More often than not, the patient compartment of your ambulance won't require more than a quick wipe-down after a call. Your gurney, though, will always require a thorough cleaning, and sometimes, other equipment will, too. After particularly messy calls, you may need to do an extensive cleaning of all surfaces and equipment.

In this guide, we'll walk you through the basic principles and techniques of cleaning your ambulance, whether after a routine call or a major biohazard. Your particular company or agency may mandate slightly different procedures, but this guide should give you an idea of what to expect.

Essential Definitions

You may often hear the terms cleaning, decontamination, and disinfection used interchangeably, but they each refer to different things.

• Cleaning refers to the process of removing dust, dirt, and other detritus that isn't (or isn't likely to be) contaminated with disease-causing pathogens or biohazards, but can nonetheless pose health hazards to your patients.
• Decontamination involves removing most (but not all) pathogens and biohazards from surfaces and equipment using bleach, CaviCide or other cleaners, such that a healthy person is unlikely to be adversely affected by coming into contact with them. Note that decontamination alone is not sufficient to render surfaces and equipment sanitary or sterile—it just gets them "pretty clean."
• Disinfection cleans surfaces and equipment with a chemical or process, such as autoclaving, designed to kill or inactivate virtually all disease-causing microorganisms.

With these definitions in mind, let's review the standards of cleanliness for your ambulance and equipment.

• The cab of your ambulance, as well as the floor and seats of the patient area, should always be clean, but it's not necessary to constantly decontaminate or disinfect them. Doing so once daily and after exposure to biohazards should suffice.
• Your gurney, equipment cabinets, and any gear that comes into direct contact with your patients but doesn't break the skin should be decontaminated regularly, at least once daily. Examples include your defibrillator, blood pressure cuff, stethoscope, and pulse oximetry sensor.
• Any surfaces or equipment that become contaminated by biohazards should be thoroughly disinfected before being placed back in service. If your department has reusable equipment such as scalpels, these should be disinfected after each use as well, but virtually all EMS agencies use disposable versions of tools designed to break the skin.

Put Yourself First

Always wear personal protective equipment (PPE) — gloves, at the least — even when only a light, routine cleaning is necessary. More extensive biohazards may warrant more extensive PPE. Shop Personal Protective Equipment

Establish Decontamination Zones, If Necessary

In the event of a particularly large or dangerous biohazard, you'll need to set up hot, warm, and cold zones to properly decontaminate your ambulance and protect your crew.

• The hot (or exclusion) zone is where the known contaminants are. Personnel in this area must wear PPE appropriate for the type of biohazard.
• The warm (or transition) zone is an area reserved for decontaminating personnel and their equipment once they've left the hot zone.
• The cold (or support) zone is free of contaminants and is used for planning, staging, and disposal of non-hazardous materials.

It's critically important to know and respect the different purposes of these three zones. You shouldn't move between them any more than necessary to minimize the potential for the biohazard to contaminate new areas.

At no time should you move directly from the hot zone to the cold zone. The proper flow of people and equipment is a one-way street from hot to warm, from warm to cold, and from cold to hot. Your company or agency will provide exact guidelines for details such as required PPE and the minimum distance between zones.

General Cleaning Strategies

The following decontamination procedures apply regardless of whether hot, warm, and cold zones are necessary. Depending on the extent of contamination, it may be necessary to take your ambulance out of service until it's back in top shape. Similarly, consider replacing particular equipment if cleaning it will take a substantial amount of time.

Clean Big Messes and Essential Equipment First

Once you're ready to climb into your truck and start cleaning, be careful not to track in dirt, mud or other contaminants from outside the vehicle. Pull your gurney out of the ambulance and clean it outside and in a fully unfolded position, but still within the hot zone (if applicable). Inside the ambulance, use towels or paper towels to soak up any large volumes of liquid first and dispose of them in biohazard bags or containers. Then collect and dispose of any large, solid, hazardous materials, such as used IV tubing.

Next, start cleaning from the top of your ambulance to the bottom so that contaminants don't drip or fall from higher surfaces onto those you've already cleaned. If your ambulance was exposed to a particular pathogen or hazard, and you know what it is, use a cleaning agent designed to kill it or halt its growth, if one is available. Otherwise, use a general-purpose cleaner such as CaviCide.

Detail-Oriented Disinfecting

Pay special attention to fixtures and equipment that are shaped or positioned in such a way as to make contamination less obvious. Check the underside and backside of your defibrillator, the bottom surfaces of the seats and gurney, and the tracks in your supply cabinets, if they have sliding doors. Scrutinize hinges, zippers, buckles, straps, doorknobs, the bottom of your drug box, and anywhere else that droplets or particles might be hiding.

It may seem like overkill to check and clean so many surfaces after every call, but once you do so several times, you'll develop a quick and efficient routine that should take only a few minutes. Also, for routine calls that present no obvious biohazards, you don't need to clean areas such as the interior of a locked cabinet that was never opened. It's generally fine to clean these areas on a daily or weekly basis.

Tidy Up and Restock

Once you thoroughly cleaned up and disposed of all hazardous substances and wiped down the surfaces that were exposed to them, make another pass for general cleaning. Throw away food wrappers and paper waste, empty the trash cans, and wipe down the floor, walls, and seats one last time for good measure. EMS work is dirty work; your ambulance will never again look like it just rolled off the factory floor, but it should be clean enough to meet your patients' expectations of professionalism.

Finally, do a quick inventory check and restock any supplies that you used during the call or that are below minimum stock levels. Wash your hands thoroughly and, if necessary, change your clothes or take a shower. Properly document any unusual or dangerous hazards that you encountered, along with the specific cleaning agents you used.

Resources and Further Reading

Your local medical director will have precise guidelines regarding the specific procedures, cleaning agents, and reporting methods you should use. These vary from one area to another, but the following resources should serve as good starting points.

• CDC guidelines for disinfecting an ambulance exposed to Ebola (or other highly infectious diseases)
• APIC (Association for Professionals in Infection Control) guide to infection prevention for EMS provider (see Appendix A for ambulance cleaning guidelines)
• Selected EPA-Registered Disinfectants