An Evidence-Based Approach to the Cleaning of Stethoscopes

Introduction

Due to the lack of cleaning personal equipment, stethoscopes are known to harbor bacteria that may harm patients and possibly equipment owners.

PROJECT

References

• Surveyed staff and OR personnel
• Collaborated with the Clinical Educator
• Multiple meetings with the Infectious Surveillance Coordinator
• EBPP Poster
• Patient Advocate Handout

Translation into Practice

Center for Disease and Control. (2010). Cleaning and disinfecting athletic facilities for MRSA. Retrieved April 05, 2013, from http://www.cdc.gov/mrsa/environment

Heart of Lancaster Regional Medical Center. (2008). Peripheral intravenous accessing and maintenance. Department of Nursing. Policy Number 600.321. Retrieved August 20, 2013.

Merlin, M.A., Wong, M.L., Pryor, P.W., Rynn, K., Marques-Baptista, A., Perritt, R., Stanescu, C.G., & Fallon, T. (2009). Prevalence of methicillin-resistant staphylococcus aureus on the stethoscopes of emergency medical services providers. Preliminary Reports, 13(1), 71-74. doi10.1080/10903120802471972

Newhouse, R., Dearholt, S., Poe, S., Pugh, L.C., & White, K., (2005). The John Hopkins nursing evidence-based practice rating scale. Baltimore, MD: The John Hopkins University School of Nursing.

Nick, J.M. (1999). Organic buildup and residual blood on infant stethoscopes in maternal-infant areas. JOGNN Clinical Studies, 28, 143-150.

Parmar, R.C., Valvi, C.C., Sira, P., & Kamat, J.R. (2004). A prospective, randomized, doubled-blinded study of comparative efficacy of immediate versus daily cleaning of stethoscopes using 66% ethyl alcohol. Indian Journal of Medical Sciences, 58, 423-430.

Rehman, S., Razzaq, H., & Owais, A. (2011). Could stethoscope be a source of infection? Pakistan Journal of Medical Sciences, 27, 510-512

Russell, A., Secrest, J., & Schreeder, C. (2012). Stethoscopes as a source of hospital-acquired methicillin-resistant staphylococcus aureus. American Society of PeriAnesthesia Nurses, 27(2), 82-87. doi:10.1016/j.jopan.2012.01.004

Rutala, W.A., & Weber, D.J. (2008). Guideline for disinfection and sterilization in healthcare facilities. Retrieved September 9, 2013, from www.cdc.gov/hicpac/pdf/guidelines/disinfection_nov_2008.pdf.

Uneke, C.J, Ogbonna, A., Oyibo, P.G., & Onu, C.M (2010). Bacterial contamination of stethoscopes used by health workers: public health implications. Journal of Infection in Developing Countries, 4, 436-441.

Vajravelu, R.K., Guerrero, D.M., Jury, L.A., & Donskey, C.J. (2012). Evaluation of stethoscopes as vectors of clostridium difficile and methicillin-resistant staphylococcus aureus. Infection Control and Hospital Epidemiology, 33(1), 96-98.

Whittington, A.M., Whitlow, G., Hewson, C., Thomas, C., & Brett, S.J. (2009). Bacterial contamination of stethoscopes on intensive care unit. Journal of the Association of Anaesthetists of Great Britain and Ireland, 64, 620-624.

Evaluation of stethoscope as Vectors of Clostridium difficile and Methicillin-Resistant Staphylococcus aurus

• Stethoscopes are not being cleaned
• Pathogenic bacteria such as MRSA and C. Difficile are found on the diaphragm and earpiece of stethoscopes
• When used with friction, ALCOHOL can eliminate the presence of bacteria counts

• Nonrandomized clinical trial
• N=92
• Examine the risk for transmission of Clostridium difficile and MRSA by stethoscopes

An Evidence-Based Approach to the Cleaning of Stethoscopes

Could Stethoscopes be a source of Infection?

Results: Stethoscopes acquired and transferred C. difficile as often as gloved hands

Alcohol wipes were effective in removing MRSA and Gauze moistened in alcohol were more effective in removing C. difficile

• Prospective audit
• N=92
• Bacterial colonies grew on stethoscopes
• What cleaning agents used routinely

Jenetta Harris, RN to BSN

• Cleaning
• Disinfectant
• Personal equipment
• Nosocomial Infection

Purpose

Results: 94% were contaminated with some form of staphylococcus species

Hospital acquired infections (HAIs) are infections that patients develop during the course of receiving healthcare treatment for other conditions

Insurance companies are refusing to pay for HAIs

HAIs are on the rise and account for more than 1.7 million infections each year

Introduction

• MRSA
• 6.3 per 100,000 patients
• African American
• Males
• Over the age of 64 years
• Staff education
• Alcohol And Friction

Stethoscopes as a Source of Hospital-Acquired Methicillin-Resistant Staphylococcus aureus

Bacterial contamination of Stethoscopes on the Intensive Care Unit

• Pretest/posttest
• N=141
• Determine the presence of MRSA on the diaphragms of personal and unit stethoscopes

Results: No MRSA growth was noted

• One-group, pretest/posttest
• N=24
• Determine the current cleaning practice of stethoscopes
• Degree of bacterial contamination

A Prospective, Randomised, Double-Blind Study of Comparative Efficacy of Immediate Versus Daily Cleaning of Stethoscope using 66% Ethyl Alcohol

Results: One personal Stethoscope showed multi-drug resistant and was colonized with both MRSA and a multi-drug resistant Enterobacte cloacae

One ICU bedside earpiece was colonized with MRSA

Organic Buildup and Residual Blood on Infant Stethoscopes in Maternal-Infant Areas

• Prospective double-blind
• N=100
• Determine the type of contamination
• Efficacy of 66% ethyl alcohol

• Retrospective, non-experimental, two groups, and posttest
• N=97
• Identify organic matter and residual blood on "clean" stethoscopes

Results: 80% of L&D and 72% of Nursery had Organic buildup

Results: Group A- Grew multiple organisms

Prevalence of Methicillin-Resistant Staphylococcus aureus on the Stethoscopes of Emergency Medical Services Providers

• Prospective, observational
• N=50
• Identify the prevalence of MRSA on stethoscopes of emergency medical services providers in the prehospital setting

Results: 32% grew MRSA