates surfaces and textiles [42,43] P. aeruginosa Gram -Contaminates surfaces in ambulances [44,45] E. faecalis Gram + Contaminates surfaces and textiles [42,43] C. difficile Gram + Contaminates surfaces and textiles [42,43] and resistant to laundering [43] MRSA Gram + Present in EMS workers and on EMS equipment [6,46] S. pneumoniae Gram + Present in EMS workers and on EMS equipment [6,46] Viruses Influenza Enveloped Highly contagious, vaccine available but many refuse [47] Adenovirus Non-Enveloped Highly contagious, major cause of emergencies in elderly [48] Norovirus Non-Enveloped Highly contagious, spread by contact and aerosol, environmentally stable [49,50] Disinfection standard operating protocols (SOPs) in place may not be sufficient in high-touch, high-use areas or against environmentally stable pathogens. The primary objective of this study was to document evidence of the HAI (see Table 1) on surfaces at fire stations and engines to inform disinfection procedures and identify which pathogens might contribute to occupational exposures.…”

“…A study evaluating 65 high-touch surfaces in 11 vehicles (ambulances and fire engines) and common areas of two fire stations found that bacterial, yeast, and mold contamination of the surfaces was significant [44]. Reports on surface contamination of ambulances and occupational exposures of EMS show that several drug-resistant bacteria and highly contagious viruses are of concern, especially in iatrogenic and nosocomial infections (Table 1) [44][45][46][47][48]. Low concentrations of enveloped respiratory viruses have been found to retain infectivity on common environmental surfaces, such as Teflon, polyvinyl chloride (PVC), ceramic tiles, glass, silicon rubber, and stainless steel [49].…”