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Şahan S, Güler S, Korkmaz E. Implementation of stethoscope disinfection: an observational study on nursing staff practice and knowledge. GMS HYGIENE AND INFECTION CONTROL 2024; 19:Doc30. [PMID: 38883408 PMCID: PMC11177224 DOI: 10.3205/dgkh000485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Background Healthcare-associated infections cause high mortality and morbidity, and lack of stethoscope disinfection is one of the reasons for healthcare-associated infections. Nurses who frequently use stethoscopes in the clinic do not disinfect stethoscopes at high rates. This study aimed to identify the frequency of stethoscope disinfection by nurses and their knowledge about the same. Methods This was a mixed-methods observational study. The quantitative part of the study included 202 nurses, the qualitative part included 12. Two researchers who made observations during stethoscope use recorded the procedures the nurses performed on the "Observation Form". Semi-structured in-depth interviews were conducted based on phenomenological methods. Results 23.7% of the nurses disinfected their stethoscopes before contact with patients, 11.8% after contact with patients and 6.4% before and after contact with patients. The nurses used a stethoscope on an average of 7.42 patients without disinfecting it. In the qualitative interview, some nurses stated that they did not have information about the disinfectants to be used for stethoscopes and their effectiveness. Some of the participants in the present study stated that they did not receive training on stethoscope disinfection and that they did not know that there were guidelines about it. Conclusion Since there were deficiencies in the implementation of stethoscope disinfection as well as knowledge, the transfer of knowledge in this context must receive more attention in education and training.
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Affiliation(s)
- Seda Şahan
- İzmir Bakircay University, Health Sciences Faculty, Nursing Department, İzmir, Turkey
| | - Sevil Güler
- Erciyes University, Health Sciences Faculty, Nursing Department, Kayseri, Turkey
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Bhan A, Green CV, Liang Philpotts L, Doherty M, Greenfield AS, Courtney A, Shenoy ES. Educational interventions to improve compliance with disinfection practices of noncritical portable medical equipment: A systematic review. Infect Control Hosp Epidemiol 2024; 45:360-366. [PMID: 37929604 DOI: 10.1017/ice.2023.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
OBJECTIVE To describe educational interventions that have been implemented in healthcare settings to increase the compliance of healthcare personnel (HCP) with cleaning and disinfection of noncritical portable medical equipment (PME) requiring low-level disinfection (LLD). DESIGN Systematic review. METHODS Studies evaluating interventions for improving LLD practices in settings with HCP, including healthcare students and trainees, were eligible for inclusion. RESULTS In total, 1,493 abstracts were identified and 1,416 were excluded, resulting in 77 studies that underwent full text review. Among these, 68 were further excluded due to study design, setting, or intervention. Finally, 9 full-text studies were extracted; 1 study was excluded during the critical appraisal process, leaving 8 studies. Various forms of interventions were implemented in the studies, including luminescence, surveillance of contamination with feedback, visual signage, enhanced training, and improved accessibility of LLD supplies. Of the 8 included studies, 4 studies reported successes in improving LLD practices among HCP. CONCLUSIONS The available literature was limited, indicating the need for additional research on pedagogical methods to improve LLD practices. Use of visual indicators of contamination and multifaceted interventions improved LLD practice by HCP.
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Affiliation(s)
- Aarushi Bhan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts
- Infection Control Unit, Massachusetts General Hospital, Boston, Massachusetts
| | - Chloe V Green
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts
- Infection Control Unit, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Megan Doherty
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts
- Infection Control Unit, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Amy Courtney
- Infection Control Unit, Massachusetts General Hospital, Boston, Massachusetts
| | - Erica S Shenoy
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts
- Infection Control Unit, Massachusetts General Hospital, Boston, Massachusetts
- Infection Control, Mass General Brigham, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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Maamri H, Ben Ayed H, Ben Hmida M, Trigui M, Baklouti M, Ben Jemaa M, Ketata N, Kassiss M, Yaich S, Damak J. Effectiveness of a training program on health-care professionals' knowledge and practices regarding thermo-sensitive reusable medical devices disinfection: A quasi-experimental study. Infect Dis Health 2024; 29:1-7. [PMID: 37574407 DOI: 10.1016/j.idh.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/26/2023] [Accepted: 07/23/2023] [Indexed: 08/15/2023]
Abstract
INTRODUCTION Appropriate knowledge of healthcare professionals (HCPs) on the various aspects of disinfection and reuse of medical devices is a basic requirement to ensure proper disinfection and to minimize the risk of healthcare associated infections. In this regard this study aimed to assess the effectiveness of a training intervention on knowledge and practices regarding thermosensitive reusable medical devices (TRMD) disinfection among HCPs. METHODS This was a quasi-experimental study including a pre-test, an intervention (workshops, demonstrations, posters), and a post-test evaluation of the HCPs' knowledge and practices regarding the disinfection of TRMD. It was conducted between February and July 2022 at Hedi Chaker University hospital, Sfax, Southern Tunisia. RESULTS Overall, 31 participants were females (54.4%). The global Knowledge Score (KS) had significantly risen from pre-to post-training test (61.0 ± 9 vs 74.0 ± 12.5; p < 0.001). According to the disinfection type, the KS of non-critical and critical TRMD disinfection had significantly increased between pre and post-intervention (60 (IQR = [40.0-80.0]) vs 80 (IQR = [40.0-80.0]), p < 0.001) and (66.6 (IQR = [50.0-66.6]) vs 83.3 (IQR = [66.6-100.0]); p < 0.001) respectively. The mean change in global KS of TRMD disinfection was statistically higher among females (17.5 ± 11.2 vs 8.5 ± 3.2; p = 0.006) and medical staff (18.9 ± 11.9 vs 7.1 ± 3.9; p = 0.019). Conformity scores did not significantly change after the training program (58.1 ± 22.7 vs 63.7 ± 19.6; p = 0.678). CONCLUSION This study highlighted the effectiveness of the training intervention on HCP knowledge. However, practices were not improved. Conducting ongoing audits with on-the-job training is extremely needed.
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Affiliation(s)
- Hanen Maamri
- Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Tunisia.
