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Stethoscope or Staphoscope?

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Elyse Jones

on 27 November 2012

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Transcript of Stethoscope or Staphoscope?


Hospital Administration
Decrease non-reimbursed costs due to HAIs
Infection Control
Eliminate avoidable pathogen transmission
Nurse Educators/Risk Management
Provide staff in-service education creating an evidence based practice
Clients & Family
Expects their nurse will provide quality care
Ethics: Nonmaleficence "first do no harm"

ICU Nurses that don't clean their stethoscopes
before assessing each client.

Facilities Management Service Driving Forces Resisting Forces Michael Fry, Elyse Jones, Thaddeus Langer, and Elan Pardee Foam Your Scope! Stethoscope or Staphoscope? Refreezing Unfreezing Observation and Data Collection Only 8 out of 43 nurses (18.6%) cleaned their stethoscopes prior to assessing patients. “Why didn’t you clean your stethoscope before and after patient assessment?” 60% reported they were too rushed for time
20% reported not having alcohol swabs readily available while in patients’ rooms
10% reported that it was too cumbersome to use an alcohol swab to clean their stethoscopes
10% gave various miscellaneous answers However, when asked if they believed that stethoscope cleaning ought to be done, 100% of the sample said yes Literature Bacterial colonization upon stethoscopes increased substantially after using a stethoscope upon five or more patients without cleaning (Lecat, Cropp, McCord, and Haller, 2009) A study tested 50 stethoscopes of various clinicians in a practice setting and only found one free of bacteria (Mitchell et al., 2010) Stethoscopes can be contaminated by dangerous organisms such as Vancomycin-Resistant Enterococcus (VRE) (Zachary et al., 2009). Ethanol based cleanser (EBC) or isopropyl alcohol to clean stethoscopes significantly reduced bacterial growth. Verification The CDC (2010) estimates that hospital-acquired infections (HAIs) are responsible for 1.7 million infections and 99,000 deaths annually in the United States. The estimated medical costs of HAIs amount to $4.5 billion a year. Observation
Nursing Staff
Hospital Administration
Risk Management/Infection Control Departments PATIENT SAFETY!!! Unfreezing

To ensure all Renown ICU Nurses clean their stethoscopes before assessing each client.

Prevent HAIs via contaminated stethoscopes and protect the health, safety, and rights of the client Moving Refreezing Forces Driving
Change Forces Resisting
Change Forces Driving
Change Forces Resisting
Change Old Status Quo New Status Quo Foam Your Scope! Refreezing Tasks Overarching Goal
Reinforcing the new status quo Sustaining motivating factors
Establishing open communication and feedback
Measuring compliance and evaluating change effectiveness
Maintaining flexibility Compliance and Evaluation Communication and Feedback Motivation Participative approach

Managing expectations and incentives Flexibility Altering policy and performance evaluations
Positive reinforcement and competition Providing change rationale and evidence of change efficacy
"Foam Your Scope!" campaign - posters, fliers, etc.
New hire training, refresher courses Patient advocacy, infection control, and patient safety Intrinsic motivation - empowerment, ownership, buy-in, and commitment Communication

Feedback Maintaining open lines of communication before, during, and after the change
Communicating support from leadership
Fostering trust with consistency and follow through Viewing resistance as an opportunity to make improvements rather than an obstacle to overcome
Transparently discussing complications and concerns
Including feedback in decision making Compliance Patient education and surveys
Unit compliance charts in break rooms Evaluating change effectiveness Periodic cultures of stethoscopes
Tracking nosocomial infections
Evaluating cost effectiveness
Impact of change on work flow Life's a mess! Change is a reiterative, ongoing process
Anticipate and expect complications
Formulate contingency plans
Embrace adaptations as necessary Aligning change with core nursing values

Maintaining awareness Garnering support from informal leaders and
building group dynamics that support the change Conclusion Questions ? ? ? ? ? Unfreezing Unfreezing Moving Refreezing Forces Driving
Change Forces Resisting
Change Forces Driving
Change Forces Resisting
Change Old Status Quo New Status Quo Foam Your Scope! Moving Unfreezing Moving Refreezing Forces Driving
Change Forces Resisting
Change Forces Driving
Change Forces Resisting
Change Old Status Quo New Status Quo Foam Your Scope! Goal Why? Unfreezing

"Clean Stethoscope" policy from Administration?
Club instead of the Carrot!
Current Evidence Based Practice
May convince some nurses on the Unit
Others may see this as "Them" vs "Us" or "I" What would compel ICU Nurses to make the change? ...this Restraining Force requires more tangible evidence... Unfreezing

Support from the Lab (Microbiology)
Trusted source
Swab Nurses' stethoscopes in the ICU
Two day shifts and one night shift selected over a two week period.
~30 Nurses' stethoscopes swabbed and cultured.
Results reviewed at subsequent staff meeting
Nurse Educator and Infection Control facilitate.
Emphasize HAIs, client and personal safety, and proper stethoscope cleaning. Random Swab Test of ICU Nurses' Stethoscopes Re-evaluate Nurses' desire to change and address all barriers Moving Problem identification
Gathered evidence to support change - research and data collection
Force field analysis
"Foam Your Scope!" campaign
Findings: THANK YOU! ? ? ? Cleaning stethoscopes reduces bacterial colonization and HAIs
Compliance levels reached 80% to 90% at 6 months
Cost effectiveness was confirmed Goal
Implement a stethoscope cleaning protocol in Roseview ICU. Proposal
"Foam your Scope" Campaign Placed "Foam your Scope" laminated signs above the hand sanitizer pumps in the rooms.
Signs provided brief instructions on how to properly clean a stethoscope
Poster with EBP research and education displayed in breakroom
In-service education during morning huddle "Foam your Scope" Campaign Motivation Staff committee
Unit competition with prizes
Audits by unit manager and charge nurse
Incentives Neutral Stakeholders Unfreezing

Responses to initial ICU Nurse survey:
Forgot (rushed for time) ~60%
Not having alcohol wipes ~20%
Too cumbersome to use an alcohol swab ~10%
Various responses ~10%
What is the best way to clean a stethoscope?
Alcohol or Foam?
Effects of repeated cleaning on a stethoscope?
Lab Tech time and materials
Marketing time and materials
Various department personnel time Barriers to Address Benefit > Cost (HAIs) References:
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