The media has reported a fair bit about MRSA in ambulances of late, one of my commenters has asked how the London Ambulance Service deals with patients who are MRSA positive.
(Note: I'm also writing this to avoid losing my job by posting about a family who have called an ambulance more than seven times in the past week for the same illness).
Primarily the problem is that we just don't know who are MRSA positive, MRSA is prevalent in the community, and I would suggest that most nursing homes have plenty of colonised residents. I remember working in hospital, having to swab everyone coming in from a 'high risk' environment, which basically meant anyone from a nursing home, or another hospital.
It takes time to swab and grow a culture (three days if I remember correctly), and each test costs a not inconsiderable amount of money.
If a patient is MRSA positive, then our infection control booklet tells us that we should use our 'personal protective equipment' (our uniforms) plus what are known as 'universal precautions' – essentially latex gloves.
To clean an ambulance after transporting an MRSA positive patient we use 'System 1' and 'System 2 or 3'.
System 1 – Detergent. System
2 – Chlorine spray System
3 – Alcohol.
So anything the patient has come in contact with is wiped with detergent, and then we either spray it with chlorine solution, or wipe down with alcohol wipes.
The other problem that we have is that we are so chronically overworked, that we often only have a little time to clean the ambulances. If you are having a heart attack, then you won't be impressed if all the ambulances on duty are off the road waiting to dry.
When the LAS do something, we often do it right. Our boss realised that the ambulances aren't as clean as they should be, and that road staff didn't have time to 'deep clean' ambulances every shift. The solution was to contract an outside firm who now cleans and stocks our ambulances for us and from what I have seen, they do a pretty good job.
So every night a gang of underpaid workers clean as many ambulances as possible. This 'make-ready' crew are paid a frankly pitiful £6 an hour, working from 1am to 6am they can clean around 16 ambulances a night using industrial cleaning materials. Every month they are quality controlled by random swabbing. So far they have only had good results.
So I personally think that the LAS is doing something positive and effective against the spread of MRSA
MRSA will never be eradicated, unless we force everyone at gunpoint to use alcohol gel after every physical contact (and this includes 'civilians') and enforce daily antibacterial showers for the entire population of, well, the entire world. But we can do our best to prevent the spread of MRSA (and other, nastier diseases).