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Boyce JM. Hand and environmental hygiene: respective roles for MRSA, multi-resistant gram negatives, Clostridioides difficile, and Candida spp. Antimicrob Resist Infect Control 2024; 13:110. [PMID: 39334403 PMCID: PMC11437781 DOI: 10.1186/s13756-024-01461-x] [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: 06/27/2024] [Accepted: 09/04/2024] [Indexed: 09/30/2024] Open
Abstract
Healthcare-associated infections (HAIs) caused by multidrug-resistant organisms (MDROs) represent a global threat to human health and well-being. Because transmission of MDROs to patients often occurs via transiently contaminated hands of healthcare personnel (HCP), hand hygiene is considered the most important measure for preventing HAIs. Environmental surfaces contaminated with MDROs from colonized or infected patients represent an important source of HCP hand contamination and contribute to transmission of pathogens. Accordingly, facilities are encouraged to adopt and implement recommendations included in the World Health Organization hand hygiene guidelines and those from the Society for Healthcare Epidemiology of America/Infectious Diseases Society of America/Association for Professionals in Infection Control and Epidemiology. Alcohol-based hand rubs are efficacious against MDROs with the exception of Clostridiodes difficile, for which soap and water handwashing is indicated. Monitoring hand hygiene adherence and providing HCP with feedback are of paramount importance. Environmental hygiene measures to curtail MDROs include disinfecting high-touch surfaces in rooms of patients with C. difficile infection daily with a sporicidal agent such as sodium hypochlorite. Some experts recommend also using a sporicidal agent in rooms of patients colonized with C. difficile, and for patients with multidrug-resistant Gram-negative bacteria. Sodium hypochlorite, hydrogen peroxide, or peracetic acid solutions are often used for daily and/or terminal disinfection of rooms housing patients with Candida auris or other MDROs. Products containing only a quaternary ammonium agent are not as effective as other agents against C. auris. Portable medical equipment should be cleaned and disinfected between use on different patients. Detergents are not recommended for cleaning high-touch surfaces in MDRO patient rooms, unless their use is followed by using a disinfectant. Facilities should consider using a disinfectant instead of detergents for terminal cleaning of floors in MDRO patient rooms. Education and training of environmental services employees is essential in assuring effective disinfection practices. Monitoring disinfection practices and providing personnel with performance feedback using fluorescent markers, adenosine triphosphate assays, or less commonly cultures of surfaces, can help reduce MDRO transmission. No-touch disinfection methods such as electrostatic spraying, hydrogen peroxide vapor, or ultraviolet light devices should be considered for terminal disinfection of MDRO patient rooms. Bundles with additional measures are usually necessary to reduce MDRO transmission.
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Affiliation(s)
- John M Boyce
- J.M. Boyce Consulting, LLC, 214 Hudson View Terrace, Hyde Park, NY, USA.
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Peacock WF, Dhand A, Albert NM, Shahid Z, Luk A, Vollman K, Schoppelrey RB, Cadwell C, Dadwal S, Amin AN, Torriani FJ. Stethoscope barriers narrative review; It's time for a strategy unfriendly to multi-drug resistant organisms (MDROs). J Infect Public Health 2024; 17:1001-1006. [PMID: 38636310 DOI: 10.1016/j.jiph.2024.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/24/2024] [Accepted: 03/25/2024] [Indexed: 04/20/2024] Open
Abstract
The current standard of stethoscope hygiene doesn't eliminate the transmission of harmful pathogens, including multi-drug resistant organisms (MDROs). In the era of the increasing prevalence of MDRO infections, the use of new systems providing touch free barriers may improve patient safety versus traditional stethoscope cleaning practices with chemical agents. Our purpose was to provide a narrative literature review regarding barriers as an improvement over the current standard of care for stethoscope hygiene. Searching PubMed, articles were identified if they were in English and published after 1990, using the search term "stethoscope barrier", or if they were from a previously published stethoscope hygiene article using "author's name + stethoscope". Included articles evaluated or discussed stethoscope barriers. Of 28 manuscripts identified, 15 met the inclusion criteria. Barriers were considered superior to alternatives if they were single use, disposable, applied in a touch free fashion, were impervious to pathogens, provided an aseptic patient contact, and were acoustically invisible. Use of a practitioner's personal stethoscope with a disposable diaphragm barrier should be recommended as a new standard of care as this represents an improvement in patient safety and patient experience when compared to the disposable stethoscope or isopropyl alcohol stethoscope diaphragm cleaning.
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Affiliation(s)
| | | | | | - Zainab Shahid
- Memorial Sloan Kettering Cancer Center, United States
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Jovanovic A, Paunovic K, Ercegovac M, Popovic D, Davidovic D. Personal stethoscope disinfection practices and bacterial contamination: A cross-sectional study at the University Hospital Emergency Department in Belgrade, Serbia. Am J Infect Control 2024; 52:176-182. [PMID: 37598902 DOI: 10.1016/j.ajic.2023.08.006] [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: 05/17/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND A significant reduction in bacterial growth on stethoscope membranes has been noticed after performing daily disinfection. Nevertheless, disinfection is rarely performed. We aimed to assess self-reported stethoscope disinfection practices among medical doctors, detect bacterial contamination on personal stethoscopes, and estimate the effectiveness of 70% ethanol as a stethoscope disinfecting agent. METHODS To determine stethoscope disinfection practices, participants filled out a questionnaire (N = 47), followed by providing stethoscopes for bacterial analysis. Differences in bacterial contamination were observed through the self-reported frequency and method of stethoscope disinfection. The effect of disinfecting with 70% ethanol was evaluated by comparing the presence of bacterial growth before and after disinfection. RESULTS The presence of bacterial growth was found in 78.7% of the stethoscope samples, with the median (interquartile range) number of colony-forming units at 25 (10-105). The frequency of disinfection greatly impacted the number of colony-forming units, and the method affected the presence of bacterial growth. Disinfection of stethoscope membranes using 70% ethanol resulted in a compelling 97.3% reduction of bacterial growth. CONCLUSIONS Adequate stethoscope disinfection is highly efficient in reducing bacterial contamination and as such should be considered a critical step in hygienic practices.