| | - Houda Ben Ayed
- Preventive Medicine and Hygiene Department, Hedi Chaker University Hospital, University of Sfax, Tunisia
| | - Mariam Ben Hmida
- Preventive Medicine and Hygiene Department, Habib Bourguiba University Hospital, University of Sfax, Tunisia
| | - Maroua Trigui
- Preventive Medicine and Hygiene Department, Hedi Chaker University Hospital, University of Sfax, Tunisia
| | - Mouna Baklouti
- Preventive Medicine and Hygiene Department, Hedi Chaker University Hospital, University of Sfax, Tunisia
| | - Maissa Ben Jemaa
- Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Tunisia
| | - Nouha Ketata
- Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Tunisia
| | - Mondher Kassiss
- Preventive Medicine and Hygiene Department, Habib Bourguiba University Hospital, University of Sfax, Tunisia
| | - Sourour Yaich
- Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Tunisia
| | - Jamel Damak
- Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Tunisia
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Nazari-Shafti TZ, Meyborg H, Iske J, Schloss M, Seeber F, Friedrich A, Exarchos V, Richter A, Falk V, Emmert MY. A clinical study to evaluate the safe and effective use of a new, single use stethoscope cover to enable reduction in pathogen transmission during auscultation. Front Med (Lausanne) 2023; 10:1179145. [PMID: 37425319 PMCID: PMC10324409 DOI: 10.3389/fmed.2023.1179145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/15/2023] [Indexed: 07/11/2023] Open
Abstract
Objectives Stethoscopes carry a significant risk for pathogen transmission. Here, the safe use and performance of a new, non-sterile, single-use stethoscope cover (SC), that is impermeable for pathogens, was investigated by different healthcare professionals (HCPs) in the postoperative care setting of an intensive care unit (ICU). Methods Fifty-four patients underwent routine auscultations with the use of the SC (Stethoglove®, Stethoglove GmbH, Hamburg, Germany). The participating HCPs (n = 34) rated each auscultation with the SC on a 5-point Likert scale. The mean ratings of acoustic quality and the SC handling were defined as primary and secondary performance endpoint. Results 534 auscultations with the SC were performed (average 15.7/user) on the lungs (36.1%), the abdomen (33.2%), the heart (28.8%), or other body-sites (1.9%). No adverse device-effects occurred. The acoustic quality was rated at 4.2 ± 0.7 (mean) with a total of 86.1% of all auscultations being rated at least as 4/5, and with no rating as below 2. The SC handling was rated at 3.7 ± 0.8 (mean) with a total of 96.4% of all auscultations being rated at least 3/5. Conclusion Using a real-world setting, this study demonstrates that the SC can be safely and effectively used as cover for stethoscopes during auscultation. The SC may therefore represent a useful and easy-to-implement tool for preventing stethoscope-mediated infections.Study Registration: EUDAMED no. CIV-21-09-037762.
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Affiliation(s)
- Timo Z. Nazari-Shafti
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Heike Meyborg
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jasper Iske
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Maximilian Schloss
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
| | - Fabian Seeber
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
| | - Aljona Friedrich
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
| | - Vasileios Exarchos
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Anja Richter
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Maximilian Y. Emmert
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Dressler RL, Cruser B, Dressler DD. Hospital Physicians’ Stethoscopes: Bacterial Contamination After a Simple Cleaning Protocol. Cureus 2023; 15:e37061. [PMID: 37153267 PMCID: PMC10155595 DOI: 10.7759/cureus.37061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Stethoscope surfaces become contaminated with bacteria due to inconsistent cleaning practices, as cleaning frequency and practical cleansing approaches are not well-established. METHODS We investigated bacterial contamination of stethoscopes at baseline, after simple cleaning, and after examining one patient. We surveyed 30 hospital providers on stethoscope cleaning practices and then measured bacterial contamination of stethoscope diaphragm surfaces before cleaning, after cleaning with alcohol-based hand sanitizer, and after use in examining one patient. RESULTS Only 20% of providers reported cleaning stethoscopes regularly. Before cleaning, 50% of stethoscopes were contaminated with bacteria, compared with 0% after cleaning (p<0.001) and 36.7% after examining one patient (p=0.002). Among providers who reported not cleaning stethoscopes regularly, 58% had bacterial-contaminated stethoscopes compared with 17% who did report cleaning regularly (p=0.068). CONCLUSIONS Hospital providers' stethoscopes had a high probability of bacterial contamination at baseline and after examining one patient. We recommend decontamination with alcohol-based hand sanitizer immediately before each patient examination.
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Vasudevan RS, Nedjat-Haiem MA, Mahadevan A, Herbert MS, Lander L, Warsi T, Shaikh U, Harding C, Savoia MC. Assessing Changes in Stethoscope Hygiene During COVID-19: A Multicentre Cross-Sectional Study. J Hosp Infect 2022; 127:1-6. [PMID: 35671861 PMCID: PMC9167726 DOI: 10.1016/j.jhin.2022.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/29/2022] [Accepted: 05/30/2022] [Indexed: 11/18/2022]
Abstract
Background The COVID-19 (SARS-CoV-2) pandemic has increased infection control vigilance across several modes of patient contact. However, it is unknown whether hygiene pertaining to stethoscopes, which carry the potential for pathogenic contamination, has also shifted accordingly. Aim To characterize pandemic-related changes in stethoscope hygiene. Methods We surveyed healthcare providers at three major medical centres. Questions quantitatively (Likert scale and frequency) assessed stethoscope hygiene beliefs and practices with two components: before and during COVID-19. Participants were grouped based on performance of optimal stethoscope hygiene (after every patient) before and during COVID-19. Groups were compared using χ2 and analysis of variance (ANOVA). Findings Of the 515 (10%) who completed the survey, 55 were excluded (N = 460). Optimal hygiene increased from 27.4% to 55.0% (P < 0.001). There were significant increases in Likert scores for all questions pertaining to knowledge of stethoscope contamination (P < 0.001). Belief in stethoscope contamination increased (P < 0.001) despite no change in perceived hygiene education. Resident physicians were less likely compared with attending physicians and nurses to have adopted optimal hygiene during COVID-19 (P < 0.001). Conclusion Despite a positive shift in stethoscope hygiene during COVID-19, optimal hygiene was still only performed by around half of providers. Educational interventions, particularly targeting early-career providers, are encouraged.
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Affiliation(s)
- R S Vasudevan
- Department of Medicine, University of California San Diego School of Medicine, La Jolla, CA, USA.
| | - M A Nedjat-Haiem
- University of California Davis School of Medicine, Sacramento, CA, USA
| | - A Mahadevan
- University of California Irvine School of Medicine, Irvine, CA, USA
| | - M S Herbert
- Department of Psychiatry, University of California San Diego School of Medicine, La Jolla, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA; Center of Excellence for Stress and Mental Health, San Diego, CA, USA
| | - L Lander
- Department of Family Medicine and Public Health, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - T Warsi
- Department of Family Medicine and Public Health, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - U Shaikh
- University of California Davis School of Medicine, Sacramento, CA, USA
| | - C Harding
- University of California Irvine School of Medicine, Irvine, CA, USA
| | - M C Savoia
- Department of Medicine, University of California San Diego School of Medicine, La Jolla, CA, USA
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Tahir MJ, Zaman M, Babar MS, Imran F, Ajmal AN, Malik M, Khan JK, Ullah I, Asghar MS. Microbiological Impacts of Decontamination of Stethoscopes and Assessment of Disinfecting Practices among Physicians in Pakistan: A Quality Improvement Survey. Am J Trop Med Hyg 2022; 107:tpmd211283. [PMID: 35576950 PMCID: PMC9294694 DOI: 10.4269/ajtmh.21-1283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 03/26/2022] [Indexed: 11/07/2022] Open
Abstract
The study was conducted to determine bacterial contamination of stethoscopes used by doctors before and after disinfecting with isopropyl alcohol and analyze their practices of disinfecting stethoscopes. Samples from stethoscopes were taken before and after disinfecting with 70% isopropyl alcohol swab with the help of a sterile swab. All swabs were inoculated on Blood and MacConkey agar plates and were examined for growth. Stethoscopes of 78 doctors were sampled which included 45 (58%) males and 33 (42%) females. Before decontamination of diaphragms with isopropyl alcohol, 27 (34.6%) diaphragms had "growth" while 51 (65.4%) had "no growth." After decontamination with isopropyl alcohol, 5 (6.4%) had "growth" while 73 (93.6%) had "no growth." The most common microorganism isolated from stethoscopes' diaphragms was methicillin-resistant Staphylococcus epidermidis (MRSE), that is, 14 out of 78 (17.9%). The survey also evaluated factors associated with contamination of stethoscopes. Most doctors 71(91%) believe that stethoscopes can be a source of infection and 55.1% (N = 43) responded that both diaphragm and bell of stethoscopes can transmit infections. Many doctors (41%, N = 32) reported that "forgetfulness/laziness" was the barrier which they faced regarding stethoscope hygiene followed by "lack of time" (21.8%, N = 17). The contamination rate (66.6%) is highest in those doctors who are using their stethoscopes for 3-5 years. Of them, 30 doctors (38.5%) never decontaminated their stethoscopes among which 17 had growth in their stethoscopes before cleaning with isopropyl alcohol, while three had growth even after decontamination. Most doctors used sanitizer (29.5%) and isopropyl alcohol (25.6%) as cleaning agents.
