Environmental cleanliness of emergency ambulances: a prospective comparative study

Ms Tanya Somani1, Dr Paul Simpson1,2, Dr Kingsley Agho2, Mr David Morris1, Mrs Kathryn Hipsley1, Dr Liz Thyer2, Mr Damien Bartolo2, Ms Sarah Johnson2, Mr Adam Schrieber2, Mr Giuseppe  Fierravanti2

1NSW Ambulance, Rozelle, Australia,
2Western Sydney University, Parramatta, Australia


Traditionally, environmental cleaning of ambulances and equipment is the responsibility of paramedics.  In 2016 NSW Ambulance introduced the Make Ready Model (MRM), where by ambulances are routinely cleaned by trained, non-clinical support staff.  This study aimed to 1) provide a baseline level of ambulance cleanliness; and 2) compare the MRM to a traditional cleaning model (TCM).


A prospective comparative study was conducted comparing cleanliness of ambulances in the TCM to MRM.  Adenosine-triphosphate (ATP) bioluminescence testing was performed in a pseudo-randomised sample of ambulances.  Six ‘high touch’ areas within each ambulance were systematically sampled. The primary outcome was ‘overall bioburden’, measured in relative light units (RLU)Non-parametric tests were used to assess differences in RLU values between each of the test points, while Poisson multivariate regression was used to compare median overall bioburden between the two groups, adjusting for the confounder variable of 14-day ambulance workload.


Sixty-eight ambulances were sampled, 32 TCM and 36 MRM.  When comparing test points, the only high touch area showing a significant difference in RLU was the steering wheel (SCM 1578 v MRM 702; p=0.0012).  With regard to the primary outcome, the MRM was associated with a 35% unadjusted decrease in overall bioburden, and 38% reduction after adjusting for 14-day ambulance workload (ARR 0.62 (95%CI 0.61-0.63); p=0.001).


The innovative MRM suggests improved environmental cleanliness in ambulances, whilst contributing to effective infection control practice in paramedicine.  Future research should focus on cost effectiveness of the MRM and applicability to broader ambulance service provision.


Tanya Somani is an operational paramedic with 10 years’ experience with NSW Ambulance, having worked in both regional and metropolitan areas state-wide. Tanya has attained a Bachelor of Paramedical Science and a Graduate Certificate in Clinical Redesign, focusing on environmental cleaning in the out of hospital setting. Tanya is passionate about improving the working environment for paramedics and enhancing safer provision of care for patients by reducing the risk of healthcare associated infections.

Currently Tanya is working on Make Ready Model project which provides a dedicated environmental cleaning and logistics service for the preparation of ambulances under the Paramedic Response Network Program, and is currently studying to attain her IC credentialing.

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