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Affiliation(s)
- Ana Jovanovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Institute of Hygiene and Medical Ecology, Belgrade, Serbia
| | - Katarina Paunovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Institute of Hygiene and Medical Ecology, Belgrade, Serbia
| | - Marko Ercegovac
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Clinic of Neurology, Clinical Center of Serbia, Belgrade, Serbia
| | - Dusan Popovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Department of Gastroenterology, Clinic for Internal Medicine, Clinical Hospital Center "Dr Dragisa Misovic-Dedinje", Belgrade, Serbia
| | - Dragana Davidovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Institute of Hygiene and Medical Ecology, Belgrade, Serbia.
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Zhuge Y, Rong L, Ye L, Liu J, Su L, Zhang Z, Wang J, Zhang Z. The value of the wireless stethoscope in patients with COVID-19 infection in a makeshift hospital. Biomed Eng Online 2023; 22:71. [PMID: 37452420 PMCID: PMC10347834 DOI: 10.1186/s12938-023-01136-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVE When COVID-19 sweeps the world, traditional stethoscopes are seen as infectious agents and then the use of stethoscopes is limited especially when health providers were in their personal protective equipment. These reasons led to the ignoring of the values of stethoscopes during pandemics. This study aims to explore the value of wireless stethoscopes in patients of a makeshift hospital. MATERIAL AND METHODS 200 consecutive hospitalized patients with confirmed SARS-CoV-2 at Lingang Makeshift Hospital in Shanghai, China, were enrolled from April 10 to May 10, 2022 (Trial Registration Number: ChiCTR2000038272,2020/9/15). They were randomly divided into two groups. In group A (n = 100), patients were examined without a stethoscope. In group B (n = 100), lung breath sounds and heart sounds were examined with a wireless stethoscope, and positive signs were recorded. The duration of cough and tachycardia symptoms, as well as emergency cases, were compared between the two groups. In addition, the pressure, anxiety, and depression of patients in the two groups were investigated using the DAS-21 questionnaire scale, to observe the psychological impact of the stethoscope-based doctor-patient communication on patients in the makeshift hospital. RESULTS There was no significant difference in baseline characteristics between the two groups. In group B, some significant positive signs were detected by wireless stethoscopes, including pulmonary rales and tachycardia, etc. Moreover, the therapeutic measures based on these positive signs effectively alleviated the symptoms of cough and tachycardia, which showed that the duration of symptoms was significantly shorter than that of group A (cough: 2.8 ± 0.9 vs. 3.6 ± 0.9; palpitation: 1.4 ± 0.7 vs. 2.6 ± 0.7). In particular, the number of emergency cases in group B is less than that in group A (1% vs. 3%), and the severity is lower. Notably, stethoscope-based doctor-patient communication was found to be effective in alleviating psychological measures of group B patients. CONCLUSION Wireless stethoscopes in makeshift hospitals can avoid cross-infections and detect more valuable positive signs, which can help health providers make accurate decisions and relieve patients' symptoms more quickly. Moreover, stethoscope-based doctor-patient communication can diminish the psychological impacts of the epidemic on isolated patients in makeshift hospitals. Trial registration This study was registered in the Chinese Clinical Trial (ChiCTR2000038272) at http://www.chictr.org.cn . http://www.chinadrugtrials.org.cn/clinicaltrials.searchlistdetail.dhtml .
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Affiliation(s)
- Ying Zhuge
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine (Originally Named "Shanghai First People's Hospital"), 100 Haining Road, Shanghai, 200080, People's Republic of China
| | - Liu Rong
- Department of Critical Care Medicine, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine (Originally Named "Shanghai First People's Hospital"), Shanghai, China
| | - Lei Ye
- Department of Nursing, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine (Originally Named "Shanghai First People's Hospital"), Shanghai, China
| | - Jiaqi Liu
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine (Originally Named "Shanghai First People's Hospital"), 100 Haining Road, Shanghai, 200080, People's Republic of China
| | - Lingyun Su
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine (Originally Named "Shanghai First People's Hospital"), 100 Haining Road, Shanghai, 200080, People's Republic of China
| | - Zhiping Zhang
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine (Originally Named "Shanghai First People's Hospital"), 100 Haining Road, Shanghai, 200080, People's Republic of China
| | - Junshan Wang
- Department of Gastroenterology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Zhi Zhang
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine (Originally Named "Shanghai First People's Hospital"), 100 Haining Road, Shanghai, 200080, People's Republic of China.
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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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Adhikari S, Adhikaree N, Paudel KP, Nepal R, Poudel B, Giri S, Khadka S, Khawas S, Sapkota S, Regmi RS, Rijal KR. Bacterial Assessment of Stethoscopes Used by Healthcare Workers at a Tertiary Care Government Hospital in Bharatpur, Nepal. Diseases 2023; 11:diseases11020055. [PMID: 37092437 PMCID: PMC10123714 DOI: 10.3390/diseases11020055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/13/2023] [Accepted: 03/28/2023] [Indexed: 04/05/2023] Open
Abstract
The transmission of healthcare-associated infections (HCAIs) in healthcare settings is a serious challenge in the medical fraternity. Medical devices, such as stethoscopes used by healthcare workers (HCWs), are likely to harbor a considerable number of pathogenic microbes, which may result in the transmission of HCAIs. This study sought to investigate bacterial contamination of stethoscopes used by HCWs at Bharatpur Hospital, Nepal. During the study period of 3 months from December 2019 to February 2020, a total of 87 stethoscopes were examined; bacterial pathogens were isolated and identified by culture and biochemical tests, and their susceptibilities against different antibiotics were determined using standard protocols of the Clinical and Laboratory Standards Institute (CLSI). The disc diffusion method was used primarily to screen for extended-spectrum beta-lactamase (ESBL)- and metallo-beta-lactamase (MBL)-producing isolates, followed by their confirmation using cephalosporin/clavulanate combination discs and the disc potentiation methods, respectively. In addition, molecular detection of blaCTX-M and blaVIM genes was performed using conventional polymerase chain reaction (PCR). Of the 87 stethoscopes examined, more than a quarter (28.7%) were colonized with different pathogenic bacteria. Bacterial contamination of stethoscopes was found to be significantly associated with various factors, such as disinfecting routine, method of disinfection, and department of the hospital (p < 0.05). A higher rate of bacterial contamination was observed on the diaphragm of the stethoscope (12.64%) and among HCWs who overlooked hand hygiene practices (45.45%). The prevalence of methicillin-resistant S. aureus (MRSA) was 44.44%, and approximately half of the Gram-negative isolates (47%) were multidrug resistant (MDR). Imipenem (81.25%) and chloramphenicol (83.33%) were found to be the most effective antibiotics for Gram-negative and Gram-positive bacteria, respectively. Phenotypic screening showed that 43.75% of isolates were ESBL producers, and 18.75% were MBL producers, but blaCTX-M and blaVIM genes were detected in only 31.25% and 6.25% of isolates, respectively. The results of the study call for effective stethoscope disinfection practices along with the judicious use of antibiotics by HCWs in order to minimize cross-contamination, emergence of resistance, and spread of nosocomial infections in clinical settings.