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Affiliation(s)
- Muhammad Junaid Tahir
- Ameer-ud-Din Medical College, Affiliated with University of Health Sciences, Lahore, Pakistan
- Lahore General Hospital, Lahore, Pakistan
| | - Musharaf Zaman
- Ameer-ud-Din Medical College, Affiliated with University of Health Sciences, Lahore, Pakistan
- Lahore General Hospital, Lahore, Pakistan
| | - Muhammad Saad Babar
- Ameer-ud-Din Medical College, Affiliated with University of Health Sciences, Lahore, Pakistan
- Lahore General Hospital, Lahore, Pakistan
| | - Fareeha Imran
- Ameer-ud-Din Medical College, Affiliated with University of Health Sciences, Lahore, Pakistan
- Lahore General Hospital, Lahore, Pakistan
- Postgraduate Medical Institute, Lahore, Pakistan
| | - Aasma Noveen Ajmal
- Ameer-ud-Din Medical College, Affiliated with University of Health Sciences, Lahore, Pakistan
- Lahore General Hospital, Lahore, Pakistan
- Postgraduate Medical Institute, Lahore, Pakistan
| | - Muna Malik
- Ameer-ud-Din Medical College, Affiliated with University of Health Sciences, Lahore, Pakistan
- Lahore General Hospital, Lahore, Pakistan
- Postgraduate Medical Institute, Lahore, Pakistan
- Medical Microbiology and Infectious Diseases Society of Pakistan, Karachi, Pakistan
| | - Jalees Khalid Khan
- Ameer-ud-Din Medical College, Affiliated with University of Health Sciences, Lahore, Pakistan
- Lahore General Hospital, Lahore, Pakistan
- Postgraduate Medical Institute, Lahore, Pakistan
| | - Irfan Ullah
- Kabir Medical College, Gandhara University, Peshawar, Pakistan
- Undergraduate Research Organization, Dhaka, Bangladesh
- Naseer Teaching Hospital, Peshawar, Pakistan
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Natural Rubber (NR) Latex Films with Antimicrobial Properties for Stethoscope Diaphragm Covers. MATERIALS 2022; 15:ma15103433. [PMID: 35629460 PMCID: PMC9146985 DOI: 10.3390/ma15103433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/28/2022] [Accepted: 04/30/2022] [Indexed: 01/04/2023]
Abstract
Systematic disinfection of the stethoscope diaphragm is required to ensure that it does not act as a vector for cross-transmission of health-related diseases. Thus, an antimicrobial latex film could be used as a cover to inhibit pathogenic bacteria from growing on its surface. The aim of this work is to determine the antimicrobial activity and mechanical properties of antimicrobial natural rubber (NR) latex films with different types of antimicrobial agents (mangosteen peel powder (MPP), zinc oxide nanoparticles (ZnO NP), and povidone-iodine (PVP-I)). The antimicrobial loading was varied from 0.5, to 1.0, and 2.0 phr to monitor the effective inhibition of Gram-negative bacteria and fungi growth. For MPP and PVP-I antimicrobial agents, a loading of 2.0 phr showed good antimicrobial efficacy with the largest zone of inhibition. Simultaneously, ZnO NP demonstrated excellent antimicrobial activity at low concentrations. The addition of antimicrobial agents shows a comparable effect on the mechanical properties of NR latex films. In comparison to control NR latex film (29.41 MPa, 48.49 N/mm), antimicrobial-filled films have significantly greater tensile and tear strengths (MPP (33.84 MPa, 65.21 N/mm), ZnO NP (31.79 MPa, 52.77 N/mm), and PVP-I (33.25 MPa, 50.75 N/mm). In conclusion, the addition of antimicrobial agents, particularly ZnO NP, can be a better choice for NR latex films because they will serve as both an activator and an antimicrobial. In a clinical context, with regard to frequently used medical equipment such as a stethoscope, such an approach offers significant promise to aid infection control.
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Vasudevan RS, Amin A, Hannula DL, Maisel AS. Stethoscope hygiene: A legal consideration for cardiologists practicing in a new era of infection control (COVID-19). ACTA ACUST UNITED AC 2021; 7:100039. [PMID: 34350422 PMCID: PMC8323512 DOI: 10.1016/j.ahjo.2021.100039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/03/2021] [Accepted: 07/21/2021] [Indexed: 12/03/2022]
Abstract
The stethoscope is a tool cherished by the field of cardiology and ubiquitous throughout medicine. However, little consideration has been given to its safe usage regarding its potential for pathogenic contamination despite thorough evidence that stethoscopes can harbor pathogens that can be transmitted to patients upon contact. The COVID-19 (SARS-COV-2) pandemic has led to increased infection control vigilance, including toward the stethoscope, as evidenced by a recent increase in literature highlighting stethoscope hygiene/contamination. A consequence of this increase in awareness is that stethoscopes may be implicated in medical malpractice lawsuits as a potential cause of healthcare-associated infections (HAIs). While there is limited evidence demonstrating a direct connection between stethoscope contamination and HAIs, malpractice lawsuits often do not require direct causative evidence. Regardless, efforts should be made to bolster stethoscope hygiene to not only mitigate patient harm, but also prevent providers from potential medical-legal conflicts. The continued relevance and utility of the stethoscope as a rapid, cost-effective diagnostic tool needs to be appropriately balanced with increased hygiene performance. Providers should anticipate increased scientific evidence and patient awareness regarding stethoscope contamination in the post-COVID-19 era.
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Affiliation(s)
- Rajiv S Vasudevan
- Department of Medicine, University of California, San Diego School of Medicine, La Jolla, CA, United States of America
| | - Alpesh Amin
- Department of Medicine, University of California, Irvine School of Medicine, Irvine, CA, United States of America
| | - Daniel L Hannula
- Rush, Hannula, Harkins, Kyler LLP, Tacoma, WA, United States of America
| | - Alan S Maisel
- Department of Medicine, University of California, San Diego School of Medicine, La Jolla, CA, United States of America
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Stethoscope hygiene: A call to action. Recommendations to update the CDC guidelines. Infect Control Hosp Epidemiol 2021; 42:740-742. [PMID: 34009112 DOI: 10.1017/ice.2021.115] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Healthcare-acquired infections are a tremendous challenge to the US medical system. Stethoscopes touch many patients, but current guidance from the Centers for Disease Control and Prevention does not support disinfection between each patient. Stethoscopes are rarely disinfected between patients by healthcare providers. When cultured, even after disinfection, stethoscopes have high rates of pathogen contamination, identical to that of unwashed hands. The consequence of these practices may bode poorly in the coronavirus 2019 disease (COVID-19) pandemic. Alternatively, the CDC recommends the use of disposable stethoscopes. However, these instruments have poor acoustic properties, and misdiagnoses have been documented. They may also serve as pathogen vectors among staff sharing them. Disposable aseptic stethoscope diaphragm barriers can provide increased safety without sacrificing stethoscope function. We recommend that the CDC consider the research regarding stethoscope hygiene and effective solutions to contemporize this guidance and elevate stethoscope hygiene to that of the hands, by requiring stethoscope disinfection or change of disposable barrier between every patient encounter.
