Ambulances or sanitary transport transport daily to sick people who may have suffered accidents or who have acquired some type of infectious disease.
To ensure the safety of health personnel traveling in the ambulance and that of the patients themselves, we must resort to cleaning and disinfection that guarantee the total elimination of infectious microorganisms or fluids.
Below, we highlight some cleaning protocols that must be followed to ensure that ambulances are available in the shortest possible time and in optimal conditions for use.

Basic principles for cleaning and disinfection in ambulances

To perform the cleaning in an ambulance the following rules must be followed:

Remove the metal objects and treat them separately to prevent oxidation.
Wash the cleaning material with water and detergent and replace it when necessary.
Consider biosafety standards to minimize risks.
Ventilate the ambulance, opening the doors and windows for about 15-30 minutes in an outside place and little traffic.

For disinfection we will consider three possible options depending on the level of risk of infection:

Critical surfaces, such as surgical material, will be disinfected by sterilization.
Semicritic surfaces, such as intubation equipment, will be treated by high-level disinfection.
Non-critical surfaces, such as wedges or stethoscope, will intervene with an intermediate level disinfection.

Cleaning and disinfection of the interior of the ambulance

To proceed with the cleaning of the interior of the ambulance we must previously remove all moving objects.

Next, the floor, ceiling and other surfaces will be cleaned with mops or cloths of nonwoven fabric impregnated in a solution of water and detergent.
The metal surfaces will be rinsed with water and dried immediately to prevent oxidation.
The disinfection will be carried out taking into account the classification of the previous point. All ambulance surfaces, including driver’s seats and belts and co-drivers, will be treated.

Once the cleaning and disinfection has been carried out, we must wait about 30 minutes before allowing access to the interior of the ambulance.

Cleaning and disinfection of medical devices

Medical devices will also be treated with a solution of water and detergent for about five minutes and then rinsed with a damp cloth.
All medical devices that need to be sterilized will be removed in a suitable bag to be treated in a space exclusively for sterilization.
In order to leave the ambulance provided with the necessary material for the next service, these will be replaced by newly sterilized or new devices.
Those medical devices considered critical, such as the stethoscope, will be disinfected with alcohol at 70 °.

Cleaning and disinfection of the stretcher
To carry out the hygiene of the stretcher, probably the element that establishes the most contact with the patient, we must remove the sheet and store it in a suitable bag.
The surface of the stretcher will be washed with liquid detergent, including railings, seat belts and legs.
This solution will be allowed to act for about 5 minutes and will be rinsed with a damp cloth a minimum of three times.
For disinfection, we will use a chlorinated or ammonium-based solution and let it act for 10 minutes.

In the case that we use sodium hypochlorite, we will apply a damp cloth to prevent oxidation.
Finally, clean sheets and blankets will be placed to cover the next service.

Cleaning and disinfection of ambulance furniture

The drawers, lamps and paper and soap dispensers are also part of the ambulance and, therefore, also respond to a specific cleaning and disinfection protocol.
In general, the furniture will be cleaned with a detergent solution, rinsed with a damp cloth and disinfected with sodium hypochlorite or alcohol at 70º depending on the level of infectious risk present.
As regards soap dispensers, they must be disassembled for a more thorough cleaning and, if deemed necessary, will be sent to the sterilization center.
Of course, the disposable material will be collected in a suitable bag and replaced by new material.

Cleaning and disinfection in ambulances minimizes the risks of the patient’s condition getting worse or that his stay in the hospital is prolonged.

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Studies have shown that proper hand washing can effectively prevent the spread of disease. Autumn and winter seasons are high seasons for a variety of infectious diseases, and the prevention of these diseases can be effectively prevented by strengthening hand hygiene.

What should I pay attention to when washing my hands properly?

Always use running water when washing your hands. Do not use basin water. It takes at least 15 seconds to wash your hands. You can’t just wash your hands with water. Use soap or hand soap to remove pathogens. In addition, the soap should be kept dry during use, and the soap box should be cleaned in time. If the bottom of the box can not be kept dry, bacteria will also grow in a humid environment. In addition, it should be noted that many people share the soap and are not hygienic.