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Affiliation(s)
- Sanjib Adhikari
- Central Department of Microbiology, Tribhuvan University, Kirtipur 44618, Nepal
- Department of Microbiology, Birendra Multiple Campus, Bharatpur 44207, Nepal
| | - Neetu Adhikaree
- Department of Microbiology, Bharatpur Hospital, Bharatpur 44200, Nepal
- Department of Microbiology, College of Medical Sciences, Bharatpur 44207, Nepal
| | | | - Roshan Nepal
- Central Department of Microbiology, Tribhuvan University, Kirtipur 44618, Nepal
- Department of Microbiology, Birendra Multiple Campus, Bharatpur 44207, Nepal
| | - Birendra Poudel
- Department of Microbiology, Birendra Multiple Campus, Bharatpur 44207, Nepal
| | - Sujan Giri
- Department of Microbiology, Birendra Multiple Campus, Bharatpur 44207, Nepal
| | - Suman Khadka
- Department of Microbiology, Birendra Multiple Campus, Bharatpur 44207, Nepal
| | - Saphala Khawas
- Department of Microbiology, Birendra Multiple Campus, Bharatpur 44207, Nepal
| | - Sanjeep Sapkota
- Department of Microbiology, Birendra Multiple Campus, Bharatpur 44207, Nepal
| | - Ramesh Sharma Regmi
- Central Department of Microbiology, Tribhuvan University, Kirtipur 44618, Nepal
| | - Komal Raj Rijal
- Central Department of Microbiology, Tribhuvan University, Kirtipur 44618, Nepal
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Frank Peacock W, Torriani FJ, Shahid Z, Dhand A, Luk A, Dadwal S. Our Third Hand: Stethoscope Hygiene in the Era of Alcohol-Resistant Organisms. Am J Med 2023; 136:551-554. [PMID: 36740208 DOI: 10.1016/j.amjmed.2023.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 01/17/2023] [Indexed: 02/05/2023]
Affiliation(s)
- W Frank Peacock
- Department of Emergency Medicine, Baylor College of Medicine, Houston, Tex.
| | - Francesca J Torriani
- UC San Diego Health's Infection Prevention and Clinical Epidemiology Unit, Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, San Diego
| | - Zainab Shahid
- Infectious Diseases Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Abhay Dhand
- Transplant Infectious Diseases, Westchester Medical Center/New York Medical College, New York, NY
| | - Alfred Luk
- Section of Infectious Diseases, Deming Department of Medicine, Tulane University School of Medicine, New Orleans, La
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Peacock WF, Chemaly RF, Torriani F, Shahid Z, Dawal S. A new normal for the clinician's third hand: Stethoscope hygiene and infection prevention. Am J Infect Control 2023; 51:114-118. [PMID: 36351475 DOI: 10.1016/j.ajic.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/07/2022] [Accepted: 10/12/2022] [Indexed: 11/09/2022]
Affiliation(s)
- W Frank Peacock
- Research Henry JN Taub Department of Emergency Medicine Baylor College of Medicine, Houston, TX.
| | - Roy F Chemaly
- Clinical Virology Research Department of ID/IC/EH UT MD, Anderson Cancer Center, Houston, TX; Division of Epidemiology, Human Genetics, and Environmental Sciences, UT School of Public Health, Houston, TX; Medicine Baylor College of Medicine, Houston, TX
| | - Francesca Torriani
- Infection Prevention and Clinical Epidemiology and Tuberculosis Control UC San Diego Health, Clinical Division of ID And Global Health at UC San Diego San Diego, CA
| | - Zainab Shahid
- Memorial Sloan Kettering Cancer Center, Manhattan, NY
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Ullrich C, Luescher AM, Koch J, Grass RN, Sax H. Silica nanoparticles with encapsulated DNA (SPED) to trace the spread of pathogens in healthcare. Antimicrob Resist Infect Control 2022; 11:4. [PMID: 35012659 PMCID: PMC8743744 DOI: 10.1186/s13756-021-01041-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/06/2021] [Indexed: 01/05/2023] Open
Abstract
Background To establish effective infection control protocols, understanding pathogen transmission pathways is essential. Non-infectious surrogate tracers may safely explore these pathways and challenge pre-existing assumptions. We used silica nanoparticles with encapsulated DNA (SPED) for the first time in a real-life hospital setting to investigate potential transmission routes of vancomycin-resistant enterococci in the context of a prolonged outbreak. Methods The two study experiments took place in the 900-bed University Hospital Zurich, Switzerland. A three-run ‘Patient experiment’ investigated pathogen transmission via toilet seats in a two-patient room with shared bathroom. First, various predetermined body and fomite sites in a two-bed patient room were probed at baseline. Then, after the first patient was contaminated with SPED at the subgluteal region, both patients sequentially performed a toilet routine. All sites were consequently swabbed again for SPED contamination. Eight hours later, further spread was tested at predefined sites in the patient room and throughout the ward. A two-run ‘Mobile device experiment’ explored the potential transmission by mobile phones and stethoscopes in a quasi-realistic setting. All SPED contamination statuses and levels were determined by real-time qPCR. Results Over all three runs, the ‘Patient experiment’ yielded SPED in 59 of 73 (80.8%) predefined body and environmental sites. Specifically, positivity rates were 100% on subgluteal skin, toilet seats, tap handles, and entertainment devices, the initially contaminated patients’ hands; 83.3% on patient phones and bed controls; 80% on intravenous pumps; 75% on toilet flush plates and door handles, and 0% on the initially not contaminated patients’ hands. SPED spread as far as doctor’s keyboards (66.6%), staff mobile phones (33.3%) and nurses’ keyboards (33.3%) after eight hours. The ‘Mobile device experiment’ resulted in 16 of 22 (72.7%) positive follow-up samples, and transmission to the second patient occurred in one of the two runs. Conclusions For the first time SPED were used to investigate potential transmission pathways in a real hospital setting. The results suggest that, in the absence of targeted cleaning, toilet seats and mobile devices may result in widespread transmission of pathogens departing from one contaminated patient skin region.