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Abstract
Objective To evaluate whether Clostridioides (formerly Clostridium) difficile–contaminated stethoscope diaphragms remained aseptic by the placement of an aseptic diaphragm barrier. Methods On November 1, 2019, fresh cultures of C difficile were diluted to 107 colony-forming units (CFU)/mL and used to inoculate 16 stethoscope diaphragms; 8 had an aseptic diaphragm barrier applied and 8 served as nonbarrier controls. Contaminated stethoscopes were anaerobically incubated, then swabbed at 15 and 30 minutes, 2 and 4 hours, and 1, 2, 3, and 7 days after inoculation and subsequently plated onto blood, chocolate, and cycloserine-cefoxitin fructose agar. Plates were incubated for 48 hours and on November 9, 2019, the resulting colonies were manually counted. Statistical analyses (RStudio, version 1.0.153) used analysis of variance with post hoc Tukey honestly significant difference. Results Overall, mean colony count was 33 CFU on stethoscopes without barriers vs zero on those with barriers (P≤.05). Growth was greatest at 48 hours, with colony counts as high as 160 CFU. The presence of the barrier resulted in no growth in 100% of stethoscope diaphragms for up to 1 week. Conclusion We found that stethoscope diaphragm barriers provide an aseptic patient contact point, thus reducing the potential for transmission of C difficile during the physical examination. In critical care environments, in which many hospitals use acoustically inferior disposable stethoscopes, the option of a disposable aseptic stethoscope barrier may allow high-quality auscultation while reducing the potential for pathogen transmission.
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Sahiledengle B, Tekalegn Y, Bekele K, Tesemma A, Edward Quisido BJ. Disinfection of Stethoscope and Non-Infrared Thermometer: Practices of Physicians in Ethiopia in the Era of COVID-19. Risk Manag Healthc Policy 2021; 13:3245-3257. [PMID: 33447105 PMCID: PMC7802342 DOI: 10.2147/rmhp.s289125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/23/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Stethoscopes and non-infrared thermometers are the customary medical equipment used by the physicians on a daily basis, among various patients. With the rise of potential infections in the healthcare facilities and the transmission nature of the current COVID-19 pandemic, consistent and correct disinfections of these devices after each use should not be pardoned. This study, therefore, aimed to assess the level of stethoscope and non-infrared thermometer disinfection practices among physicians involved in direct patient contact during the COVID-19 pandemic. METHODS A web-based cross-sectional survey was conducted among physicians working in Ethiopia to assess their practice of stethoscope and non-infrared thermometer disinfection. The online survey was circulated using an anonymous and self-reporting questionnaire via Google form with a consent form appended to it. The developed Google form link was shared with physicians through their email addresses and social media pages. A descriptive summary was computed and presented by tables and figures. Multivariable logistic regression model was used to identify factors associated stethoscope and non-infrared thermometer after every use. RESULTS The proportion of stethoscope and non-infrared thermometer disinfections after every use was 13.9% (95% CI: 10.9-17.6) and 20.4% (95% CI: 16.7-24.5), respectively. Taking COVID-19 training (AOR: 2.52; 95% CI: 1.29-4.92) and the availability of stethoscope disinfection materials at the workplace (AOR: 3.03; 95% CI: 1.29-7.10) were significantly increased the odds of stethoscope disinfection after every use. The odds of stethoscope disinfection after every use was significantly decreased for those who reported the use of shared stethoscope (AOR: 0.34; 95% CI: 0.12-0.92). CONCLUSION Only a wee share of the respondents reported that they have disinfected their stethoscopes and non-infrared thermometers after every use - possibly jeopardizing both patients and clinicians safety, particularly during the COVID-19 pandemic.
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Affiliation(s)
- Biniyam Sahiledengle
- Madda Walabu University Goba Referral Hospital, School of Health Sciences, Public Health Department, Goba, Bale, Ethiopia
| | - Yohannes Tekalegn
- Madda Walabu University Goba Referral Hospital, School of Health Sciences, Public Health Department, Goba, Bale, Ethiopia
| | - Kebebe Bekele
- Madda Walabu University Goba Referral Hospital, Department of Surgery, Goba, Bale, Ethiopia
| | - Abdi Tesemma
- Madda Walabu University Goba Referral Hospital, Department of Surgery, Goba, Bale, Ethiopia
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Vasudevan RS, Horiuchi Y, Torriani FJ, Cotter B, Maisel SM, Dadwal SS, Gaynes R, Maisel AS. Persistent Value of the Stethoscope in the Age of COVID-19. Am J Med 2020; 133:1143-1150. [PMID: 32569591 PMCID: PMC7303610 DOI: 10.1016/j.amjmed.2020.05.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/04/2020] [Indexed: 12/25/2022]
Abstract
The stethoscope has long been at the center of patient care, as well as a symbol of the physician-patient relationship. While advancements in other diagnostic modalities have allowed for more efficient and accurate diagnosis, the stethoscope has evolved in parallel to address the needs of the modern era of medicine. These advancements include sound visualization, ambient noise reduction/cancellation, Bluetooth (Bluetooth SIG Inc, Kirkland, Wash) transmission, and computer algorithm diagnostic support. However, despite these advancements, the ever-changing climate of infection prevention, especially in the wake of the COVID-19 pandemic, has led many to question the stethoscope as a vector for infectious diseases. Stethoscopes have been reported to harbor bacteria with contamination levels comparable with a physician's hand. Although disinfection is recommended, stethoscope hygiene compliance remains low. In addition, disinfectants may not be completely effective in eliminating microorganisms. Despite these risks, the growing technological integration with the stethoscope continues to make it a highly valuable tool. Rather than casting our valuable tool and symbol of medicine aside, we must create and implement an effective method of stethoscope hygiene to keep patients safe.
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Affiliation(s)
- Rajiv S Vasudevan
- Department of Medicine, University of California San Diego, La Jolla.