Misunderstanding of hand washing

Myth 1: All hand sanitizers can be sterilized

Hand sanitizers are mainly classified into common type and antibacterial type, so not all hand sanitizers have a bactericidal effect. In the antibacterial and germicidal hand sanitizer, the antibacterial type has a bactericidal effect, but the sterilization rate is relatively low, generally more than 90% can be labeled as an antibacterial effect, and the bactericidal hand sanitizer requires a sterilization rate of 99.99% for the target bacteria.

Myth 2: Wash hands with disposable hand sanitizer

With a disposable hand sanitizer, there will always be substances left on the surface of the hand, so use them as little as possible. It is best to wash your hands with running water and soap. In addition, many people use the “saving” wipes instead of washing their hands before eating. Experts pointed out that wet wipes can not replace hand washing, how to wipe the wet wipes repeatedly, and can not remove bacteria on the surface of the skin.

Myth 3: The more you use the hand sanitizer, the better.

Many people are afraid that they can’t be cleaned, so press a lot of hand sanitizer on the hand and wash it hard. In fact, such deep cleaning can damage the skin, so that the skin not only can not retain moisture, but also easier to invade the bacteria.

Myth 4: Wash your hands with a wash basin

Many people think that washing hands with a wash basin can also wash your hands. In fact, after repeated washing, the water in the wash basin is dirty. Wash your hands with dirty water, your hands are still dirty, and you won’t be able to wash your hands. Even many people use a basin of water to wash their hands, and the degree of contamination is even more serious.

Myth 5: Dry your hands with a towel after washing your hands

Dry hands or dry with a disposable paper towel after washing hands. It is best not to use a towel, because the towel is easy to hide the germs, it is easy to make the washed hands contaminated with germs, not to use public towels.

Misunderstanding 6: Do not wash your clothes after drying your clothes

Dirty clothes and bacteria in the washing machine will be contaminated on the clothes during the washing process. During the process of drying clothes, the hands are likely to be stained with these bacteria. After the clothes are exposed to ultraviolet rays, they can eventually achieve the purpose of disinfection, but the hands are often ignored.

Seven steps to properly wash your hands

The first step: wash your palms. Moisten your hands with water, apply hand sanitizer (or soap), palms, and close your fingers.

Step 2: Wash the back side finger joints. The palms of the hands are rubbed against each other along the back of the fingers, and the hands are exchanged.

The third step: wash the palm side finger joints. The palms are opposite, and the hands cross each other along the fingers.

Step 4: Wash your fingers. Bend each finger joint, and put the back of the finger in the palm of the other hand and rotate it with both hands.

Step 5: Wash your thumb. With one hand holding the other hand, the thumb is rotated and the hands are exchanged.

Step 6: Wash your fingertips. Bend each finger joint, close the fingertips and rotate it in the palm of the other hand, and exchange the hands.

Step 7: Wash your wrists and arms, rub wrist, arm, hands exchange.

Under what circumstances should I wash my hands?

1. Prepare food and contact with raw meat;

2, before meals (feeding), before taking medicine;

3. After contacting the coins;

4. After contacting others, especially after going to the hospital or after contacting the patient (before);

5. After the cleaning work is completed, the garbage is disposed of;

6, outdoor sports, homework, after shopping;

7. After the outdoor play is contaminated with dirty things;

8. After contact with blood, tears, sputum, sputum and saliva;

9. Before holding a child, especially those who have been exposed to infectious materials, they must be disinfected and washed repeatedly;

10. After touching the pet.

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1. Disinfected dose
The disinfecting dose is the basic condition for killing microorganisms, which includes both disinfection intensity and time. The disinfection intensity refers to the temperature when it is thermally disinfected; when it is chemically disinfected, it refers to the concentration of the substance; when it is disinfected by ultraviolet rays, it refers to the intensity of ultraviolet radiation. In general, increasing the intensity of the disinfection treatment can increase the speed of disinfection (sterilization); while reducing the time of disinfection can also reduce the disinfection effect. Of course, if the disinfection intensity is reduced to a certain extent, even if the time is extended, the disinfection purpose is not achieved.

2. Species and quantity of microbial contamination
Different types of organisms have different effects on their disinfection. In addition, the amount of microorganisms also affects the disinfection effect, so the type and amount of microbial contamination should be considered before disinfection. In general, the stronger the resistance of microorganisms, the more serious the pollution, and the more difficult it is to disinfect.

