Bacterial pathogens in ambulances: results of unannounced sample collection.
The concern that the health care environment may harbor a substantial reservoir of infectious agents has been vigorously examined by microbiology and infectious disease experts. Although universal precautions and disposable equipment reduces risks to patients and providers, the ambulance remains vulnerable to bacterial contamination from biological secretions. Additionally, the nature of emergency medical services creates pressures on prehospital care providers.


OBJECTIVE
We hypothesized that a discrepancy exists between the expectation of disinfection of reusable equipment in emergency medical services (EMS) and the cleaning that actually occurs.


METHODS
We chose five areas within the ambulance for specimen collection for their reasoned propensity to yield a large spectrum of bacteria. Four first-due ambulances were selected for culturing. The crews did not have advance knowledge of the study or sample collection. Specific identifications with antibiotic susceptibility were completed, identifying three multidrug resistant organisms.


RESULTS
Specimens from all four ambulances grew moderate-to-large quantities of environmental and skin flora. Newer, automated microbiological techniques and concerns regarding multiple-drug-resistant organism prevalence as well as the potential for biological warfare make complete identification more important.


CONCLUSIONS
This study examined the bacterial pathogens found in EMS vehicles. Four of the seven species isolated were substantial nosocomial pathogens, and three of these four possess formidable antibiotic resistance patterns. All of the organisms detected are susceptible to the disinfectant agents currently in common use by EMS agencies.
Alves
Donald W
DW
Department of Emergency Medicine, Division of Special Operations, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21224, USA. hvngchstpn@aol.com
Bissell
Richard A
RA
D000552:Ambulances; D001419:Bacteria / Q000145:classification / Q000254:growth & development / Q000302:isolation & purification*; D004864:Equipment and Supplies / Q000382:microbiology*; D017053:Infection Control; D013048:Specimen Handling