| | - Yu Horiuchi
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Francesca J Torriani
- Department of Medicine, University of California San Diego, La Jolla; Division of Infectious Diseases
| | - Bruno Cotter
- Department of Medicine, University of California San Diego, La Jolla; Division of Cardiovascular Medicine, University of California San Diego, La Jolla
| | | | - Sanjeet S Dadwal
- Division of Infectious Diseases, City of Hope National Medical Center, Duarte, Calif
| | - Robert Gaynes
- Division of Infectious Diseases, Emory University, Atlanta, Ga
| | - Alan S Maisel
- Department of Medicine, University of California San Diego, La Jolla; Division of Cardiovascular Medicine, University of California San Diego, La Jolla
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Rostkowska OM, Zgliczyński WS, Jankowski M, Kuthan R, Pinkas J, Durlik M. Hand Hygiene Among Doctors in Transplant Departments in Poland: A Cross-sectional Survey. Transplant Proc 2020; 52:1964-1976. [PMID: 32359828 DOI: 10.1016/j.transproceed.2020.01.111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 01/22/2020] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Hand hygiene (HH) is often under-discussed in clinical work, but it is hard to overestimate its role in preventing health care associated infections (HCAIs), especially among immunocompromised populations such as transplant patients. OBJECTIVES This study aimed to investigate the compliance of doctors in transplant departments in Poland with HH and other selected infection control measures. MATERIAL AND METHODS An on-line cross-sectional survey was carried out among doctors from all Polish transplant departments listed by POLTRANSPLANT. The questionnaire addressed HH in different clinical settings and based on the World Health Organization (WHO) "My 5 Moments for Hand Hygiene." RESULTS Completed questionnaires were obtained from 204 physicians (49% women; response rate: 24.7%). The lowest proportion of doctors who always comply with HH was observed in 2 out of 5 critical moments for hand hygiene: "before touching a patient" (40.2%) and "after contact with patient surroundings" (21.6%). Most respondents declared correct HH action that they would apply in a particular clinical situation as listed in the survey. More than half of doctors (57.4%) declared disinfecting stethoscopes "before and/or after each use." The lack of alcohol-based hand-rub nearby or nonfunctional containers, daily rush, and occurring emergencies were identified as the main reasons for noncompliance with HH recommendations. CONCLUSION Doctors in transplant departments in Poland have a satisfactory level of knowledge about HH in various situations. However, further organizational and educational activities are needed to promote compliance with HH recommendations in health care facilities.
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Affiliation(s)
- Olga Maria Rostkowska
- Department of Transplantation Medicine, Nephrology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | | | - Mateusz Jankowski
- School of Public Health, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Robert Kuthan
- Chair and Department of Medical Microbiology, Medical University of Warsaw, Warsaw, Poland
| | - Jarosław Pinkas
- School of Public Health, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Magdalena Durlik
- Department of Transplantation Medicine, Nephrology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
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Vasudevan R, Shin JH, Chopyk J, Peacock WF, Torriani FJ, Maisel AS, Pride DT. Aseptic Barriers Allow a Clean Contact for Contaminated Stethoscope Diaphragms. Mayo Clin Proc Innov Qual Outcomes 2020; 4:21-30. [PMID: 32055768 PMCID: PMC7010972 DOI: 10.1016/j.mayocpiqo.2019.10.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 10/15/2019] [Indexed: 11/30/2022] Open
Abstract
Objective To determine whether a single-use stethoscope diaphragm barrier surface remains aseptic when placed on pathogen-contaminated stethoscopes. Methods From May 31 to August 5, 2019, we tested 2 separate barriers using 3 different strains of 7 human pathogens, including extended-spectrum β-lactamase-producing Escherichia coli, methicillin-resistant Staphylococcus aureus, and vancomycin resistant Enterococcus faecium. Results For all diaphragms with either of the 2 barriers tested, no growth was recorded for any of the pathogens. Stethoscopes with aseptic barriers remained sterile for up to 24 hours. These single-use barriers also provided aseptic surfaces when stethoscope diaphragms were inoculated with human specimens, including saliva, stool, urine, and sputum. Conclusion Disposable aseptic diaphragm barriers may provide robust and efficient solutions to reduce transmission of pathogens via stethoscopes.
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Key Words
- B+, stethoscope diaphragms with disc barriers
- BC, disc barriers colonized with microorganisms
- B−, colonized diaphragms without disc barriers
- CFU, colony-forming unit
- Ctrl, control
- ESBL, extended-spectrum β-lactamase–producing Escherichia coli
- HAI, health care–associated infection
- HP, health care provider
- MDR, multidrug resistant
- MDRO, multidrug-resistant organism
- MRSA, methicillin-resistant Staphylococcus aureus
- VRE, vancomycin-resistant Enterococcus
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Affiliation(s)
- Rajiv Vasudevan
- Department of Medicine, University of California, San Diego, TX
| | - Ji H Shin
- Department of Pathology, University of California, San Diego, TX
| | - Jessica Chopyk
- Department of Pathology, University of California, San Diego, TX
| | - William F Peacock
- Department of Emergency Medicine, Baylor College of Medicine, Houston, TX
| | | | - Alan S Maisel
- Department of Medicine, University of California, San Diego, TX
| | - David T Pride
- Department of Medicine, University of California, San Diego, TX.,Department of Pathology, University of California, San Diego, TX
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Zehra D, Iqbal M, Safdar A, Jamil H, Inam SHA, Zahid MA. Awareness Among Healthcare Professionals Regarding Contaminated Stethoscopes as a Source of Nosocomial Infections. Cureus 2019; 11:e5968. [PMID: 31777697 PMCID: PMC6867348 DOI: 10.7759/cureus.5968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 10/22/2019] [Indexed: 11/14/2022] Open
Abstract
Objectives The objective of this study was to determine the awareness among healthcare professionals regarding stethoscopes as a source of nosocomial infections, their cleaning practices in this regard before or after examination, and to find out about the existence of any guidelines and accountability criteria issued by the hospitals in this regard. Methodology A descriptive cross-sectional study of 243 healthcare professionals using non-probability convenience sampling was done to include consultants, residents, final-year medical students, and nursing staff and excluding medical students from pre-clinical years as well as doctors of those departments with infrequent use of a stethoscope. The study was conducted for a period of nine months at tertiary health care facilities of Rawalpindi and Islamabad. A self-administered structured questionnaire was used for data collection. Results Participants from both genders included 54 participants (22.2%) from the final year, 48 (19.8%) house officers, 106 (43.6%) postgraduate trainees, nine (3.7%) specialists, and 26 (10.7%) nurses. A total of 210 (86.4%) were aware of stethoscopes as a source of nosocomial infections. Among participants, 23 (9.5%) cleaned their stethoscope per patient, 50 (20.6%) did it daily, 48 (19.8%) did it weekly, 41 (16.9%) did it monthly, 12 (4.9%) participants cleaned it six-monthly while 69 (28.4%) respondents had never cleaned their stethoscope. Almost 127 participants (52.3%) used alcohol wipes to clean their stethoscopes, 11 (4.5%) used a wet cloth, six (2.5%) used tissue paper. Sixty-one (24.9%) agreed that the hospital issued protocols for the decontamination of stethoscopes while 189 (77.8%) did not. A total of 241 (99.2%) believed that there were no accountability criteria set for the assessment of the cleanliness of stethoscopes in their hospitals. Conclusion A majority of the participants were aware of stethoscopes being a source of nosocomial infections and believed in cleaning stethoscopes regularly. However, a majority of the participants believed that their hospital did not issue any protocols for the decontamination of stethoscopes. Further research can expand our recommendations.
