title: Spread of infectious microbes during emergency medical response.
abstract: BACKGROUND
  To our knowledge, no studies to date demonstrate potential spread of microbes during actual emergency medical service (EMS) activities. Our study introduces a novel approach to identification of contributors to EMS environment contamination and development of infection control strategies, using a bacteriophage surrogate for pathogenic organisms.
  
  
  METHODS
  Bacteriophage ΦX174 was used to trace cross-contamination and evaluate current disinfection practices and a hydrogen peroxide (H2O2) wipe intervention within emergency response vehicles. Prior to EMS calls, 2 surfaces were seeded with ΦX174. On call completion, EMS vehicle and equipment surfaces were sampled before decontamination, after decontamination per current practices, and after implementation of the intervention.
  
  
  RESULTS
  Current decontamination practices did not significantly reduce viral loads on surfaces (P = .3113), but H2O2 wipe intervention did (P = .0065). Bacteriophage spread to 56% (27/48) of sites and was reduced to 54% (26/48) and 40% (19/48) with current decontamination practices and intervention practices, respectively.
  
  
  CONCLUSIONS
  Results suggest firefighters' hands were the main vehicles of microbial transfer. Current practices were not consistently applied or standardized and minimally reduced prevalence and quantity of microbial contamination on EMS surfaces. Although use of a consistent protocol of H2O2 wipes significantly reduced percent prevalence and concentration of viruses, training and promotion of surface disinfection should be provided.
authors.affiliation: Mel & Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ. Electronic address: MKValdez@email.arizona.edu.
authors.forename: Melissa K
authors.initials: MK
authors.lastname: Valdez
authors.affiliation: Mel & Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Sexton
authors.affiliation: Mel & Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Lutz
authors.affiliation: Mel & Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ.
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Reynolds
mesh_terms: D000891:Anti-Infective Agents, Local; D010584:Bacteriophage phi X 174; D004203:Disinfection / Q000379:methods* / Q000592:standards; D004632:Emergency Medical Services / Q000592:standards*; D004866:Equipment Contamination / Q000517:prevention & control; D006801:Humans; D006861:Hydrogen Peroxide; D017053:Infection Control / Q000379:methods* / Q000592:standards; D050296:Microbial Viability
chemical_list: D000891:Anti-Infective Agents, Local; D006861:Hydrogen Peroxide
keywords: Emergency medical service; Health care–associated infection; Hydrogen peroxide; Infection control; Intervention; Phage tracer