Ambulances - weak link in the fight against MRSA

Sep 6 2005

Targets, time and money pressures create a lethal cocktail that could allow superbugs to thrive in our ambulances said UNISON, the UK's largest health union, this week.

Ambulance cleanliness is a key factor in the battle against MRSA, and other superbugs and the government's failure to tackle this issue is a major flaw in infection control policy.

As ambulances transport patients throughout the NHS there is a danger that the very vehicles designed to save lives are spreading lethal diseases.

UNISON is calling for set ambulance cleanliness standards to be properly applied and monitored, after investigations into ambulance cleaning practices across the UK, revealed that many ambulance workers are worried about the infection risk posed by their vehicles.

The London and Scottish Ambulance Services are at the top of the list for taking infection control measures seriously, in contrast ambulance crews in Wales and the East Midlands complained that cleaning was "pretty rough and ready".

Karen Jennings, UNISON Head of Health said:

"Effective infection control cannot stop on the hospital steps. UNISON raised the alarm with the Healthcare Commission last year about the lack of joined up thinking in relation to infection control and ambulances.

"It's clear that ambulances are potentially the weakest link in the fight against MRSA and other superbugs and we need national standards to be applied more rigorously and staff properly trained in effective procedures to close this loophole.

"In theory there is guidance on infection control from the joint national Ambulance Health and Safety Committee among others, but in practice ambulance crews do not always have time between emergency calls to keep their vehicles clean and infection free."

UNISON's investigation shows most ambulance crews are still responsible for cleaning their own vehicles and for some that means deep cleaning doesn't get done, or is only done on a very irregular basis. Ambulance stations may have colour coded mops and buckets for different areas, but they use a bewildering variety of cleaning materials and methods. As one ambulance worker put it - "you mop out at the beginning of the shift and then wipe it as you go along".

Most ambulances carry some cleaning equipment and, if there is no time to get back to the depot with a contaminated vehicle, the crew is expected to clean it as best they can. London Ambulance Service is rolling out a "make-ready" scheme where if an ambulance becomes contaminated, crews can take their vehicle back and swap it.

Karen Jennings went on to say:

"This is a good system but requires spare ambulances and dedicated cleaning staff - and that costs money. Ambulance Trusts should employ in-house cleaners to ensure quality cleaning and this would free up ambulance crews to get on with their job, dealing with emergencies and caring for patients.

"Time and time again money comes up as the root cause of the failure to address today's cleanliness problems in the NHS. The Government continues to ignore the obvious evidence that the increase in hospital acquired infections is directly related to the halving of hospital cleaning staff through privatisation. It would be further folly to pretend that dirty ambulances are not an issue either.

"The evidence points to short-term financial considerations as a prime factor in the Government's approach. However, this is a false economy. We need joined up thinking because superbugs kill around 5,000 people and infect over 100,000 each year. Dealing with these infections costs the country more than £1bn a year, whereas good prevention practice would cost a fraction of this and, most importantly save lives."

Comments from ambulance crews across the UK:

Paramedic - Wales Ambulance Service "Crews do what they can and carry out routine cleaning between 999 calls but there is a difference between looking clean and being deep down clean. It can be very muddy and difficult to clean up on a Sunday morning after picking up mountain bike casualties or injuries from rugby or football games."

Paramedic - East Midlands Ambulance "If you picked any ambulance across the country and took a swab, people would be horrified at the results. At one time we used a chemical bomb that could get into all the corners, but these are now considered dangerous and we don't have an effective alternative.