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Affiliation(s)
- Desaar Zehra
- Internal Medicine, Army Medical College, Rawalpindi, PAK
| | - Mishal Iqbal
- Internal Medicine, Military Hospital, Rawalpindi, PAK
| | - Ayesha Safdar
- Internal Medicine, Army Medical College, Rawalpindi, PAK
| | - Hamza Jamil
- Internal Medicine, Army Medical College, Rawalpindi, PAK
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Stethoscope disinfection is rarely done in Ethiopia: What are the associated factors? PLoS One 2019; 14:e0208365. [PMID: 31246946 PMCID: PMC6597050 DOI: 10.1371/journal.pone.0208365] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 06/12/2019] [Indexed: 11/19/2022] Open
Abstract
Introduction The stethoscope, which is non-critical medical devices and a symbol of healthcare, is likely to be contaminated by pathogenic microorganisms and can play a contributory role in the transmission of hospital-acquired infection. And regular cleaning of the diaphragm of the stethoscope with a suitable disinfectant is decisive. However, in the resource-constrained setting like many healthcare facilities in Ethiopia healthcare provider’s stethoscope disinfection practice and its associated factors have not been well studied so far. Therefore, this study sought to determine stethoscope disinfection practice and associated factors among the healthcare providers in Addis Ababa, Ethiopia. Methods A facility-based cross-sectional study was carried out between April and May 2016. For this study, 576 healthcare providers (physicians, health officers, nurses, midwives, and anesthesiologist) were included from 21 healthcare facilities in Addis Ababa. A pre-tested structured questionnaire was used for data collection. Descriptive statistics were computed. Bivariate and multivariable logistic regression analyses were used to identify factors that were significantly associated with stethoscope disinfection after every use. Results A total of 546 healthcare providers participated in this study, for a response rate of 94.7%. Two-fifths, 39.7% (95%CI: 35.9, 44.0%) of healthcare providers disinfecting their stethoscope after every use. And a significant number of participants 34.6% (95%CI: 30.8, 38.5%) never disinfect their stethoscope. Three out of four (76.0%) healthcare providers believe that stethoscope contamination can contribute to the transmission of infections. Safe infection prevention practice (AOR = 3.79, 95%CI: 2.45–5.84), awareness on infection prevention guideline (AOR = 1.93; 95%CI: 1.31, 2.82), and favorable attitude towards infection prevention (AOR = 1.73, 95%CI: 1.02, 2.93) were significantly associated with stethoscope disinfection after every use. The study also found that the odds of stethoscope disinfection were likely to be reduced by 79% among physicians than nurses (AOR = 0.21; 95%CI: 0.09, 0.49). Conclusions Only a small proportion of healthcare providers disinfect their stethoscopes after every use. Factors such as safe infection prevention practice, awareness on infection prevention guidelines, and favorable attitude towards infection prevention were the independent predictors of stethoscopes disinfection after every use. Hence, promotion of stethoscope hygiene along with an educational program to enhance disinfection compliance in healthcare facilities may have a positive effect.
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Vasudevan RS, Mojaver S, Chang KW, Maisel AS, Frank Peacock W, Chowdhury P. Observation of stethoscope sanitation practices in an emergency department setting. Am J Infect Control 2019; 47:234-237. [PMID: 30415805 DOI: 10.1016/j.ajic.2018.08.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 08/30/2018] [Accepted: 08/31/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Stethoscopes harbor pathogens that can be transferred to patients when proper sanitary measures are not taken. Our aim was to assess medical provider stethoscope cleaning and hand hygiene in an emergency department setting. METHODS The frequency and methods of stethoscope cleaning during and after provider-patient encounters were observed anonymously in an emergency department of the VA San Diego Healthcare System. RESULTS Among the total of 426 encounters, 115 (26.9%) involved the use of a personal stethoscope. In 15 of these 115 encounters (13.0%), the provider placed a glove over the stethoscope before patient contact. In 13 of these 115 encounters (11.3%), the provider cleaned the stethoscope with an alcohol swab after patient interaction. Stethoscope hygiene with water and a hand towel before patient interaction was observed in 5 of these 115 encounters (4.3%). Hand sanitizer use or handwashing was observed in 213 of the 426 encounters (50.0%) before patient interaction. Gloves were used before patient interaction in 206 of these 426 encounters (48.4%). Hand sanitizer or handwashing was used in 332 of the 426 encounters (77.9%) after patient interaction. CONCLUSIONS Rates of stethoscope and hand hygiene performance were lower than expected. Further investigation of stethoscope contamination and the associated risk of nosocomial infection are needed. Perhaps clearer guidelines on proper stethoscope cleaning would reduce this risk.
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Affiliation(s)
- Rajiv S Vasudevan
- Division of Cardiovascular Medicine, University of California, San Diego, La Jolla, CA.
| | - Sean Mojaver
- Division of Cardiovascular Medicine, University of California, San Diego, La Jolla, CA
| | - Kay-Won Chang
- Division of Cardiovascular Medicine, University of California, San Diego, La Jolla, CA
| | - Alan S Maisel
- Division of Cardiovascular Medicine, University of California, San Diego, La Jolla, CA
| | - W Frank Peacock
- Department of Emergency Medicine, Baylor College of Medicine, Houston, TX
| | - Punam Chowdhury
- Division of Cardiovascular Medicine, University of California, San Diego, La Jolla, CA; Department of Emergency Medicine, VA San Diego Healthcare System, La Jolla, CA
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Boulée D, Kalra S, Haddock A, Johnson TD, Peacock WF. Contemporary stethoscope cleaning practices: What we haven't learned in 150 years. Am J Infect Control 2019; 47:238-242. [PMID: 30396696 DOI: 10.1016/j.ajic.2018.08.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 08/02/2018] [Accepted: 08/02/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Stethoscopes can be microorganism reservoirs. The US Centers for Disease Control and Prevention (CDC) has published medical equipment disinfection guidelines to minimize infection transmission risk, but studies of guideline adherence have been predominately survey based, with little direct observation of disinfection practices. METHODS We performed an observational, cross-sectional, anonymous study of patient-provider interactions, assessing practitioners' frequency and methods of stethoscope and hand disinfection practices. RESULTS Stethoscopes were disinfected in 18% of 400 observed interactions, with less than 4% verified as conforming to CDC guidelines. None was disinfected before patient examinations involving open chest or abdominal wounds, as recommended by the CDC. Hands were cleaned before and after encounters 27 times (6.8%) but were not cleaned at all in 231 (58%) encounters, although gloves were worn in 197 (85.3%) of these cases. DISCUSSION Stethoscope disinfection is grossly overlooked, possibly jeopardizing patient safety, particularly in acute care interactions. Periodic stethoscope disinfection, although inconvenient, helps reduce bacterial contamination and may reduce health care-associated infections. CONCLUSIONS Stethoscopes were disinfected per CDC guidelines in less than 4% of encounters and were not disinfected at all in 82% of encounters. Although hands were rarely cleaned (6.8%) per CDC guidelines, gloves were usually worn, but no convenient stethoscope equivalent exists. Stethoscope cleanliness must be addressed.
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Affiliation(s)
- David Boulée
- School of Health Professions, Baylor College of Medicine, Houston, TX.
