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Environmental Cleaning of Ambulances

Project Added:
7 December 2018
Last updated:
13 December 2018


To reduce the risk of healthcare associated infections (HAIs) in NSW Ambulance. This will provide safer care for patients and improve the working environment for paramedics.

View a poster from the Centre for Healthcare Redesign graduation, December 2018.


To improve the environmental cleaning process inside ten ambulances by June 2019 and reduce the risk of HAI transmission for patients and paramedics.

Objective 1: Meet the Clinical Excellence Commission environmental cleaning standard compliance rate of 88% using visual auditing of 10 transport ambulances in Sydney Metropolitan area by December 2018.

Objective 2: Improve the paramedic experience by delivering patient care in environmentally cleaner ambulances by December 2019 and improve the level of activity involving cleaning between patients to 50%.


  • Reduced risk of HAI’s in the NSW Healthcare system
  • Improved patient outcomes and reduced adverse events
  • Improving paramedic working environment
  • New employment opportunities for specialised environmental cleaning within NSW Health
  • NSW Ambulance environmental cleaning stewardship development
  • Development  of a scheduled and benchmarked environmental cleaning model
  • National and international scalability
  • Established partnerships and creation of academic literature


There are around 200,000 HAIs reported in Australian health facilities each year. They are the most common complication affecting patients in hospital and not only cause great suffering to patients, but also impact healthcare resources. It is estimated that HAIs account for two million hospital bed days in Australia each year.1

There are currently no dedicated cleaning facilities for paramedics at hospitals and cleaning practices for ambulances are not benchmarked or standardised.


  • A review of the current ‘as is’ environmental cleaning processes. The project team visited ambulance stations and surveyed 200 paramedics to perform a gap analysis of the challenges in attaining environmental cleaning standard across the out of hospital setting.
  • Revision of the policy and infrastructure at emergency departments and ambulance stations. Peer-reviewed literature and data was examined with key stakeholders and change agents.
  • Workshops with 50 paramedics and local management teams to discuss and understand the challenges, generate solutions, understand challenges, and receive feedback for further refinement.
  • A new ‘cleaning between patients’ service at emergency departments is scheduled for implementation in February 2019. This will include measurement of bio-burden using auditing tools endorsed by the Clinical Excellence Commission to identify further opportunities for sustainability.


Pre-implementation – Planning for the project is well underway. Stakeholder and consultation has occurred with introduction of solutions still scheduled early 2019.


1 -28 February 2019: trial environmental for the cleaning of ambulances between patients at a major hospital.

Implementation sites

Sydney Greater Metropolitan local health districts


Collaborative partnerships have been developed with:

  • HealthShare NSW
  • Clinical Excellence Commission
  • Agency Clinical Innovation


Evaluation will occur from two of the four endorsed methods of environmental cleaning auditing endorsed by the Clinical Excellence Commission:

  • ATP Swabbing (adenosine triphosphate assessment)
  • visual audit assessment.

Lessons learnt

  • Be passionate about improving safety and reducing risk of HAIs - everyone can play a part!
  • Change of stakeholders throughout the project requires the project team to remain resilient.
  • Do not be dissuaded if little or no data exists about this area. This just reinforces how important the project is.


  1. Clinical Excellence Commission. Healthcare associated infections

Further reading


David Morris
Program Manager Make Ready Model
NSW Ambulance

Tanya Somani
Paramedic Advisor Make Ready Model
NSW Ambulance

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