A strategy to reduce MRSA colonization of stethoscopes

Analysis of bacterial contamination and the effectiveness of UV light-based reprocessing of everyday medical devices

Background

The reprocessing of daily used medical devices is often inadequate, making them a potential source of infection. In addition, there are usually no consistent and technically standardized procedures available for this purpose. Hence, the aim of this study is to analyze the bacterial contamination and the effectiveness of Ultraviolet light-based (UV light-based) reprocessing of daily used medical devices.

Material and methods

Six different everyday medical devices (20 each; stethoscopes, tourniquets, bandage scissors, reflex hammers, tuning forks, and nystagmus glasses) were tested for bacterial contamination. All medical devices were then exposed to UV-C light for 25 seconds. Medical devices with a smooth surface were pre-cleaned with a water-based wipe. Contact samples were taken before and after reprocessing.

Results

Immediately after clinical use, 104 of 120 contact samples showed an average bacterial contamination of 44.8±64.3 colony forming units (CFU) (0–300 CFU), also including potentially pathogenic bacteria. Two further culture media were completely overgrown with potentially pathogenic bacteria. The stethoscopes were found to have the highest average contamination of 90±91.6 CFU. After reprocessing, 118 of 120 samples were sterile, resulting in an average residual contamination of 0.02±0.1 CFU in two samples, whereby only bacteria of the ordinary skin flora were found.

Conclusion

The present study shows the potentially clinically relevant bacterial contamination of everyday used medical devices. The reprocessing method tested here using UV light appears to be a suitable method for disinfection, especially for objects that up to now have been difficult to disinfect or cannot be disinfected in a standardized manner.

Stethoscope hygiene: A legal consideration for cardiologists practicing in a new era of infection control (COVID-19)

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.

Bacteriological Study of Electronic Devices Used by Healthcare Workers at Ruhengeri Referral Hospital

Electronic devices have become one of the most essential accessories being used in hospitals. Those devices increase the communication and contact making healthcare delivery more efficient and quality service oriented. The study was designed to collect reliable information about the spreading of pathogens through electronic devices especially in sensitive departments. The objectives of this study were to evaluate the bacterial colonization of electronic devices and determine the effectiveness of disinfection with alcohol 70% (w/v) to reduce the bacterial colonization of electronic devices. It was a cross-sectional study where samples were collected by means of moistened swabs in sterile saline solution from 30 electronic devices used by healthcare workers at Ruhengeri Referral Hospital within four different units: maternity, neonathology, intensive care, and theater room. To evaluate the effects of disinfection using 70% isopropyl alcohol, the second sample collection was carried out after decontamination with 70% isopropyl alcohol. Samples were analyzed in the microbiology lab of INES-Ruhengeri. The result showed that Staphylococcus aureus was the most predominant with 22.5%. Lactobacillus and Citrobacter spp. were 12.5%; Pseudomonas aeruginosa, coagulase-negative Staphylococci, and Serratia marcescens were 10%; Escherichia coli was 7.5%; Klebsiella spp. and Providencia spp. were at 5%. The lowest prevalence was 2.5% of Enterobacter spp. and Salmonella spp. The threat of dissemination of isolated microorganisms is valid, since all devices evaluated in this study showed bacterial contamination of species associated to hospital-acquired infections. Special care should be taken when using electronic devices in healthcare settings in addition to disinfection to reduce the risk of transmission of bacterial agents. Further studies should evaluate the antibiotic susceptibility for better conclusive results since all isolated bacteria in this study were subjected to high resistance and were associated with nosocomial infections.

Methods of Disinfecting Stethoscopes: Systematic Review

The aim of this systematic review was to investigate the effectiveness of various disinfection methods available for stethoscopes. In March 2019, we performed a search in PubMed and Scopus using the search terms: "reducing stethoscopes contamination" and "disinfection stethoscopes"; the Mesh terms used in PubMed were "Decontamination/methods" or "Disinfection/methods" and "Stethoscopes/microbiology". Selection criteria were: English language; at least one disinfection method tested. A total of 253 publications were screened. After title, abstract, and full-text analysis, 17 papers were included in the systematic review. Ethanol at 90%, Ethanol-Based Hands Sanitizer (EBHS), triclosan, chlorhexidine, isopropyl alcohol, 66% ethyl alcohol, sodium hypochlorite, and benzalkonium chloride have been proven to lower the presence of bacteria on stethoscopes' surfaces. In addition, alcohol wipes show effective results. A wearable device emitting ultraviolet C by Light-Emitting Diode (LED) resulted efficacious against common microorganisms involved in Healthcare Associated Infections. The cover impregnated with silver ions seemed to be associated with significantly higher colony counts. Instead, copper stethoscopes surface reduced bacterial load. The disinfection of stethoscopes appears to be essential. There are many valid methods available; the choice depends on various factors, such as the cost, availability, and practicality.

