Ambulance sanitation in Italy: a pilot study

Abstract

Abstract
 Introduction: the assessment of biological agents' exposure in the work environment is an employer's duty. Air and surfaces could be transmission's vehicles of pathogens. We consider the ambulance as the work environment where, respecting hygienic targets of low risk, we can prevent out-of-hospital infections for workers and patients. Our study analyzes standard sanitation and fumigation; the aim is to reach the lower level of surfaces' contamination. 
 Materials and Methods: we chose, thanks to bibliography, three points of sampling: stretcher, oxygen knob and backdoor's handle. The points were tested before sanification on three different ambulances. We made thus standard sanitation with Sodium Hypochlorite on two ambulances and fumigation on the other one. After that, we sampled the same three points on each ambulance. Samples were analyzed with standard culture methods after 72 hours. 
 Results: first samples showed a high bacterial load on every surface. Both standard sanification and fumigation showed success in decreasing bacterial load. Without approved rating standards for ambulance's hygiene we refer to ISPESL's Guidelines about safety and hygiene in surgical wards. Here the standard is 50 cfu/sample, referred to a surface of 20 cm², without pathogens. 
 Discussion and Conclusions: our analysis is just quantitative, further qualitative analysis should be conducted in order to assess pathogens on ambulances. Both standard sanitation and fumigation show success in decreasing bacterial load however with higher levels than those indicated by guidelines. Further analysis would be needed to define load standards in order to ensure a safe environment for workers and patients.