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MRSA in the Ambulance

Nearly half of 21 ambulances in a single fleet tested positive for MRSA.

Transmission of methicillin-resistant Staphylococcus aureus (MRSA) is

becoming increasingly common in hospitals, through such fomites as stethoscopes,

blood pressure cuffs, and computer terminals. Gyms and prisons are other known

sites of MRSA colonization. Researchers assessed whether ambulances are

another source of MRSA contamination by collecting swabs from five areas within

each of 21 ambulances (16 advanced life support, 3 basic life support, and 2

critical care transport) at two stations from one urban fleet.

At 96 hours after plating, 13 samples isolated from 10 ambulances (12% of

swabs, 48% of ambulances) were positive for MRSA. Positive samples were obtained

from the steering wheel (1), patient stretcher (4), emergency medical

technician work area (7), and Yankauer suction tip (1). The authors note that

high

patient turnover rates and limited time for equipment sanitation could

contribute to MRSA contamination.

Comment: Greatly aided by inappropriate use of antibiotics, MRSA has become

ubiquitous, but finding it in ambulances is a condemnation of our current

sanitation practices and warns of an excessively casual attitude toward this

highly destructive organism. If these findings are reproduced in other emergency

medical systems, ambulances would represent an important reservoir for MRSA

transmission. Prehospital providers should focus decontamination efforts on

interior surfaces of ambulances as well as patient stretchers. Taking measures

to decrease transmission of drug-resistant organisms now is critical, before

other resistant organisms (such as vancomycin-resistant Enterococcus

faecalis) become more prevalent.

— Kristi L. Koenig, MD, FACEP

Published in Journal Watch Emergency Medicine June 8, 2007

Citation(s):

Roline CE et al. Can methicillin-resistant Staphylococcus aureus be found in

an ambulance fleet? Prehosp Emerg Care 2007 Apr-Jun; 11:241-4.

Pub Med Abstract

Prehosp Emerg Care. 2007 Apr-Jun;11(2):241-4.Related Articles, Links

Can methicillin-resistant Staphylococcus aureus be found in an ambulance

fleet?

Roline CE, Crumpecker C, Dunn TM.

town University School of Medicine, Washington, DC 20007, USA.

OBJECTIVE: To perform an initial screening study of methicillin-resistant

Staphylococcus aureus (MRSA) contamination in an ambulance fleet. METHODS: This

was a cross-sectional study of MRSA contamination in an ambulance fleet

operating in the western United States in June 2006. Five specific areas within

each of 21 ambulances (n = 105) were tested for MRSA contamination using

dacron swabs moistened with a 0.85% sterile saline solution. These samples were

then plated onto a screening media of mannitol salt agar containing 6.5% NaCl

and 4 mcg/mL oxacillin. RESULTS: Thirteen samples isolated from 10 of the 21

ambulances (47.6%) in the sample group tested positive for MRSA. CONCLUSIONS:

The results of this preliminary study suggest that ambulances operating in

the emergency medical services (EMS) system may have a significant degree of

MRSA contamination and may represent an important reservoir in the transmission

of potentially serious infections to patients.

PMID: 17454817 [PubMed - in process]

Louis N. Molino, Sr., CET

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