Methicillin-resistant Staphylococcus aureus infection in the hand

BACKGROUND

Methicillin-resistant Staphylococcus aureus has become an increasingly common cause of skin and soft-issue infections. The purpose of this study was to review and summarize the most recent literature on methicillin-resistant S. aureus infections of the hand.

METHODS

The English-language literature related to methicillin-resistant S. aureus infections of the hand was reviewed, and information related to the history, epidemiology, clinical presentation, and treatment of methicillin-resistant S. aureus infections of the hand was summarized.

RESULTS

Community-acquired methicillin-resistant S. aureus hand infections have increased rapidly in prevalence over the past two decades. The prevalence varies markedly around the world, but in the United States, community-acquired methicillin-resistant S. aureus now causes the majority of purulent hand infections.

CONCLUSIONS

Purulent hand infections should be treated with surgical drainage. When antibiotics are indicated, empiric coverage for community-acquired methicillin-resistant S. aureus should be provided if local prevalence rates exceed 10 to 15 percent.

The stethoscope and healthcare-associated infection: a snake in the grass or innocent bystander?

There is a concern that stethoscopes may transmit infectious agents which could result in healthcare-associated infection (HCAI). The aim of this review was to evaluate the available literature as to the role of the stethoscope in the development of HCAI. A literature search was conducted across several databases for relevant studies and reports. Stethoscopes were consistently shown to harbour bacteria. The mean rate of stethoscope contamination across 28 studies was 85% (range: 47-100%). The majority of bacteria isolated were deemed to be non-pathogenic. The most frequently isolated organisms were coagulase-negative staphylococci. The mean level of contamination was in excess of the French Normalization standard for cleanliness (which equates to <20 colony-forming units per membrane) in all six studies in which contamination levels were quantified. Potentially pathogenic organisms cultured from stethoscopes included: Staphylococcus aureus, Pseudomonas aeruginosa, vancomycin-resistant enterococci, and Clostridium difficile. There was evidence that bacteria can transfer from the skin of the patient to the stethoscope and from the stethoscope to the skin. However, studies were not designed to detect a correlation between stethoscope contamination and subsequent HCAI. Surveys assessing cleaning practices revealed a suboptimal commitment to stethoscope disinfection among doctors and medical students. The optimum method for stethoscope cleaning has not been defined, although alcohol-based disinfectants are effective in reducing bacterial contamination. In conclusion, a link between contaminated stethoscopes and HCAI has not yet been confirmed, but transfer of bacteria between skin and stethoscope has been shown. The available information would suggest that stethoscopes should be decontaminated between patients.

Infectious risk moments: a novel, human factors-informed approach to infection prevention

We pilot tested a novel human factors-informed concept to identify infectious risk moments (IRMs) that occur with high frequency during routine intensive care. Following 30 observation-hours, 28 potential IRMs related to hand hygiene, gloves, and objects were expert rated. A comprehensive IRM inventory may provide valuable taxonomy for research, training, and intervention.

