Not enough time to clean. The ambulance services dirty little secret…

It seems such a shame that after the much-anticipated launch of Northern Ireland’s new Air Ambulance this month the service should find itself the subject of yet another negative article in the Irish News, this time regarding the condition of our road ambulances and stations.

The article reports on how a surprise visit by the Regulation and Quality Improvement Authority (RQIA) exposed a number of hygiene breaches in the two ambulance stations inspected, and more importantly in our ambulances. This will come as no surprise to frontline staff or indeed our managers – they have been acutely aware of the underlying issues for some time and will only be spurred into action as a result of this report and associated media coverage despite staff raising concerns over the past 2 years.

Our infection control policy is comprehensive and throughout the document it emphasises how we have a personal and professional responsibility to keep the highest possible hygiene standards to ensure a clean, safe working environment for both staff and above all, our patients. Failure to comply is, quite rightly, a potential disciplinary issue. However NIAS are failing in their corporate responsibility to provide the cleanest, safest environment for staff and patients by not allowing crews to clean vehicles in accordance with their own policy, knowingly putting patient health at risk and only now instituting remedial action due to this surprise inspection and subsequent negative press.

If proper procedure is followed, each ambulance should be cleaned by two staff once a week, inside and out, over a period of 2 hours. In the past two years I can only remember being stood-down to clean an ambulance THREE times and I am certainly not alone.  Due to the pressures on the service it is increasingly more difficult to stand down an emergency crew for 2 hours to undertake cleaning duties but operational requirements surely need to be offset by the need to keep ambulances clean and patients safe.

The cleaning of vehicles is logged by control, so managers definitely know the scale of the problem but have so far chosen to keep dirty ambulances on the road and compromise patient safety rather than finding another way of keeping our ambulances clean. We can clean our trolleys after every patient has been handed over but we have to resort to spot-cleaning whenever we have a spillage that comes in contact with the interior of the ambulance. Given the obvious nature of these spillages this is far from acceptable.

We are glad that the issue is now being heard in the public domain, all we ask for is a safe, clean environment for staff and patients. It is extremely frustrating to have had our concerns and complaints ignored on yet another vital issue, only to see action because of a surprise inspection and media whistle-blowing. How many other problems could be avoided if managers just listened to staff?

The Ambulance Service should be ashamed to fail on this very basic level of patient care. The first rule of medicine is “primum non nocere” – first, do no harm. The most basic way we can achieve this is by providing a clean, safe patient area. Not allowing crews the time to clean is harming patients and further eroding trust in the service.

If just one patient acquires an infection as a result of our treatment it is too many. We also have to think of staff welfare, especially in the context of our abnormally high sickness levels. I have just finished a run of four extremely busy 12-hour shifts. I never finished on time, and on 3 of these days I did not get a break until the 9th hour of the shift. I am now home, exhausted and with diarrhoea. The combination of over-worked, run-down staff and dirty ambulances is a recipe for disaster and is bound to also affect patients and our families.

As I watched the news coverage of our new Air Ambulance being launched at the start of this month I was more than a little bemused at the spectacle of politicians and headquarters staff as they  jostled for position next to the shiny new helicopter, eager to be associated with our sexy new trauma service. It is depressing to see the enthusiasm and energy directed into a helicopter when our managers can’t ensure the most basic level of cleanliness in an ambulance.

The Air Ambulance was a breath of fresh air, a positive news story for once. We do not want to see any more negative press coverage about the service. The recurrent theme through all my articles has been on the need for staff engagement. We are really encouraged by the approach of our new Chief Executive but have yet to see much positive interaction with our managers. Let’s start listening to staff, acting on their concerns and above all, keeping patients and staff safe.

The post was written by a serving paramedic.

This is a guest slot to give a platform for new writers either as a one off, or a prelude to becoming part of the regular Slugger team.