Spread of infectious microbes during emergency medical response

Valdez, Melissa K.; Sexton, Jonathan D.; Lutz, Eric; Reynolds, Kelly A.

doi:10.1016/j.ajic.2015.02.025

Cited by 20 publications

(29 citation statements)

References 33 publications

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“…To determine the best collection, processing, and results representation approach, three sampling approaches Additionally, coliphage MS2 (ATCC 15597-B1; American Type Culture Collection, Manassas, VA) was used to seed the same three canals (one experiment per canal) to serve as a microbial tracer organism. This non-pathogenic virus has been used as a surrogate for many pathogens in various environments (Reynolds et al, 2015;Sinclair et al, 2009;Valdez et al, 2015). Coliphage samples were serially diluted with sterile phosphate-buffered saline (PBS; pH 7.4; Sigma-Aldrich, St. Louis, MO) to create 10, 1, -1 , 10 -2 , 10 -3 , and -4 ml duplicate subsamples.…”

Section: Field Analysis and Sample Collectionmentioning

confidence: 99%

Optimal strategies for monitoring irrigation water quality

Lothrop

Bright

Sexton

et al. 2018

Agricultural Water Management

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The quality of irrigation water drawn from surface water sources varies greatly. This is particularly true for waters that are subject to intermittent contamination events such as runoff from rainfall or direct entry of livestock upstream of use. Such pollution in irrigation systems increases the risk of food crop contamination and require adoption of best monitoring practices. Therefore, this study aimed to define optimal strategies for monitoring irrigation water quality. Following the analysis of 1,357 irrigation water samples for Escherichia coli, total coliforms, and physical and chemical parameters, the following key irrigation water collection approaches are suggested: 1) explore up to 950 m upstream to ensure no major contamination or outfalls exists; 2) collect samples before 12:00 PM local time; 3) collect samples at the surface of the water at any point across the canal where safe access is available; and 4) composite five samples and perform a single E. coli assay. These recommendations comprehensively consider the results as well as sampling costs, personnel effort, and current scientific knowledge of water quality characterization. These strategies will help to better characterize risks from microbial pathogen contamination in irrigation waters in the Southwest United States and aid in risk reduction practices for agricultural water use in regions with similar water quality, climate, and canal construction. HIGHLIGHTS • Microbial testing practices must be based on irrigation water-specific research. • Assaying sample composites is the most cost-effective best representation of microbial content. • Contamination events have 2-log10 reductions 950 m downstream. • Microbial concentrations are highest before noon. • Microbial concentrations are homogenous throughout the canal water column.

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Section: Field Analysis and Sample Collectionmentioning

confidence: 99%

Optimal strategies for monitoring irrigation water quality

Lothrop

Bright

Sexton

et al. 2018

Agricultural Water Management

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“…The ambulances are non-static environments that must be ready for service shortly after delivering the patient to the emergency department, hence offering limited time and equipment to clean and decontaminate [ 7 ]. In addition to logistic challenges, studies indicate that implementation of cleaning measures [ 7 , 8 ] and efficiency of cleaning [ 9 ] within the EMS vary. Moreover, pathogens have been found in both the ambulances [ 6 , 7 , 10 ], on uniforms [ 11 , 12 ] and on the hands of the providers [ 13 ], and the spread of microbes within the ambulance environment is a proven reality [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Prehospital infection control and prevention in Denmark: a cross-sectional study on guideline adherence and microbial contamination of surfaces