3. Temperature effect
In addition to thermal disinfection relies entirely on temperature to kill microorganisms, various other disinfection methods are also affected by temperature changes. In general, the temperature is better as it is in physical disinfection or disinfectant. The extent of the effect of temperature changes on the disinfection effect often varies with the method of disinfection, the type of drug and the type of microorganism, and is generally expressed by the temperature coefficient.

4. Relative temperature
The influence of the relative humidity of the disinfection environment on the gas disinfection and fumigation disinfection is very obvious. If the temperature is too high or too low, the disinfection effect will be affected, and even the disinfection failure will be caused. The relative humidity of indoor air formaldehyde fumigation should be 80–90%, the relative humidity of small ethylene oxide disinfection treatment should be 40–60%, and the large disinfection (>0.15 cubic meters) should be 50%–80%. . In addition, the ultraviolet light has a strong bactericidal power below 60% relative humidity, and the sterilizing power is reduced by 30%-40% at 80%-90%, because the relative humidity increases to affect the penetration of the ultraviolet ray.

5. PH (pH)
Changes in pH can directly affect the effectiveness of certain sterilization methods. On the one hand, the effect of pH on the disinfectant itself reduces or increases the activity of the disinfectant; on the other hand, the effect of pH on the microorganisms. For example, when glutaraldehyde is raised from 3 to 8, the bactericidal effect is gradually enhanced; while in hypochlorite solution, when the pH is increased from 3 to 8, the bactericidal effect is gradually decreased; chlorhexidine and quaternary ammonium compounds The bactericidal effect is large in an alkaline environment.

6. Organic matter
Organic substances in the disinfection environment can often inhibit or reduce the sterilization ability of disinfection factors, especially the sterilization ability of chemical disinfectants. This is because on the one hand, the organic matter is surrounded by microorganisms, which protects the microorganisms and hinders the penetration of the disinfection factor. On the other hand, in the chemical disinfectant, the organic matter itself can also consume a part of the chemical disinfectant through the chemical reaction. Various disinfectants are affected by organic substances. For example, in the presence of organic substances, the bactericidal effect of chlorine-containing disinfectants is significantly reduced; the disinfection of quaternary ammonium salts, biguanides and peroxy compounds is also affected by organic matter. However, disinfectants such as ethylene oxide and glutaraldehyde are less affected by organic substances. If organic matter is present, the amount of disinfectant should be increased.

7. Antagonistic substance
For chemical disinfection methods, attention should be paid to the neutralization and interference of antagonistic substances. For example, the action of quaternary ammonium disinfectants can be neutralized by soap or anionic detergents; acidic or alkaline disinfectants can be neutralized by alkaline or acidic substances, reducing their disinfection.

8. Penetration
When the item is sterilized, the bactericidal factor must act directly on the microorganism itself to sterilize. Different disinfection factors have different penetrating powers. For example, dry heat sterilization is inferior to wet heat penetration; formaldehyde steam sterilization is less penetrating than ethylene oxide; UV disinfection can only act on microorganisms on the surface of objects and shallow liquids, and a piece of paper can make it bactericidal. Reduce by more than 95%.

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Do you know how hard the human society’s understanding of the health of the opponents has gone through?

150 years ago, there was no concept of “sanitization and sterilization” in the world; the doctor dissected the body in one second, and immediately performed other operations in the next second, without changing clothes or washing hands.

What prevented this scene from continuing was the Hungarian obstetrician Ignaz Semmelweis (Ignaz Semmelweis).

Hungarian Obstetrician Ignaz Semmelweis

In 1846, Ignaz Semmelweis was appointed to the head of the First Obstetrics and Gynecology Clinic affiliated to the Vienna General Hospital, which also had another second obstetrics clinic. As the total hospitalization of the first obstetric clinic, he was surprised to find that the first obstetric clinic had a maternal mortality rate of 10% due to fever, but the second was less than 4%.

This caused Ignaz Semmelweis to question: the two facilities are equipped with the same facilities, why is the death rate so different?

After the data was known to the public, the people suddenly “talked about the color change in the first clinic.” Some of them were pregnant and they would cry to the first obstetric clinic. They couldn’t be screwed up. They would rather be born on the road, so they would not have to go to the clinic. Can enjoy other benefits.