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Comparison of two alcohol hand rubbing techniques regarding hand surface coverage among hospital workers: a quasi-randomized controlled trial. Antimicrob Resist Infect Control 2022; 11:132. [PMID: 36329519 PMCID: PMC9635155 DOI: 10.1186/s13756-022-01172-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The adapted 6-step without interlock (A6Sw/oI) hand rub technique, commonly practiced in Japan, adds the "wrist" but omits the "interlock" step compared to the WHO 6-step technique (WHO6S). The first objective of this study was to assess the differences of the two techniques regarding surface coverage. The second objective was to analyze the coverage differences between hand sizes. METHODS Hospital workers went under stratified quasi-randomization by glove size. The overall mean coverage, and the coverage of the sections of the hands were evaluated by fluorescent dye-based coverage assessment using a digital device with artificial intelligence technology. RESULTS Total of 427 workers were randomly allocated to WHO6S (N = 215) or the A6Sw/oI (N = 212). The overall mean dorsum coverage by WHO6S and A6Sw/oI was 90.6% versus 88.4% (p < 0.01), and the percentage of the participants with insufficient coverage of the backs of the four fingers ranged from 0.0-7.4% versus 28.2-51.4% (p < 0.001). Dorsum coverage varied largely between hand size for both techniques, and significant differences were found between small and large hands. CONCLUSION The WHO6S was superior to the locally adapted technique regarding hand surface coverage. Hand size should be considered when assessing coverage differences between procedures. No trial registrations or fundings.
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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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12
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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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13
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Impact of alcohol-based hand-rub disinfection on bacterial bioburden on stethoscopes in a real-world clinical setting. Infect Control Hosp Epidemiol 2022:1-3. [DOI: 10.1017/ice.2022.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
In this randomized study, use of alcohol-based hand-rub disinfection significantly reduced bacterial bioburden of stethoscopes in routine clinical use. Prior cleaning of stethoscopes on the study day did not affect baseline contamination rates, which suggests that the efficacy of alcohol disinfection is short-lived and may need to be repeated between patients.
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14
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Amod F, Swalaha FM, Reddy P. Assessment of Bacterial Transfer From Patient to Chiropractor During Spinal Manipulation. J Chiropr Med 2022; 20:43-52. [PMID: 34987320 DOI: 10.1016/j.jcm.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 08/09/2021] [Accepted: 08/09/2021] [Indexed: 11/19/2022] Open
Abstract
Objective This study aimed to measure the amount of bacteria that may be transferred from patient to chiropractor during spinal manipulation and the efficacy of decontaminants commonly used by chiropractic practitioners. Methods We chose Kwazulu-Natal, South Africa as the location, which is an area with an increased burden of immunocompromised patients resulting from HIV and tuberculosis. In this region, we obtained samples from 40 chiropractors' hands before and after spinal manipulation. Viable counts of colony-forming units were enumerated to verify the presence of bacteria. A modified Kirby-Bauer technique was used to ascertain the efficacy of the top 5 decontaminants used by chiropractors in this area against the bacteria isolated from their hands. Results Both normal microflora and potentially pathogenic bacteria were found. These included Staphylococcus spp., Micrococcus spp., Bacillus spp., Pseudomonas spp., Escherichia coli, Streptococcus spp., and Staphylococcus aureus. Higher bacterial counts were found on chiropractors' hands after patient contact for spinal manipulation, which are similar to findings from studies of other healthcare personnel. The 5 commonly used disinfectants tested in a lab setting were not as effective against bacterial samples when compared with an antimicrobial pharmaceutical medication. Conclusions The net transfer of bacteria to chiropractors' hands from the patient to the practitioner during spinal manipulation included primary and opportunistic pathogens. The detergents commonly used by chiropractors in this region showed varying efficacies against microbial growth when tested in vitro.
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Affiliation(s)
- Fariha Amod
- Department of Chiropractic, Durban University of Technology, Durban, KwaZulu-Natal, South Africa
| | - Feroz M Swalaha
- Department of Biotechnology and Food Technology, Durban University of Technology, Durban, KwaZulu-Natal, South Africa
| | - Poovendhree Reddy
- Department of Community Health Studies, Durban University of Technology, Durban, KwaZulu-Natal, South Africa
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15
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Pelzer ES, Stewart Z, Peters H, O'Callaghan J, Bryan E, Wager L, Chiruta J. Implementation of a structured practical activity to analyse student healthcare worker perceptions and compliance with prescribed infection control procedures. BMC MEDICAL EDUCATION 2021; 21:617. [PMID: 34906108 PMCID: PMC8672573 DOI: 10.1186/s12909-021-03048-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 11/12/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Non-compliance with infection control guidelines has been reported within healthcare settings. Infection control education in undergraduate healthcare education programs forms a critical component in preparing student healthcare workers for vocational roles. METHODS Clinical sciences students (nutrition science, paramedicine, pharmacy, podiatry, optometry studying for qualifications recognised by the Australian Health Practitioner Regulation Agency) self-reported hygiene perceptions and practices and collected microbiological swabs from personal or medical equipment items before and after recommended disinfection procedures. RESULTS Cultivable microorganisms were isolated from 95% of student medical equipment items. Disinfection significantly reduced microbial growth on student medical equipment items (P < 0.05). CONCLUSIONS Student perceptions of infection control procedures do not always correlate with infection control practice. Infection control education of undergraduate healthcare students requires ongoing assessment to ensure successful translation into clinical practice.
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Affiliation(s)
- Elise S Pelzer
- Queensland University of Technology, School of Biomedical Sciences, Faculty of Health, 2 George Street, Brisbane City, QLD, 4000, Australia.
