Limpeza e desinfecção de superfícies clínicas de alta incidência ao toque em ambulâncias do Serviço de Atendimento Móvel de Urgência

Abstract

In Brazil, the control of microbiological contamination in mobile pre-hospital settings remains largely unexplored, despite its importance for the prevention of healthcare-associated infections. In this context, the cleaning and disinfection of ambulances play a fundamental role in ensuring the safety of patients and healthcare professionals. However, there is a scarcity of national studies on surface contamination in these settings, with a predominance of research in hospitals using multiple evaluation methods. Internationally, prehospital studies generally feature small sample sizes and the use of a single assessment method. Furthermore, there is a gap in the assessment of the knowledge, attitudes, and practices of Mobile Emergency Care Service professionals regarding the cleaning and disinfection of ambulances, as no studies of this nature exist in the country. To evaluate compliance with cleaning and disinfection procedures for high-touch surfaces in ambulances of the Mobile Emergency Care Service in the southeastern and eastern regions of southern Minas Gerais, as well as to analyze the teams’ knowledge, attitudes, and practices. A cross-sectional, descriptive, and quantitative study conducted in two phases. The first stage (May to July 2025) assessed critical surfaces before and after cleaning through visual inspection, fluorescent marker testing, and microbiological counting. The second stage (July to November 2025) administered a survey on knowledge, attitudes, and practices to nurses, physicians, and nursing technicians. Analyses included descriptive and inferential statistics, association tests, effect sizes, multiple linear regression, Item Response Theory, and ROC curves. Stage 1: 500 samples were analyzed, with basic-level ambulances accounting for the majority (70.0%). Upon visual inspection immediately after disinfection, the stretcher mattress, pulse oximeter, and blood glucose meter were the items with the highest failure rates (100%, 80%, and 80%, respectively). The mean microbial counts were similar before and after cleaning (2.66 vs. 2.73 CFU/cm²). The fluorescent marker showed a statistically significant association with the type of surface (p = 0.001; Cramer’s V = 0.53) and with visual inspection (p = 0.048; Cramer’s V = 0.20), indicating that the presence of residual dirt varied more markedly among the different surface types and, to a lesser extent, according to visual assessment. Postcleaning counts distinguished between approved and failed surfaces (AUC = 0.639; p = 0.028). Step 2: there were significant differences between categories: physicians demonstrated less knowledge regarding protocols, disinfectants, and cleaning steps (p = 0.001); attitudes were favorable, with greater adherence among nursing technicians (p=0.001); and practices showed greater variability, especially regarding disinfection documentation, product verification, and access to the cleaning schedule, with a high effect size. The cleaning and disinfection of SAMU ambulances showed limited effectiveness in reducing the microbiological load, due to gaps in technical knowledge and inconsistencies in the adoption of standardized practices. The findings reinforce the need for continuing education, institutionalized protocols, continuous monitoring, and complementary methods to improve sanitation and enhance safety in prehospital care. This study highlights relevant contributions not only for nursing but for all healthcare professionals involved in mobile care settings, emphasizing their central role in the management and execution of cleaning and disinfection practices. The findings underscore the importance of strengthening technical competencies, evidencebased decision-making, and leadership in the implementation of safety protocols. Furthermore, they provide a basis for the development of educational strategies, assessment tools, and indicators of care quality, promoting the systematization of practices and contributing to the reduction of risks related to healthcare in the pre-hospital setting. Thus, the study reinforces the need for a multidisciplinary and integrated approach in promoting safer environments for patients and professionals.