London Health Sciences Centre Interfacility Transport Information

For consistency, we ask that anyone transporting a patient into LHSC follow the principles outlined below. Observing these principles will protect transport staff, the patient, and everyone else at the hospital and aligns with expectations already in place for hospital staff.

Please note that this communication applies to interfacility patient transports outside of the Emergency Departments.

Before entering LHSC: 

• All stretcher siderails and frequently touched stretcher/wheelchair surfaces/handles must be disinfected.
• Any medical equipment deemed necessary to accompany the patient must be disinfected.
• Face protection (mask, mask with visor, respirator, etc.) can remain in place according to employer protocol and in compliance with LHSC’s current COVID-19 protocols.
• Gloves and gown used for patient care or worn during transport must be removed and hand hygiene performed.
• If gloves and a gown are required while transporting the patient into the hospital, new PPE must be donned at this time.
• At this time all patients entering the hospitals are asked to wear a mask, if tolerable. Please provide the patient with a mask on entry. Hospital provided masks are available for this purpose with the exception of patients entering Victoria Hospital via the D2 entrance. Here, transport staff will need to provide a mask.

After arriving at the destination department/unit:

• Once the patient has been transferred from the transport stretcher/wheelchair, the stretcher/wheelchair must be disinfected.
• If required, hospital provided disinfectant wipes are available at convenient locations and within/in close proximity to each patient room/bed space.
• Cleaning of the transport stretcher/wheelchair must occur before leaving the destination room/bed space unless in critical care areas, where space is limited (i.e. cleaning of the stretcher/wheelchair should not occur in a hallway unless in critical care).
• Gowns and gloves must be removed and hand hygiene performed – PPE removal should occur just before exiting the destination room/bed space.
• Face protection (mask, mask with visor, respirator, etc.) can remain in place according to employer protocol and in compliance with LHSC’s current COVID-19 protocols.

When leaving LHSC with a patient:

• Perform hand hygiene and don any required PPE.
• Transfer patient to transport stretcher/wheelchair.
• Provide a mask to the patient, if the patient can tolerate it.

In summary, think “clean in, clean out” – whenever entering the hospital or leaving a patient room/space, you and your equipment should be clean, including your hands and your attire (either by wearing new PPE or by removing used PPE).

Frequently Asked Questions Related to PPE Use

and Interfacility Transports

Q: What is the reasoning for the changing of the gown and gloves? The removal of our PPE increases our chances of contamination only to don new PPE (where supplies are limited). How do paramedics maintain patient care if they are required to remove themselves from the patient side and then doff and don? We utilize the second medic as a safety officer for donning and doffing process.

A: While we recognize that care on transport does occur, many patients do not require care during transport within the hospital. When care is not required between the ambulance and the destination floor, LHSC requests that those entering our building are not wearing contaminated PPE and have clean hands. This minimizes the risk of contaminating the hospital environment and our vulnerable patients while walking in busy hallways, entering elevators, passing equipment and supplies in the hallways, etc. Certainly if care is being provided enroute, we would support transport staff wearing the required PPE as indicated by your organizational precaution practices. This is also in line with LHSC’s requirements of its own staff on transport throughout the building (i.e. LHSC staff providing care WHILE transporting a patient do wear PPE indicated as per Routine Practices and Additional Precautions).

Q: Why must patient care equipment be disinfected when all equipment is disinfected between patient contacts and this process has the disinfection occur mid transfer? What is the rationale for paramedics to stop patient care, clean a stretcher that has a patient on it, that we will still be exposed to, and continue patient care until the transfer of care is complete?

A: To clarify, the requirement to disinfect “all stretcher siderails and frequently touched stretcher/wheelchair surfaces/handles” and “any medical equipment deemed necessary” is not equivalent to an entire stretcher disinfection nor full clean of a device. The purpose of this disinfection is to ensure that frequently touched surfaces, including those touched by gloved and potentially contaminated hands, have been disinfected prior to entering the hospital. Certainly we recognize that the patient continues to be a source of contamination throughout the transport, but infection prevention and control guidelines have always and continue to highlight the importance of decreasing the bioburden on frequently touched surfaces and by cleaning and disinfecting these frequently touched surfaces prior to entering the organization, it reduces the risk of transport staff contaminating their hands and then potentially the hospital environment, while moving through the building. This has been an expectation of LHSC staff for quite some time. For example, if a patient is leaving his/her hospital room for a test, the porter must also disinfect the handles/siderails of the wheelchair/stretcher before moving into the hallway. Disposable cleaning wipes with short contact times are beneficial in these circumstances, as many products have as short a contact time as 1-3 minutes and only require a single wipe to achieve disinfection. When transport staff are leaving LHSC, they are welcome to use a hospital cleaning wipe to disinfect their equipment and stretcher.

Q: Is there a location for paramedics to complete the doffing and donning and disinfection?

A: When entering the organization, donning and doffing and disinfection of frequently touched surfaces (e.g. stretcher siderails and handles) can occur at the ambulance. When leaving the organization, the communication below states the following “cleaning of the transport stretcher/wheelchair must occur before leaving the destination room/bed space unless in critical care areas, where space is limited (i.e. cleaning of the stretcher/wheelchair should not occur in a hallway unless in critical care)”.

Q: Is LHSC supplying the extra PPE required for transfers? Paramedic services are trying to preserve PPE as much as possible, with gowns being in short supply at the moment. We do not have the supply to support double the use of select PPE for a single patient.

A: Extra PPE required may include gloves and a gown (depending on Additional Precautions requirements). Face protection does not require changing based on the principles outlined below. While we recognize the challenges all organizations have had over the past several months related to a sufficient supply chain for PPE, we are not aware of a shortage of gloves and understand your vehicles should be sufficiently stocked to allow for glove changes as outlined below. In terms of gowns, certainly we did discuss access to gowns as a potential barrier as we vetted the text below, but felt this remained an important component of the recommendation and request that your staff have access to sufficient supplies of gowns to support this practice. If access to gowns is severely restricted, continued use of the gown for a single patient, while not ideal, would be supported, but a glove change with hand hygiene with alcohol based hand rub in between is required. Again, wearing a gown and gloves into the building should only occur if the patient is on Additional Precautions OR if care is being provided to a patient who is not on precautions but a Risk Assessment has identified a potential exposure to blood, body fluids, secretions, etc.

Q: Are escorts at sending hospitals being made aware of these provisions?

A: Thank you for highlighting escorts as a stakeholder in this recommendation. While we did share this information with the transportation company contracted to LHSC (Voyago), we did not consider escorts. We will develop a plan to address this group.

Thank you for being a collaborate partner in care. Together we can ensure a safe environment for everyone.