- Queensland University of Technology, PO Box 2434, Brisbane, Queensland, 4001, Australia.
| | - Zachary Stewart
- Queensland University of Technology, School of Biomedical Sciences, Faculty of Health, 2 George Street, Brisbane City, QLD, 4000, Australia
| | - Holly Peters
- Queensland University of Technology, School of Biomedical Sciences, Faculty of Health, 2 George Street, Brisbane City, QLD, 4000, Australia
| | - Jessica O'Callaghan
- Queensland University of Technology, School of Biomedical Sciences, Faculty of Health, 2 George Street, Brisbane City, QLD, 4000, Australia
| | - Emily Bryan
- Queensland University of Technology, School of Biomedical Sciences, Faculty of Health, 2 George Street, Brisbane City, QLD, 4000, Australia
| | - Lucas Wager
- Queensland University of Technology, School of Biomedical Sciences, Faculty of Health, 2 George Street, Brisbane City, QLD, 4000, Australia
| | - Juliana Chiruta
- Queensland University of Technology, School of Biomedical Sciences, Faculty of Health, 2 George Street, Brisbane City, QLD, 4000, Australia
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16
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Pegu KD, Perrie H, Scribante J, Fourtounas M. Microbial contamination of the hands of healthcare providers in the operating theatre of a central hospital. S Afr J Infect Dis 2021; 36:221. [PMID: 34485495 PMCID: PMC8378170 DOI: 10.4102/sajid.v36i1.221] [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: 05/20/2020] [Accepted: 02/03/2021] [Indexed: 11/22/2022] Open
Abstract
Background Effort is invested in maintaining the sterility of the operating field, but less attention is paid to potential healthcare associated infection (HAI) sources through patient contact with non-scrubbed healthcare providers (HCPs). A single microbiological assessment of hands can provide a good assessment of the potential dynamic transmission of microorganisms. The aim of this study was to identify and quantify the microbial growth on the hands of HCPs in the operating theatres of Chris Hani Baragwanath Academic Hospital. Methods A prospective, contextual and descriptive study design was followed. Seventy-five samples were collected using convenience sampling from an equal number of surgeons, anaesthetists and nurses. Specimens were taken using agar plates and underwent semi-quantitative analysis. Results All the hands of the HCPs displayed growth; 95% grew commensals and 64% grew pathogens. Eighteen commensal microorganisms and 21 pathological microorganisms were noted. Comparisons of commensal, pathological and combined levels of contamination among the three groups were not statistically significant (p = 0.061, p = 0.481, p = 0.236). No significant difference between the growth of combined microorganisms (p = 0.634) and pathological microorganisms (p = 0.499) among the groups. Surgeons had significantly more commensal growth (p = 0.041). There was no statistically significant difference between sexes (p = 0.290). Conclusion It was concerning that 100% of the hands of HCPs who were about to commence with the surgical list had microbial growth. These HCPs could have already been in contact with patients and equipment in the theatre environment.
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Affiliation(s)
- Kylesh D Pegu
- Department of Anaesthesiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Helen Perrie
- Department of Anaesthesiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Juan Scribante
- Department of Anaesthesiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Maria Fourtounas
- Department of Anaesthesiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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17
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Lotfinejad N, Peters A, Tartari E, Fankhauser-Rodriguez C, Pires D, Pittet D. Hand hygiene in health care: 20 years of ongoing advances and perspectives. THE LANCET. INFECTIOUS DISEASES 2021; 21:e209-e221. [PMID: 34331890 DOI: 10.1016/s1473-3099(21)00383-2] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/14/2021] [Accepted: 06/14/2021] [Indexed: 12/14/2022]
Abstract
Health-care-associated infections are the most prevalent adverse events of hospital care, posing a substantial threat to patient safety and burden on society. Hand hygiene with alcohol-based hand rub is the most effective preventive strategy to reduce health-care-associated infections. Over the past two decades, various interventions have been introduced and studied to improve hand hygiene compliance among health-care workers. The global implementation of the WHO multimodal hand hygiene improvement strategy and constant efforts to replace the use of soap and water with alcohol-based hand rub have led to a faster and more efficient hand cleaning method. These strategies have strongly contributed to the success of behaviour change and a subsequent decrease in health-care-associated infections and cross-transmission of multidrug-resistant organisms worldwide. The WHO multimodal behaviour change strategy requires a series of elements including system change as a prerequisite for behaviour, change, education, monitoring and performance feedback, reminders in the workplace, and an institutional safety climate. Successful adoption of the promotion strategy requires adaptation to available resources and sociocultural contexts. This Review focuses on the major advances and challenges in hand hygiene research and practices in the past 20 years and sets out various ways forward for improving this lifesaving action.
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Affiliation(s)
- Nasim Lotfinejad
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Alexandra Peters
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Ermira Tartari
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland; Faculty of Health Sciences, University of Malta, Malta
| | | | - Daniela Pires
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Didier Pittet
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
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18
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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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19
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Qamar S, Tekin A, Taweesedt PT, Varon J, Kashyap R, Surani S. Stethoscope - An essential diagnostic tool or a relic of the past? Hosp Pract (1995) 2021; 49:240-244. [PMID: 34180345 DOI: 10.1080/21548331.2021.1949170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Rene Laennec came up with the idea of a stethoscope in 1816 to avoid the embarrassment of performing immediate auscultation on women. Soon many doctors around the world started using this tool because of its increased accuracy and ease of use. Stethoscopes hold great significance in the medical community. However, is the importance placed on stethoscopes justified today? We now have devices like portable ultrasound machines that make it much easier to visualize the body. These devices offset their higher initial cost by reducing downstream costs due to their greater accuracy and their capability of detecting diseases at an earlier stage. Also, because of the COVID-19 pandemic, new ways are being investigated to reduce the transmission of diseases. Stethoscopes being a possible vector for infectious agents coupled with the advent of newer devices that can visualize the body with greater accuracy put into question the continued use of stethoscopes today. With that said, the use of stethoscopes to diagnose diseases is still crucial in places where buying these new devices is not yet possible. The stethoscope is a great symbol of medicine, but its use needs to be in line with what is best for the patient.
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Affiliation(s)
| | | | | | - Joseph Varon
- United Memorial Medical Center, Houston, TX, USA
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20
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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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21
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Gaisser DJ, Lowey SE, Barbel P. An Examination and Comparison of Stethoscope Hygiene in Nursing Education Programs. J Nurs Educ 2021; 60:277-280. [PMID: 34039141 DOI: 10.3928/01484834-20210420-07] [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: 11/20/2022]
Abstract
BACKGROUND Improper stethoscope hygiene has been found to contribute to the development of health care associated infections, which affects approximately one in every 30 hospitalized patients. Various pathogens have been found on the stethoscopes of health care workers. METHOD A correlational descriptive design was used to compare stethoscopes from 117 nursing students. Sterile swab samples were obtained from four separate areas of each stethoscope. Samples were plated and incubated for 24 to 48 hours. RESULTS Bacteria were found on all parts of the stethoscopes from both undergraduate and graduate nursing students, with the earpiece having the highest percentage of contamination. Staphylococcus was the most prevalent microbe found on all four swab sites. CONCLUSION Educating students about stethoscope hygiene and consistently reinforcing it in practice are essential to reduce the transmission of pathogens in the health care environment. Nurses can model best practice with students and other disciplines to increase the likelihood of adherence. [J Nurs Educ. 2021;60(5):277-280.].