Vikke

Giebner

Kolmos

2018

Scand J Trauma Resusc Emerg Med

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BackgroundPrehospital acute care and treatment have become more complex, and while invasive procedures are standard procedures, focus on infection control and prevention is scarce. We aimed to evaluate guideline adherence, microbial contamination, and associated risk factors.MethodsIn a nationwide cross-sectional study, we evaluated guideline adherence to thorough cleaning (TC) once a day, and moderate cleaning (MC) in-between patient courses. Microbial contamination on hand-touch sites (HTS) and provider-related sites (PRS) was assessed by total aerobic colony forming units (CFU) and presence of selected pathogens, using swab and agar imprints. Also, microbial contamination was assessed in relation to potential risk factors.Results80 ambulances and emergency medical service (EMS) providers were enrolled. Adherence to guidelines regarding TC was 35%, but regarding MC it was 100%. In total, 129 (27%) of 480 HTS presented a total CFU > 2.5/cm2 and/or pathogenic growth, indicating hygiene failures. The prevalence of selected pathogens on HTS was: S. aureus 7%; Enterococcus 3% and Enterobacteriaceae 1%. Total CFU on the PRS ranged from 0 to 250/cm2, and the prevalence of pathogens was 18% (S. aureus 15%, Enterococcus 3% and Enterobacteriaceae 0.3%). Methicillin-resistant S. aureus was found in one sample, and Vancomycin-resistant Enterococcus in two. No Enterobacteriaceae with extended-spectrum beta-lactamases were recorded.ConclusionGuideline adherence was suboptimal, and many HTS did not comply fully with proposed standards for cleanliness. Pathogens were demonstrated on both HTS and PRS, indicating that the EMS may be a source of infection in hospitalized patients. Moreover, cleaning effort and time appears associated with microbial contamination, but a comprehensive investigation of risk factors is needed.

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“…Rago et al (5) found S. aureus in 69% (49/71) of ambulances serving a metropolitan area; 77% (77/100) of the isolates were resistant to at least one antibiotic, and 34% (34/100) were resistant to two or more antibiotics. Valdez et al (6) seeded two high-contact surfaces with a bacteriophage and found that the contamination was spread to 56% (27/48) of other commonly-touched surfaces that were examined, primarily by hand contact. Standard cleaning practices only partly reduced the contamination.…”

Section: Introductionmentioning

confidence: 99%

Ambulance disinfection using Ultraviolet Germicidal Irradiation (UVGI): Effects of fixture location and surface reflectivity

Lindsley

McClelland

Neu

et al. 2017

Journal of Occupational and Environmental Hygiene

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Ambulances are frequently contaminated with infectious microorganisms shed by patients during transport that can be transferred to subsequent patients and emergency medical service workers. Manual decontamination is tedious and time-consuming, and persistent contamination is common even after cleaning. Ultraviolet germicidal irradiation (UVGI) has been proposed as a terminal disinfection method for ambulance patient compartments. However, no published studies have tested the use of UVGI in ambulances. The objectives of this study were to investigate the efficacy of a UVGI system in an ambulance patient compartment and to examine the impact of UVGI fixture position and the UV reflectivity of interior surfaces on the time required for disinfection. A UVGI fixture was placed in the front, middle, or back of an ambulance patient compartment, and the UV irradiance was measured at 49 locations. Aluminum sheets and UV-reflective paint were added to examine the effects of increasing surface reflectivity on disinfection time. Disinfection tests were conducted using Bacillus subtilis spores as a surrogate for pathogens. Our results showed that the UV irradiance varied considerably depending upon the surface location. For example, with the UVGI fixture in the back position and without the addition of UV-reflective surfaces, the most irradiated location received a dose of UVGI sufficient for disinfection in 16 s, but the least irradiated location required 15 hr. Because the overall time required to disinfect all of the interior surfaces is determined by the time required to disinfect the surfaces receiving the lowest irradiation levels, the patient compartment disinfection times for different UVGI configurations ranged from 16.5 hr to 59 min depending upon the UVGI fixture position and the interior surface reflectivity. These results indicate that UVGI systems can reduce microbial surface contamination in ambulance compartments, but the systems must be rigorously validated before deployment. Optimizing the UVGI fixture position and increasing the UV reflectivity of the interior surfaces can substantially improve the performance of a UVGI system and reduce the time required for disinfection.

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Spread of infectious microbes during emergency medical response

Cited by 20 publications

References 33 publications

Optimal strategies for monitoring irrigation water quality

Optimal strategies for monitoring irrigation water quality

Prehospital infection control and prevention in Denmark: a cross-sectional study on guideline adherence and microbial contamination of surfaces

Ambulance disinfection using Ultraviolet Germicidal Irradiation (UVGI): Effects of fixture location and surface reflectivity

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