To subvert his idea, the proportion of maternal women who are born on the street is lower because of calving fever. “It is reasonable to say that the outside environment should be more dirty. Is there a deadly virus in the hospital?”

After careful investigation and coincidence, he focused the crux on the medical staff.

It turned out that the first clinic was a teaching hospital, which was responsible for teaching tasks. The staff needed to dissect the body to give lectures. Sometimes the hand that had just been dissected had to help the mother to deliver the baby. The second clinic was mostly an obstetric medical student who did not touch the body. The incidence of calving fever is lower.

Another way of saying this is that one of his colleagues died of sepsis after accidentally cutting his hand at the autopsy, which made Semmelweis aware that it was possible that the substance in the hands of doctors and interns had caused calving fever. He named this unknown substance pale particles. )

To this end, Ignaz Semmelweis proposed that all medical staff wash their hands with chlorine-containing disinfectant water before the treatment. After everyone made his request, the maternal mortality rate dropped below 2%.

What is incredible to the contemporary people is that the Vienna General Hospital does not recognize the discovery of Semmelweis, because they felt that his discovery was insulting the hospital’s honor, and he did not renew his work contract and swept it out.

Moreover, his family did not understand him and support him. Finally, his family deceived the “father of hospital infection control” into a mental hospital where he was beaten in a mental hospital and died of sepsis, at the age of 47.

In the 1870s, the microbiologist Pasteur discovered streptococcus, and the idea of ​​Ignaz Semmelweis began to receive attention. The medical community also confirmed that hemolytic streptococcus is a key pathogen in the occurrence of sputum fever, and iatrogenic factors, The lack of disinfection and cross-infection in the hospital is an important cause of transmission. The concept of “hand disinfection” has since entered the medical profession, and “hospital infections” have received increasing attention. As a result, the “hand disinfection” program has saved countless lives.

100 years later…

In 1961, the United States began requiring medical staff to wash their hands with soap before and after receiving patients.

Hand hygiene is the most cost-effective way to prevent hospital-related infections!

The hand is the most important way to spread hospital infections;

It is estimated that you can save 1,000,000 lives of sick people by washing your hands every year! (from the World Health Organization WHO network)

Since 2009, the World Health Organization initiative launched May 5th each year as World Hand Sanitation Day, which aims to emphasize the importance of improving the hand hygiene of medical staff and reducing iatrogenic infections during medical care.

Proposed by the World Health Organization on May 5, 2019

Slogan:

1. Everyone’s cleaning care – just in your hands

2. The medical workers: “Leading clean care – is in your hands.”

3. Infection prevention and control leader: “Monitoring infection prevention and control standards – taking action to improve practice.”

4. Medical institutions: “Does your institution meet WHO’s infection control and hand hygiene standards? Participate in the WHO 2019 survey and act!”

5. Health sector: “Is your country meeting the standards for infection prevention and control? Monitor and act to achieve quality universal health coverage.”

6. Patient advocacy organization: “Requires cleansing care – this is your right.”

After WHO launched the “Clean and Safer” plan, there are 10 reasons why you should also be involved:

1. Keeping your hands clean at the right time saves your life.

2. Maintaining hand hygiene in health care has saved millions of lives in the past few years.

3. Hand hygiene is a quality indicator of a safe healthcare system.

4. Problems such as health care-related infections are often intangible but still occurring. These are the political and social challenges we must address now.

5. Good hand hygiene can prevent infection, and less than $10 can prevent patients and health workers from being harmed.

6. There are already affordable life-saving technologies available! The ethanol-based hand sanitizer is about $3 a bottle, which prevents health care-associated infections and prevents millions of deaths every year.

7. There is a theme tag in the media – #handhygiene, which indicates that hand hygiene is an important issue due to health care-related infections or due to fatal diseases such as Ebola.

8. Incorporate specific moments in the implementation of hand hygiene measures into the workflow of health care workers, so that the right actions can be taken every day and every day.

9. Prevention of infection is the key to strengthening the health care system. Hand hygiene is essential for all interventions, whether insertion of invasive devices, management of surgical wounds, or injections.

10. This social initiative has been promoted with the help of a successful global campaign entitled “Save Lives: Clean Your Hands” to promote hand hygiene in patient care settings.

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