| | - Sarathi Kalra
- University of South Alabama College of Medicine, Department of Emergency Medicine, Mobile, AL
| | - Alison Haddock
- Department of Emergency Medicine, Baylor College of Medicine, Houston TX; Harris County Hospital, Houston, TX
| | - T David Johnson
- School of Health Professions, Baylor College of Medicine, Houston, TX
| | - W Frank Peacock
- Department of Emergency Medicine, Baylor College of Medicine, Houston TX; Harris County Hospital, Houston, TX
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20
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Messina G, Spataro G, Rosadini D, Burgassi S, Mariani L, Tani M, Cevenini G. A novel approach to stethoscope hygiene: A coat-pocket innovation. Infect Dis Health 2018. [DOI: 10.1016/j.idh.2018.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Horiuchi Y, Wettersten N, Vasudevan RS, Barnett O, Maisel AS. Stethoscope as a Vector for Infectious Disease. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2018. [DOI: 10.1007/s40138-018-0167-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Affiliation(s)
- Anne E Breen
- Anne E. Breen is a CVICU clinical nurse and research specialty scholar at Jersey Shore University Medical Center in Neptune, N.J. Amanda J. Hessels is an associate research scientist at Columbia University School of Nursing in New York, N.Y., with a joint appointment as a nurse scientist at Hackensack-Meridian Health in Neptune, N.J
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Quon JS, Dilauro M, Ryan JG. Disinfection of the Radiologist Workstation and Radiologist Hand Hygiene: A Single Institution Practice Quality Improvement Project. Can Assoc Radiol J 2017; 68:270-275. [DOI: 10.1016/j.carj.2016.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 08/23/2016] [Accepted: 09/11/2016] [Indexed: 10/19/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the workstation disinfection rates and hand hygiene of radiologists and trainees at shared departmental workstations and assess the impact of education and reminder placards on daily habits. Methods A 10-question survey was administered to all staff radiologists, fellows, and residents at our institution. The questions pertained to workstation disinfection, hand hygiene habits, and accessibility to disinfectant wipes and hand sanitizer stations. Subsequently, a short educational PowerPoint presentation was emailed to the department and small reminder placards were placed at each workstation. A follow-up survey was administered. Chi-square and Wilcoxon signed-rank tests were used to analyse the results. Results The percentage of participants who disinfect their workstations 1-2 times/week, 3-4 times/week or everyday increased from 53.4% (45 of 84 participants) to 74.3% (55 of 74 participants; P = .01), while the number who disinfect their workstation <1 time/week or never decreased from 46.4% (39 of 84 participants) to 25.7% (19 of 74 participants; P = .01). Hand washing before working at the workstation increased from 41.6% (35 of 84 participants) to 48.7% (36 of 74 participants; P = .76) and hand washing after working at the workstation increased from 50.0% (42 of 84 participants) to 56.8% (42 of 74 participants; P = .49). Conclusions At our institution, the implementation of daily reminder placards at each workstation and the administration of an educational PowerPoint presentation improved the rate of radiologist workstation disinfection.
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Affiliation(s)
| | | | - John G. Ryan
- Department of Medical Imaging, the Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
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Holleck JL, Merchant N, Lin S, Gupta S. Can education influence stethoscope hygiene? Am J Infect Control 2017; 45:811-812. [PMID: 28668135 DOI: 10.1016/j.ajic.2017.02.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 02/05/2017] [Accepted: 02/06/2017] [Indexed: 11/30/2022]
Abstract
The importance of stethoscope hygiene has been demonstrated in prior studies, and is acknowledged by guidelines, yet it is rarely done. We implemented a pilot project consisting of provider education, reminder flyers and provision of cleaning supplies at the start of clinical rotations for housestaff, medical students, and attending physicians. Hand hygiene rates did not change significantly with rates between 58% and 63% while stethoscope hygiene remained at zero.
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Affiliation(s)
- Jürgen L Holleck
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; Department of Medicine, Veterans Affairs Connecticut Healthcare System, West Haven, CT.
| | - Naseema Merchant
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; Department of Medicine, Veterans Affairs Connecticut Healthcare System, West Haven, CT
| | - Shin Lin
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; Department of Medicine, Veterans Affairs Connecticut Healthcare System, West Haven, CT
| | - Shaili Gupta
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; Department of Medicine, Veterans Affairs Connecticut Healthcare System, West Haven, CT; Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
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Schmidt MG, Tuuri RE, Dharsee A, Attaway HH, Fairey SE, Borg KT, Salgado CD, Hirsch BE. Antimicrobial copper alloys decreased bacteria on stethoscope surfaces. Am J Infect Control 2017; 45:642-647. [PMID: 28302430 DOI: 10.1016/j.ajic.2017.01.030] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 01/25/2017] [Accepted: 01/26/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Stethoscopes may serve as vehicles for transmission of bacteria among patients. The aim of this study was to assess the efficacy of antimicrobial copper surfaces to reduce the bacterial concentration associated with stethoscope surfaces. METHODS A structured prospective trial involving 21 health care providers was conducted at a pediatric emergency division (ED) (n = 14) and an adult medical intensive care unit located in tertiary care facilities (n = 7). Four surfaces common to a stethoscope and a facsimile instrument fabricated from U.S. Environmental Protection Agency-registered antimicrobial copper alloys (AMCus) were assessed for total aerobic colony counts (ACCs), methicillin-resistant Staphylococcus aureus, gram-negative bacteria, and vancomycin-resistant enterococci for 90 days. RESULTS The mean ACCs collectively recovered from all stethoscope surfaces fabricated from the AMCus were found to carry significantly lower concentrations of bacteria (pediatric ED, 11.7 vs 127.1 colony forming units [CFU]/cm2, P < .00001) than their control equivalents. This observation was independent of health care provider or infection control practices. Absence of recovery of bacteria from the AMCu surfaces (66.3%) was significantly higher (P < .00001) than the control surfaces (22.4%). The urethane rim common to the stethoscopes was the most heavily burdened surface; mean concentrations exceeded the health care-associated infection acquisition concentration (5 CFU/cm2) by at least 25×, supporting that the stethoscope warrants consideration in plans mitigating microbial cross-transmission during patient care. CONCLUSIONS Stethoscope surfaces fabricated with AMCus were consistently found to harbor fewer bacteria.
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Affiliation(s)
- Michael G Schmidt
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC.
| | - Rachel E Tuuri
- Department of Emergency Medicine, University of New Mexico, Albuquerque, NM
| | - Arif Dharsee
- North Shore-Long Island Jewish Medical Group, North Shore University Hospital, New York, NY
| | - Hubert H Attaway
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC
| | - Sarah E Fairey
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC
| | - Keith T Borg
- Division of Pediatric Emergency Medicine, Medical University of South Carolina Children's Hospital, Charleston, SC
| | - Cassandra D Salgado
- Division of Infectious Diseases, Department of Medicine, Medical University of South Carolina, Charleston, SC
| | - Bruce E Hirsch
- North Shore-Long Island Jewish Medical Group, North Shore University Hospital, New York, NY
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Rao DA, Aman A, Muhammad Mubeen S, Shah A. Bacterial contamination and stethoscope disinfection practices: a cross-sectional survey of healthcare workers in Karachi, Pakistan. Trop Doct 2017; 47:226-230. [DOI: 10.1177/0049475516686543] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Stethoscopes routinely used for clinical examination of patients may potentially transfer micro-organisms and cause iatrogenic infections. This study was undertaken to detect the presence of microorganisms on stethoscopes used clinically in hospitals of Karachi, Pakistan and to ascertain the infection control practices of healthcare workers (HCWs). In a cross-sectional study, 118 samples were collected from public and private institutions. Samples were tested for the presence and sensitivity of pathogenic microorganisms. Microorganisms were found on diaphragms of 33/64 (51.6%) and 19/57 (33.3%) stethoscopes in public and private sector hospitals, respectively. Methycillin resistance was identified in all staphylococcally contaminated samples. Only 33 (18%) respondents reported cleaning their stethoscopes regularly. We highlight the need for more and better on-the-job routines for decontaminating stethoscopes among HCWs in Karachi.
