In the beginning of the pandemic, it took some time to figure out the virus, and how to properly manage and transport those with Covid-19. Luckily, we were able to figure that out sooner rather than later. The next issue on the table was cleaning! The questions were: how do we properly clean these aircraft? How do we know they are clean? Do we need to bring an outside company in to clean it? All are valid questions and concerns that everyone should have, especially if you are flying inside these aircraft on a routine basis.

Cleanliness standards

Prior to the pandemic, the cleaning product that we used to disinfect our interiors and medical equipment was Cavicide™. Cavicide™ is an intermediate-level surface disinfectant. It is proven to be effective against viruses such as TB, HIV, HBV, MRSA and VRE. We would spray the areas and allow for a three-minute dwell time and then wipe the area clean.

The question then is, how do we know it’s clean? In the air ambulance industry, we do not have the luxury of easy and ready access to laboratory facilities for swabbing. For this reason, we decided at REVA to utilize the Hygiena System SURE Plus ATP monitoring system.

This is a proven system used in the food industry to validate sanitation systems to make sure the industry is free of pathogenic agents. By utilizing the ATP testing system, we can determine the effectiveness of our cleaning immediately after we are done wiping down the aircraft. We receive immediate and accurate results, allowing us to maintain a certain standard of cleanliness.

For an entire year prior to the pandemic, we utilized Cavicide™ as our main disinfectant post-flight and utilized this ATP testing system to determine the level of sanitation. The results throughout the year were both outstanding and reliable. The areas consistently swabbed were the patient stretcher, drink rail next to the patient, wall next to the patient and the floor. Post-flight, after cleaning the aircraft with the disinfectant, the results passed and indicated the areas were appropriately sanitized.

CDC recommendations

We, as a medical management team, felt very strongly that Cavicide™ would be an ideal disinfectant during the Covid-19 outbreak. Early in the pandemic, the US Centers for Disease Control and Prevention (CDC) recommended the use of EPA (Environmental Protection Agency) disinfectants in List N to be used during the pandemic. Cavicide™ is currently listed in EPA List N.

After our first couple of Covid-19 transfers, we were extremely diligent with cleaning the aircraft. We would wear the appropriate personal protective equipment (PPE) and spray the entire aircraft down, and test before and after. As part of our standard protocol post-flight, the medical team had to disinfect the entire aircraft with the Cavicide™, even if the patient was not a confirmed Covid-19 case. In an effort to make sure we were doing everything to maintain a clean environment, we also utilized an outside cleaning service that would biostatic spray the interior of the aircraft after Covid-19 transfers, as well as the portable isolation units used for the mission. For these cases, the medical teams still disinfected the aircraft prior to the cleaning service arriving.

We were very pleased with the results of the biostatic spraying, as the sprayer was able to get disinfectant into areas that are typically difficult to get to with a simple cleaning cloth and spray bottle. In addition to our ATP testing being done, we also noticed that the cleaning company was using the same testing method to evaluate how well they were disinfecting.

Company investment

Many discussions were had, and we ultimately decided as a company to purchase our own biostatic sprayer. In the beginning of the pandemic, these devices were nearly impossible to purchase and none were available. Fast-forward to the end of summer, and we were easily able to obtain one. With the purchase of the biostatic sprayer, we have been able to perform the spray in-house, immediately post-flight. The crews are trained on how to properly use it, and how to perform ATP testing post-clean. We are also able to utilize Cavicide™ in our sprayer, which is nice because we know it works in disinfecting our areas.

Crew safety is paramount

So far, we have successfully transferred over 40 Covid-19-infected individuals in our fixed-wing aircraft.

During this time, not a single medical crew member or pilot has contracted Covid-19 because of transferring a Covid-19 patient. PPE is very important, but taking the time to make sure that the area we work in is clean is equally as important. Making sure that the aircraft are clean, and everyone feels comfortable entering the aircraft, is extremely important to us. All our staff should feel comfortable entering our aircraft at any time, and they do.

We have extensive protocols for cleaning the aircraft and medical equipment post-flight. It was important that we shared these protocols with the rest of the company as well. Allowing our aviation and maintenance departments to have a thorough understanding of our cleaning process has also made all of them feel comfortable, and confident that we are keeping them safe. It is crucial now more than ever to have these policies in place.

We encourage anyone who does not have these policies to begin working towards developing them for their company and staff.