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22
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Lee R, Choi SM, Jo SJ, Han S, Park YJ, Choi MA, Kong BK. A quasi-experimental study on stethoscopes contamination with multidrug-resistant bacteria: Its role as a vehicle of transmission. PLoS One 2021; 16:e0250455. [PMID: 33886664 PMCID: PMC8062016 DOI: 10.1371/journal.pone.0250455] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 04/06/2021] [Indexed: 11/18/2022] Open
Abstract
Stethoscopes have been suggested to be a possible vector of contact transmission. However, only a few studies have focused on the prevalence of contamination by multidrug-resistant (MDR) bacteria and effectiveness of disinfection training to reduce. This study is to investigate the burden of stethoscope contamination with nosocomial pathogens and multidrug-resistant (MDR) bacteria and to analyze habit changes in disinfection of stethoscopes among healthcare workers (HCWs) before and after education and training. We performed a prospective pre and post quasi-experimental study. A total of 100 HCWs (55 doctors and 45 nurses) were recruited. HCWs were surveyed on their disinfection behavior and stethoscopes were cultured by pressing the diaphragm directly onto a blood agar plate before and after education on disinfection. Pulsed-field gel electrophoresis was performed to determine the relatedness of carbapenem-resistant Enterobacteriaceae. Most of the stethoscopes were contaminated with microorganisms before and after the intervention (97.9% and 91.5%, respectively). The contamination rate of stethoscopes with nosocomial pathogens before and after education was 20.8% and 19.2%, respectively. Stethoscope disinfection habits improved (55.1% vs 31.0%; p<0.001), and the overall bacterial loads of contamination were reduced (median colony-forming units, 15 vs 10; p = 0.019) after the intervention. However, the contamination rate by nosocomial pathogens and MDR bacteria did not decrease significantly. A carbapenemase-producing Klebsiella pneumoniae isolates from a stethoscope was closely related to isolates from the patients admitted at the same ward where the stethoscope was used. Stethoscopes were contaminated with various nosocomial pathogens including MDR bacteria and might act as a vehicle of MDR bacteria. Continuous, consistent education and training should be provided to HCWs using multifaceted approach to reduce the nosocomial transmission via stethoscopes.
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Affiliation(s)
- Raeseok Lee
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Su-Mi Choi
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Hospital Infection Control, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- * E-mail:
| | - Sung Jin Jo
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Songyi Han
- Department of Hospital Infection Control, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yun Jeong Park
- Department of Hospital Infection Control, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Min A. Choi
- Department of Hospital Infection Control, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Bo Kyung Kong
- Department of Microbiology, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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23
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Queiroz Júnior JRAD, Melo IO, Calado GHDS, Cavalcanti LRC, Sobrinho CRW. Identification and resistance profile of bacteria isolated on stethoscopes by health care professionals: Systematic review. Am J Infect Control 2021; 49:229-237. [PMID: 32653560 DOI: 10.1016/j.ajic.2020.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Evaluate the presence of bacteria and resistance profile in stethoscopes used by health care professionals and its consequences within the hospital environment. METHODS It is a systematic review, in which articles indexed in the BVS, CAPES-Periódicos, Cochrane Library, PubMed, Scientific Electronic Library Online, and ScienceDirect databases were searched. RESULTS Twenty-two articles were selected for this study. The significant majority of professionals does not perform hygiene of the stethoscope, either due to the lack of instructions or the lack of knowledge about the contamination's risks. In addition, over these 22 articles evaluated, only 10 demonstrated that more than 50% of the analyzed samples were contaminated with some type of bacteria. Coagulase-negative Staphylococcus spp., Staphylococcus aureus, Acinetobacter spp., Pseudomonas spp., and Klebsiella pneumoniae were the most recurrent pathogens. Besides that, multiresistant strains were also isolated, highlighting resistance to Ampicillin and Clindamycin. CONCLUSIONS Indeed, the stethoscope is a potential disseminator of bacterial infections. The contamination is explained by the possible cross reactions that make the transmission of infectious agents possible. Cleaning before and after each auscultate is an efficient alternative to minimize these pathogens.
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Affiliation(s)
| | - Isadora Oliveira Melo
- Medical Sciences Center, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | | | | | - Carlos Roberto Weber Sobrinho
- Department of Tropical Medicine, Medical Sciences Center, Federal University of Pernambuco, Recife, Pernambuco, Brazil
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24
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Durso FT, Parmar S, Heidish RS, Tordoya Henckell S, Oncul OS, Jacob JT. Improving the communication of hand hygiene procedures: Controlled observation, redesign, and randomized group comparisons. Infect Control Hosp Epidemiol 2021; 42:194-202. [PMID: 32895067 PMCID: PMC7885175 DOI: 10.1017/ice.2020.407] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/13/2020] [Accepted: 07/26/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To assess the clarity and efficacy of the World Health Organization (WHO) hand-rub diagram, develop a modified version, and compare the 2 diagrams. DESIGN Randomized group design preceded by controlled observation and iterative product redesigns. SETTING The Cognitive Ergonomics Lab in the School of Psychology at the Georgia Institute of Technology. PARTICIPANTS We included participants who were unfamiliar with the WHO hand-rub diagram (convenience sampling) to ensure that performance was based on the diagram and not, for example, on prior experience. METHODS We iterated through the steps of a human factors design procedure: (1) Participants simulated hand hygiene using ultraviolet (UV) absorbent lotion and a hand-rub technique diagram (ie, WHO or a redesign). (2) Coverage, confusion judgments, and behavioral videos informed potentially improved diagrams. And (3) the redesigned diagrams were compared with the WHO version in a randomized group design. Coverage was assessed across 72 hand areas from multiple UV photographs. RESULTS The WHO diagram led to multiple omissions in hand-surface coverage, including inadequate coverage by up to 75% of participants for the ulnar edge. The redesigns improved coverage significantly overall and often substantially. CONCLUSIONS Human factors modification to the WHO diagram reduced inadequate coverage for naïve users. Implementation of an improved diagram should help in the prevention of healthcare-associated infections.