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Affiliation(s)
- Danish Ahmed Rao
- Graduate, Hamdard College of Medicine & Dentistry, Hamdard University, Karachi, Pakistan
| | - Aiysha Aman
- Graduate, Hamdard College of Medicine & Dentistry, Hamdard University, Karachi, Pakistan
| | - Syed Muhammad Mubeen
- Professor and Head, Department of Community Health Sciences, Hamdard College of Medicine & Dentistry, Hamdard University, Karachi, Pakistan
| | - Ahmed Shah
- Graduate, Hamdard College of Medicine & Dentistry, Hamdard University, Karachi, Pakistan
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Grif Alspach J. About that health care icon dangling around your neck: do we have some cleaning up to do? Crit Care Nurse 2015; 34:11-4. [PMID: 24882825 DOI: 10.4037/ccn2014437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Jenkins IH, Monash B, Wu J, Amin A. The third hand: low rates of stethoscope hygiene on general medical services. J Hosp Med 2015; 10:457-8. [PMID: 25832965 DOI: 10.1002/jhm.2359] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 03/10/2015] [Accepted: 03/13/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Ian Harold Jenkins
- Department of Medicine, University of California, San Diego, San Diego, California
| | - Bradley Monash
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | | | - Alpesh Amin
- Department of Medicine, University of California, Irvine, Irvine, California
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Gazibara T, Radovanovic S, Maric G, Rancic B, Kisic-Tepavcevic D, Pekmezovic T. Stethoscope Hygiene: Practice and Attitude of Medical Students. Med Princ Pract 2015. [PMID: 26202790 PMCID: PMC5588273 DOI: 10.1159/000434753] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the frequency and attitude of medical students towards cleaning their stethoscopes. SUBJECTS AND METHODS A cross-sectional study was carried out in the first week of December 2013. The study included 771 students (397 in their fourth and 374 in their sixth year) from the Faculty of Medicine, University of Belgrade, Serbia. An anonymous questionnaire was distributed to students before the start of compulsory lessons in classrooms. RESULTS 317 of the 397 fourth-year students (79.8%) and 306 of the 374 sixth-year students (81.9%) cleaned their stethoscope. The stethoscope diaphragm was most commonly cleaned, while the flexible tubing was the least commonly cleaned area, mainly using ethyl alcohol-based agents. The strongest positive attitude was observed for the statement 'It is important that my stethoscope is clean' (4.3 out of 5.0). A positive correlation (Spearman's x03C1; = 0.105) was observed between a higher frequency of cleaning and the stronger positive notion that a stethoscope should be cleaned. CONCLUSION A considerably high proportion of the students studied had ever cleaned their stethoscopes. Based on the students' responses, it would be useful to implement instructions on stethoscope hygiene in the regular practical curriculum with the aim of applying stethoscope disinfection in daily work.
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Affiliation(s)
| | | | | | | | | | - Tatjana Pekmezovic
- *Tatjana Pekmezovic, Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Visegradska 26A, RS-11000 Belgrade (Serbia), E-Mail
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Longtin Y, Schneider A, Tschopp C, Renzi G, Gayet-Ageron A, Schrenzel J, Pittet D. Contamination of stethoscopes and physicians' hands after a physical examination. Mayo Clin Proc 2014; 89:291-9. [PMID: 24582188 DOI: 10.1016/j.mayocp.2013.11.016] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 11/05/2013] [Accepted: 11/14/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare the contamination level of physicians' hands and stethoscopes and to explore the risk of cross-transmission of microorganisms through the use of stethoscopes. PATIENTS AND METHODS We conducted a structured prospective study between January 1, 2009, and May 31, 2009, involving 83 inpatients at a Swiss university teaching hospital. After a standardized physical examination, 4 regions of the physician's gloved or ungloved dominant hand and 2 sections of the stethoscopes were pressed onto selective and nonselective media; 489 surfaces were sampled. Total aerobic colony counts (ACCs) and total methicillin-resistant Staphylococcus aureus (MRSA) colony-forming unit (CFU) counts were assessed. RESULTS Median total ACCs (interquartile range) for fingertips, thenar eminence, hypothenar eminence, hand dorsum, stethoscope diaphragm, and tube were 467, 37, 34, 8, 89, and 18, respectively. The contamination level of the diaphragm was lower than the contamination level of the fingertips (P<.001) but higher than the contamination level of the thenar eminence (P=.004). The MRSA contamination level of the diaphragm was higher than the MRSA contamination level of the thenar eminence (7 CFUs/25 cm(2) vs 4 CFUs/25 cm(2); P=.004). The correlation analysis for both total ACCs and MRSA CFU counts revealed that the contamination level of the diaphragm was associated with the contamination level of the fingertips (Spearman's rank correlation coefficient, ρ=0.80; P<.001 and ρ=0.76; P<.001, respectively). Similarly, the contamination level of the stethoscope tube increased with the increase in the contamination level of the fingertips for both total ACCs and MRSA CFU counts (ρ=0.56; P<.001 and ρ=.59; P<.001, respectively). CONCLUSION These results suggest that the contamination level of the stethoscope is substantial after a single physical examination and comparable to the contamination of parts of the physician's dominant hand.
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Affiliation(s)
- Yves Longtin
- Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Alexis Schneider
- Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Clément Tschopp
- Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Gesuèle Renzi
- Bacteriology Laboratory and Genomic Research Laboratory, University of Geneva Hospitals, Geneva, Switzerland
| | - Angèle Gayet-Ageron
- Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jacques Schrenzel
- Bacteriology Laboratory and Genomic Research Laboratory, University of Geneva Hospitals, Geneva, Switzerland
| | - Didier Pittet
- Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland.
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Duszak R, Lanier B, Tubbs JA, Ogilvie M, Thompson-Jaeger S. Bacterial Contamination of Radiologist Workstations: Results of a Pilot Study. J Am Coll Radiol 2014; 11:176-9. [DOI: 10.1016/j.jacr.2013.05.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Accepted: 05/20/2013] [Indexed: 11/28/2022]
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Zaghi J, Zhou J, Graham DA, Potter-Bynoe G, Sandora TJ. Improving stethoscope disinfection at a children's hospital. Infect Control Hosp Epidemiol 2013; 34:1189-93. [PMID: 24113603 DOI: 10.1086/673454] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Stethoscopes are contaminated with pathogenic bacteria and pose a risk for transmission of infections, but few clinicians disinfect their stethoscope after every use. We sought to improve stethoscope disinfection rates among pediatric healthcare providers by providing access to disinfection materials and visual reminders to disinfect stethoscopes. DESIGN Prospective intervention study. SETTING Inpatient units and emergency department of a major pediatric hospital. PARTICIPANTS Physicians and nurses with high anticipated stethoscope use. METHODS Baskets filled with alcohol prep pads and a sticker reminding providers to regularly disinfect stethoscopes were installed outside of patient rooms. Healthcare providers' stethoscope disinfection behaviors were directly observed before and after the intervention. Multivariable logistic regression models were created to identify independent predictors of stethoscope disinfection. RESULTS Two hundred twenty-six observations were made in the preintervention period and 261 in the postintervention period (83% were of physicians). Stethoscope disinfection compliance increased significantly from a baseline of 34% to 59% postintervention (P < .001). In adjusted analyses, the postintervention period was associated with improved disinfection among both physicians (odds ratio [OR], 2.3 [95% confidence interval (CI), 1.4-3.5]) and nurses (OR, 14.3 [95% CI, 4.6-44.6]). Additional factors independently associated with disinfection included subspecialty unit (vs general pediatrics; OR, 0.5 [95% CI, 0.3-0.8]) and contact precautions (OR, 2.3 [95% CI, 1.2-4.1]). CONCLUSIONS Providing stethoscope disinfection supplies and visible reminders outside of patient rooms significantly increased stethoscope disinfection rates among physicians and nurses at a children's hospital. This simple intervention could be replicated at other healthcare facilities. Future research should assess the impact on patient infections.
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