Role of MRSA reservoirs in the acute care setting

Background  Nosocomial infection remains the most common complication of hospitalisation. Despite infection control efforts, nosocomial methicillin-resistant Staphylococcus aureus (MRSA) transmission continues to rise. The associated costs of increased hospital stay and patient mortality cause considerable burden to the health system. Objectives  This review sought to evaluate the role of reservoirs, particularly the environment and equipment commonly found in the clinical area, in the transmission of MRSA within the acute hospital. This review updates a review previously completed by the authors and published by the Joanna Briggs Institute (2002). Search strategy  A systematic search for relevant published or unpublished literature was undertaken using electronic databases, the reference lists of retrieved papers and the Internet. This extended the search published in the original review. Databases searched included  Medline (1966-August Week 1 2005), CINAHL (1982-August Week 1 2005), EMBASE (1996-Week 33), as well as the Cochrane Library (Issue 3, 2005) and the Joanna Briggs Institute Evidence Library (August 2005). Selection criteria  All research reports published between 1990 and August 2005 in the English language that focused on the role of the environment and equipment commonly found in the clinical area on the nosocomial MRSA transmission in adult, paediatric or neonatal acute care settings were considered. Data collection and analysis  Two reviewers assessed each paper against the inclusion criteria and a validated quality scale. Studies that scored less than the mean quality score were excluded from the review. Data extraction was undertaken using a tool designed specifically for this review. Statistical comparisons of findings were not possible, so findings are presented in a narrative form. Results  Forty-two papers met the review inclusion criteria, of which 18 obtained a quality score above the threshold and are included in this review. Seven studies reported general investigations of MRSA in the clinical environment and 11 studies explored specific environmental aspects. All studies used exploratory, descriptive or comparative designs. The evidence suggests that MRSA strains within the environment often match those found in patients within that environment. MRSA can be found in the air around MRSA colonised or infected patients. The degree of airborne contamination is significantly increased by activities that promote airflow. Although the site of MRSA colonisation or infection can influence the degree of environmental contamination, these data are inconsistent. Therefore, there is limited evidence for tailoring infection control interventions based on the sites of MRSA colonisation or infection. The evidence suggests that the type of materials used in clinical equipment can influence the effectiveness of cleaning techniques. Current routine cleaning practices, including conventional terminal cleaning, do not necessarily effectively eradicate MRSA from the environment. This review demonstrates that there is a link between the environment and hospital equipment and the transmission of MRSA within the acute hospital setting. Further well-designed research is urgently required to explore the efficacy of specific cleaning and decontamination methods, staff compliance with infection control practices and the range of factors that affect the incidence of MRSA contamination of the environment and equipment commonly found in the clinical area.

The role of surfaces in catheter-associated infections

In this critical review the biocidal efficacies of a variety of antimicrobial coatings currently in use for catheter surfaces are discussed to formulate the best strategy for decreasing the risk of catheter-associated infections. The development of new coatings containing antimicrobial chemicals and light-activated antimicrobial agents, and their applicability for use in catheters are summarised (132 references).

Role of MRSA reservoirs in the acute care setting

BACKGROUND

Nosocomial infection remains the most common complication of hospitalisation. Despite infection control efforts, nosocomial methicillin-resistant Staphylococcus aureus (MRSA) transmission continues to rise. The associated costs of increased hospital stay and patient mortality cause considerable burden to the health system.

OBJECTIVES

This review sought to evaluate the role of reservoirs, particularly the environment and equipment commonly found in the clinical area, in the transmission of MRSA within the acute hospital. This review updates a review previously completed by the authors and published by the Joanna Briggs Institute (2002).

SEARCH STRATEGY

A systematic search for relevant published or unpublished literature was undertaken using electronic databases, the reference lists of retrieved papers and the Internet. This extended the search published in the original review.Databases searched included Medline (1966-August Week 1 2005), CINAHL (1982-August Week 1 2005), EMBASE (1996-Week 33), as well as the Cochrane Library (Issue 3, 2005) and the Joanna Briggs Institute Evidence Library (August 2005).

SELECTION CRITERIA

All research reports published between 1990 and August 2005 in the English language that focused on the role of the environment and equipment commonly found in the clinical area on the nosocomial MRSA transmission in adult, paediatric or neonatal acute care settings were considered.

DATA COLLECTION AND ANALYSIS

Two reviewers assessed each paper against the inclusion criteria and a validated quality scale. Studies that scored less than the mean quality score were excluded from the review. Data extraction was undertaken using a tool designed specifically for this review. Statistical comparisons of findings were not possible, so findings are presented in a narrative form.

RESULTS

Forty-two papers met the review inclusion criteria, of which 18 obtained a quality score above the threshold and are included in this review. Seven studies reported general investigations of MRSA in the clinical environment and 11 studies explored specific environmental aspects. All studies used exploratory, descriptive or comparative designs. The evidence suggests that MRSA strains within the environment often match those found in patients within that environment. MRSA can be found in the air around MRSA colonised or infected patients. The degree of airborne contamination is significantly increased by activities that promote airflow. Although the site of MRSA colonisation or infection can influence the degree of environmental contamination, these data are inconsistent. Therefore, there is limited evidence for tailoring infection control interventions based on the sites of MRSA colonisation or infection. The evidence suggests that the type of materials used in clinical equipment can influence the effectiveness of cleaning techniques. Current routine cleaning practices, including conventional terminal cleaning, do not necessarily effectively eradicate MRSA from the environment. This review demonstrates that there is a link between the environment and hospital equipment and the transmission of MRSA within the acute hospital setting. Further well-designed research is urgently required to explore the efficacy of specific cleaning and decontamination methods, staff compliance with infection control practices and the range of factors that affect the incidence of MRSA contamination of the environment and equipment commonly found in the clinical area.