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Affiliation(s)
- Francis T. Durso
- School of Psychology, Georgia Institute of Technology, Atlanta, Georgia
| | - Sweta Parmar
- School of Psychology, Georgia Institute of Technology, Atlanta, Georgia
| | - Ryan S. Heidish
- School of Psychology, Georgia Institute of Technology, Atlanta, Georgia
| | | | - Omer S. Oncul
- School of Psychology, Georgia Institute of Technology, Atlanta, Georgia
| | - Jesse T. Jacob
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia
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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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Kalra S, Garri RF, Shewale JB. Aseptic Disposable Stethoscope Barrier: Acoustically Invisible and Superior to Disposable Stethoscopes. Mayo Clin Proc 2021; 96:263-264. [PMID: 33413829 DOI: 10.1016/j.mayocp.2020.10.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/27/2020] [Accepted: 10/21/2020] [Indexed: 10/22/2022]
Affiliation(s)
| | | | - Jitesh B Shewale
- The University of Texas, MD Anderson Cancer Center, Houston, Texas
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Bowler P, Murphy C, Wolcott R. Biofilm exacerbates antibiotic resistance: Is this a current oversight in antimicrobial stewardship? Antimicrob Resist Infect Control 2020; 9:162. [PMID: 33081846 PMCID: PMC7576703 DOI: 10.1186/s13756-020-00830-6] [Citation(s) in RCA: 121] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 10/15/2020] [Indexed: 01/08/2023] Open
Abstract
Objective To raise awareness of the role of environmental biofilm in the emergence and spread of antibiotic resistance and its consideration in antimicrobial stewardship. Background Antibiotic resistance is a major threat to public health. Overuse of antibiotics, increased international travel, and genetic promiscuity amongst bacteria have contributed to antibiotic resistance, and global containment efforts have so far met with limited success. Antibiotic resistance is a natural mechanism by which bacteria have adapted to environmental threats over billions of years and is caused either by genetic mutations or by horizontal gene transfer. Another ancient survival strategy involves bacteria existing within a self-produced polymeric matrix, which today is termed biofilm. Biofilm similarly enables bacterial tolerance to environmental threats, and also encourages the transfer of antibiotic resistance genes between bacterial species. This natural and ubiquitous mode of bacterial life has not been considered amongst strategies to tackle antibiotic resistance in healthcare facilities, despite its ability to significantly enhance bacterial survival and persistence, and to encourage antibiotic resistance. Conclusion Biofilm must be considered synonymously with antibiotic resistance because of its proficiency in transferring resistance genes as well as its innate phenotypic tolerance to antibiotics. Although biofilm falls outside of the current definition of antimicrobial stewardship, greater awareness of the existence, ubiquity, and consequences of environmental biofilm amongst healthcare practitioners is crucial to improving hygiene practices and controlling the emergence and spread of antibiotic resistance in healthcare facilities.
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Affiliation(s)
- Philip Bowler
- Infection Prevention and Control, ConvaTec Ltd, Deeside, UK.
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Use of simulations to evaluate the effectiveness of barrier precautions to prevent patient-to-patient transfer of healthcare-associated pathogens. Infect Control Hosp Epidemiol 2020; 42:425-430. [PMID: 33040741 DOI: 10.1017/ice.2020.1215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND There is controversy regarding whether the addition of cover gowns offers a substantial benefit over gloves alone in reducing personnel contamination and preventing pathogen transmission. DESIGN Simulated patient care interactions. OBJECTIVE To evaluate the efficacy of different types of barrier precautions and to identify routes of transmission. METHODS In randomly ordered sequence, 30 personnel each performed 3 standardized examinations of mannequins contaminated with pathogen surrogate markers (cauliflower mosaic virus DNA, bacteriophage MS2, nontoxigenic Clostridioides difficile spores, and fluorescent tracer) while wearing no barriers, gloves, or gloves plus gowns followed by examination of a noncontaminated mannequin. We compared the frequency and routes of transfer of the surrogate markers to the second mannequin or the environment. RESULTS For a composite of all surrogate markers, transfer by hands occurred at significantly lower rates in the gloves-alone group (OR, 0.02; P < .001) and the gloves-plus-gown group (OR, 0.06; P = .002). Transfer by stethoscope diaphragms was common in all groups and was reduced by wiping the stethoscope between simulations (OR, 0.06; P < .001). Compared to the no-barriers group, wearing a cover gown and gloves resulted in reduced contamination of clothing (OR, 0.15; P < .001), but wearing gloves alone did not. CONCLUSIONS Wearing gloves alone or gloves plus gowns reduces hand transfer of pathogens but may not address transfer by devices such as stethoscopes. Cover gowns reduce the risk of contaminating the clothing of personnel.
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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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Use of viral DNA surrogate markers to study routes of transmission of healthcare-associated pathogens. Infect Control Hosp Epidemiol 2020; 42:274-279. [PMID: 32993827 DOI: 10.1017/ice.2020.443] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The hands of healthcare personnel are the most important source for transmission of healthcare-associated pathogens. The role of contaminated fomites such as portable equipment, stethoscopes, and clothing of personnel in pathogen transmission is unclear. OBJECTIVE To study routes of transmission of cauliflower mosaic virus DNA markers from 31 source patients and from environmental surfaces in their rooms. DESIGN A 3-month observational cohort study. SETTING A Veterans' Affairs hospital. METHODS After providing care for source patients, healthcare personnel were observed during interactions with subsequent patients. Putative routes of transmission were identified based on recovery of DNA markers from sites of contact with the patient or environment. To assess plausibility of fomite-mediated transmission, we assessed the frequency of transfer of methicillin-resistant Staphylococcus aureus (MRSA) from the skin of 25 colonized patients via gloved hands versus fomites. RESULTS Of 145 interactions involving contact with patients and/or the environment, 41 (28.3%) resulted in transfer of 1 or both DNA markers to the patient and/or the environment. The DNA marker applied to patients' skin and clothing was transferred most frequently by stethoscopes, hands, and portable equipment, whereas the marker applied to environmental surfaces was transferred only by hands and clothing. The percentages of MRSA transfer from the skin of colonized patients via gloved hands, stethoscope diaphragms, and clothing were 52%, 40%, and 48%, respectively. CONCLUSIONS Fomites such as stethoscopes, clothing, and portable equipment may be underappreciated sources of pathogen transmission. Simple interventions such as decontamination of fomites between patients could reduce the risk for transmission.
