Cab and Equipment Disinfection: An Update

The buzz in the industry has been “clean cab initiatives” and ways to reduce carcinogens and contaminants that promote bacteriological and virological disease in fire apparatus and ambulances. As more fire departments have been called to assist on medical responses during the raging COVID-19 virus pandemic, biosafety in emergency vehicles has become as serious a concern as preventing contact with identified cancer-causing agents.

Throughout this year, preventing the spread of COVID-19 has been the focus of government agencies and companies as well as families. This awareness increased the focus on the necessity of sanitizing and determining which cleaning methods are most effective.

Fire Apparatus Manufacturers Association (FAMA) member companies have been at the forefront of developing more advanced technologies. They include removing contaminants/carcinogens and disinfecting applications that can reduce pathogenic materials in these vehicles to “safe” levels. FAMA member companies have responded to the carcinogen decontamination (decon) need with revised clean cab design and enhanced field decon procedures and products.

At the Fire Service Occupational Cancer Symposium, sponsored by the Fire Service Occupational Cancer Alliance and affiliated with the National Fallen Firefighters Foundation, for example, attendees who participated in a survey following the vehicles and exposures workshop said: “If the cab is designed and built for easier cleaning, it will get cleaned more often and more thoroughly.” Heeding some of the suggestions these firefighters offered, FAMA member companies offered options that included new materials and designs that make it easier to clean seats, floors, and other surfaces; adding a plastic cover over the instrument panel; and removing compartments from cab interiors.¹

Our focus in this article is primarily on secondary decon, those efforts that go beyond wiping down vehicle interiors with specially designed cleaning solutions or disinfecting wipes and removing soiled linens and dirty equipment from the cab interior.

Evolution of Decon/Disinfecting Needs

Historically, most decon systems in the operating and prehospital settings were focused primarily on antibiotic-resistant bacteriological contaminants such as Methicillin-Resistant Staphylococcus Aureus (MRSA), Clostridioides difficile (C-diff), and vancomycin resistant enterococcus (VRE). Today’s concern is SARS-CoV-2, a virological pathogen that can lead to COVID-19; therefore, fire departments need products that also can mitigate virological threats.

FAMA-affiliated manufacturers offer a variety of technologies that are effective against a broad spectrum of bacteriological and virological threats. They include filtering the air, spraying a chemical into the air and on surfaces, and shining UV light on surfaces and in the air.

Today, there are many choices in the industry for treating the atmosphere and surfaces inside the fire apparatus. The options can loosely be categorized as follows:

1. Systems that pull contaminated/dirty air into the device, scrub particulates or contaminants from the air, and then return clean/disinfected air into the cab.
2. Systems that use a disinfecting light source to attack contaminants in the air and on surfaces inside the cab directly.
3. Systems that use technology to actively push disinfection out into the atmosphere, attacking contaminants in the air and on surfaces.

Choices of technology include ultraviolet lighting, UV-C lights, LED-based UV-C units, ionizers, photohydroionization, and combination systems with UV-C and HEPA air filtration.

When considering which system is most appropriate for your department, consider some key items as you evaluate the different technologies:

• What type of automation is included? Will operation of the system require user interaction on a regular basis?
• Is the chosen technology treating both the air and surfaces?
• If the technology is a light-emitting-based system, what is the impact on areas that are not directly exposed to the beam?
• Can the system be active/running while the vehicle is occupied? If the system necessitates that the vehicle be unoccupied, what is the time duration that the vehicle needs to be out of service to complete the disinfection cycle?
• Is the manufacturer an Environmental Protection Agency (EPA)-registered facility, and are there third-party tests showing what the technology is effective against?
• Importantly, focus not only on the current threat from SARS-CoV-2 but also on continuing threats from common viruses, pathogens, and carcinogens.
• What type of maintenance does the system require?
• Will the chosen technology have any negative impacts on the surfaces or equipment inside the apparatus?

Automation is a feature of some of these systems. One example is automatically irradiating between calls when no one is in the cab and logging decontamination cycles so that responders can use the logs for correlation against run reports to prove decontamination was completed between patient contacts.

Resources

The Centers for Disease Control and Prevention (CDC) (Table 1) has published guidelines fire departments and end-users can use to establish procedures and practices for protecting against communicable diseases. Among them is its checklist for emergency medical services (EMS) units that explains how to minimize the risks associated with vehicles. Among the recommendations are adequate training; the proper use of personal protective equipment (PPE) and respiratory protection devices; maintaining adequate supplies of hand sanitizer, cleaning supplies, EPA-registered disinfectants, and PPE; and establishing and following good internal standard operating procedures for cleaning equipment. Table 1 has the link to access this resource and links to other sources of information.

Table 1. Guidelines and Technology Resources

• CDC General Guidelines on Disinfecting Vehicles  https://www.cdc.gov/coronavirus/2019-ncov/community/organizations/disinfecting-transport-vehicles.html
• CDC Guidelines for EMS Workers  https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-for-ems.html
• CDC Disinfectant List  https://www.epa.gov/sites/production/files/2020-04/documents/disinfectants-onepager.pdf
• Federal Drug Administration: UV Lights for Disinfection  https://www.fda.gov/medical-devices/coronavirus-covid-19-and-medical-devices/uv-lights-and-lamps-ultraviolet-c-radiation-disinfection-and-coronavirus
• Lavender Ribbon Report Best Practices for Preventing Firefighter Cancer  https://www.iafc.org/docs/default-source/1vcos/vcoslavendarribbonreport.pdf?sfvrsn=13f88b0d_8

Tips for Maximizing Health Protection

• When selecting a decon or disinfection system, evaluate the effect of this technology on mitigating virological threats.
• Keep in mind that some lighting-based legacy bio-decontamination systems are ineffective on virological threats.
• Maintain a protocol for gross decon. Best Practices for gross decon developed by the International Association of Fire Chiefs’ Volunteer and Combination Officers Section and the National Volunteer Fire Council are documented in the Lavender Ribbon Report, https://www.iafc.org/docs/default-source/1vcos/vcoslavendarribbonreport.pdf?sfvrsn=13f88b0d_8/.
• Consider that no one system solves all the problems. Some systems filter air using HEPA filters, which reduce particulates and carcinogenic contaminants; others use UV-C light, which helps to mitigate the threat of pathogenic contaminates. Some systems use both filters and light.
• Ensure that internal procedures for sanitizing and cleaning are in place and that teams have the adequate amount and proper type of equipment for sanitizing work areas.

For additional information about the systems available to help keep your vehicles safe, contact a FAMA member company.

FAMA is committed to the manufacture and sale of safe, efficient emergency response vehicles and equipment. FAMA urges fire departments to evaluate the full range of safety features offered by its member companies.

FAMA Forum creative content is contributed by unpaid volunteer authors. Any opinions expressed herein are exclusively those of the author and are not intended to represent the views of FAMA or its member companies.