Do We Need an Evaluation Method On Microbial Contamination of the Contact Surface and Air Quality Inside the Ambulance for Improvement of the Control and Prevention Measure?

: Background: Ambulances carry the risk of contamination from any medical first aid treatment in confined spaces, as well as the internal air circulation system. Many countries have implemented measures to manage and ensure the safety against microbial contamination within ambulances, including regular cleaning and disinfection to eliminate pathogens from the air and contact surfaces. However, the efficiency of the current sanitization measures has not been evaluated. Aim: Investigating microbial contamination in the air and on the contact surfaces after the disinfection process according to the standard procedures prescribed in Thailand for ambulance areas. Methods: A surface swab sample test and air sampling test using the impaction method were performed in Basic Life Support Type (BLS) ambulances at the Ruamkatanyu Foundation Headquarters in Samutprakarn province, Thailand. Results: 70 surface samples and 20 air samples were collected. The frequent contact areas included: patient bed, patient bed handles, healthcare staff seats, and ambulance floor had been contaminated by bacteria with the concentration higher than 2.5 CFU/cm 2 . The seats of the medical staff were found to have the highest level of bacterial contamination at a high concentration of 64 CFU/cm 2 . Moreover, the total bacterial count in the air was 617 CFU/m 3 , which exceeded the World Health Organization (WHO) standard of the maximum level at 100 CFU/m 3 for healthcare facilities. Additionally, the highest count of total fungal amount in the inside air reached 641 CFU/m 3 . Conclusion: The cleaning and disinfection processes in the ambulances according to the standards set by the government had limitations in the real practice. Considering the effectiveness of both processes in practice, it still cannot comply with the standard criteria, and this can pose health risks to both patients and healthcare workers. The improvement of standard procedures and guidelines for evaluating the effectiveness in the cleaning and disinfection of the ambulances to enhance effectiveness is an urgent issue to be discussed and carried out.