Emergency medical services equipment hygiene practices

To determine whether emergency medical services (EMS) systems adhere to accepted equipment hygiene standards.

Mail surveys were sent to the physician medical directors of the EMS systems of the 125 most populous cities in the United States.

Eighty-five surveys (68%) were returned. Seventy-three (86%) of the responding services have a policy addressing equipment decontamination, and 32 of these (44%) have an accompanying quality assurance program. Seventy-nine (93%) utilize either alcohol or a commercial disinfectant (A/CD) on noncritical items when visibly contaminated with blood. However, only 32 of those agencies (41%) use soap and water in addition to A/CD. Another nine (11%) exchange contaminated items at the hospital, one (1%) uses other methods, and two (2%) respondents did not know. Seventy-six (89%) of the responding agencies perform endotracheal intubation. Of the 54 that decontaminate their own blades, 20 (37%) use soap and water in addition to A/CD, 32 (59%) use A/CD alone, and two (4%) use soap and water alone.

Adherence to accepted hygiene standards among EMS systems in our most populous cities is poor. Many systems do not use soap and water prior to A/CD. Failure to do so may minimize the effectiveness of disinfection. Several systems use A/CD or soap and water alone, neither of which meets current standards for high-level disinfection recommended for items that will come in contact with mucous membranes, such as laryngoscope blades.