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Patel L, Gandhi D, Beddow D. Controversies on the Stethoscope During COVID-19: A Necessary Tool or an Unnecessary Evil? Am J Med Sci 2020; 361:278-280. [PMID: 32736834 PMCID: PMC7336914 DOI: 10.1016/j.amjms.2020.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/10/2020] [Accepted: 07/01/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Love Patel
- Department of Internal Medicine, Abbott Northwestern Hospital, Allina Health, Minneapolis, MN.
| | - Darshan Gandhi
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - David Beddow
- Department of Internal Medicine, Mercy Hospital, Allina Health, Coon Rapids, MN
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Gaitan Gomez OL, Aristizabal P, Bueno Robles LS. Práctica de inyecciones seguras por parte del personal de la salud: revisión integrativa. INVESTIGACIÓN EN ENFERMERÍA: IMAGEN Y DESARROLLO 2020. [DOI: 10.11144/javeriana.ie22.pisp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Introducción: Las prácticas de inyecciones seguras han recobrado importancia en las últimas dos décadas, como consecuencia de las infecciones asociadas con su aplicación incorrecta. Objetivo: Analizar la evidencia disponible sobre las prácticas de inyecciones seguras ejecutadas por el personal de la salud en su práctica clínica. Método: Revisión integrativa de la literatura, realizada en 12 bases de datos entre 1999 y 2018. Resultados: Se seleccionaron 29 artículos y se identificaron prácticas riesgosas como el reúso de los dispositivos de inyección en el mismo paciente o en otros, fallas en la técnica aséptica, ausencia o no seguimiento del protocolo posexposición, reencapuchado de la aguja y ausencia de inmunización contra el virus de hepatitis B. Conclusiones: Los esfuerzos orientados a la seguridad del paciente deben enfocarse también en acciones concretas dirigidas a la administración de los medicamentos.
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Holleck JL, Campbell S, Alrawili H, Frank C, Merchant N, Rodwin B, Perez MF, Gupta S, Federman DG, Chang JJ, Vientos W, Dembry L. Stethoscope hygiene: Using cultures and real-time feedback with bioluminescence-based adenosine triphosphate technology to change behavior. Am J Infect Control 2020; 48:380-385. [PMID: 31761292 DOI: 10.1016/j.ajic.2019.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/03/2019] [Accepted: 10/04/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Stethoscope hygiene is rarely done despite guideline recommendations. We wanted to determine whether demonstrating what is growing on the stethoscopes of providers via culture or bioluminescence technology alters perceptions and improves compliance. METHODS Providers were given the opportunity to (1) culture their stethoscopes before and after disinfection with alcohol pads, alcohol-based hand rub, or hydrogen peroxide disinfectant wipes and (2) swab stethoscopes for bioluminescence-based adenosine triphosphate testing before and after disinfection. Outcomes were observed for hand and stethoscope hygiene rates and before and after intervention survey responses. The bacteria that were isolated, colony-forming units (CFU), and bioluminescence scores were tracked. RESULTS A total of 1,245 observed hand hygiene opportunities showed that compliance improved from 72.5%-82.3% (P < .001). In addition, 590 observed patient-provider encounters revealed no significant change in stethoscope hygiene rates of 10% initially and 5% afterward (P = .08), although self-reported rates trended from 56%- 67% postintervention (P = .06). Perceptions regarding stethoscope hygiene importance improved (8.5/10 to 9.3/10; P = .04). Disinfection with alcohol pads, alcohol-based hand rub, and hydrogen peroxide disinfectant wipes were equivalent in CFU reduction (P = .21). CONCLUSIONS Showing providers what is growing on their stethoscopes via cultures and bioluminescence technology before and after disinfection improved "buy in" regarding stethoscope hygiene importance. Both methods were rated as having an equal impact, however, objective observations failed to show improvement.
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Affiliation(s)
- Jürgen L Holleck
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT; Department of Medicine, Veterans Affairs Connecticut Healthcare System, West Haven, CT.
| | - Sheldon Campbell
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT; Department of Pathology and Laboratory Medicine, Veterans Affairs Connecticut Healthcare System, West Haven, CT
| | | | - Cynthia Frank
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT; Department of Medicine, Veterans Affairs Connecticut Healthcare System, West Haven, CT
| | - Naseema Merchant
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT; Department of Medicine, Veterans Affairs Connecticut Healthcare System, West Haven, CT
| | - Benjamin Rodwin
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT; Department of Medicine, Veterans Affairs Connecticut Healthcare System, West Haven, CT
| | - Mario F Perez
- Department of Pulmonary, Critical Care and Sleep Medicine, University of Connecticut, Storrs, CT
| | - Shaili Gupta
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT; Department of Medicine, Veterans Affairs Connecticut Healthcare System, West Haven, CT
| | - Daniel G Federman
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT; Department of Medicine, Veterans Affairs Connecticut Healthcare System, West Haven, CT
| | - John J Chang
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT; Department of Medicine, Veterans Affairs Connecticut Healthcare System, West Haven, CT
| | - Wilson Vientos
- Department of Pathology and Laboratory Medicine, Veterans Affairs Connecticut Healthcare System, West Haven, CT; Quinnipiac University, Hamden, CT
| | - Louise Dembry
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT; Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT; Department of Medicine, Veterans Affairs Connecticut Healthcare System, West Haven, CT
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Napolitani M, Bezzini D, Moirano F, Bedogni C, Messina G. Methods of Disinfecting Stethoscopes: Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1856. [PMID: 32182989 PMCID: PMC7143198 DOI: 10.3390/ijerph17061856] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 03/06/2020] [Accepted: 03/09/2020] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
| | - Daiana Bezzini
- Department of Life Sciences, University of Siena, 53100 Siena, Italy;
| | | | - Corrado Bedogni
- Medical and General Management, S. Croce e Carle Hospital, 12100 Cuneo, Italy;
| | - Gabriele Messina
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy
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Community-acquired in name only: A cluster of carbapenem-resistant Acinetobacter baumannii in a burn intensive care unit and beyond. Infect Control Hosp Epidemiol 2020; 41:531-538. [PMID: 32106898 DOI: 10.1017/ice.2020.15] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To describe an investigation into 5 clinical cases of carbapenem-resistant Acinetobacter baumannii (CRAB). DESIGN Epidemiological investigation supplemented by whole-genome sequencing (WGS) of clinical and environmental isolates. SETTING A tertiary-care academic health center in Boston, Massachusetts. PATIENTS OR PARTICIPANTS Individuals identified with CRAB clinical infections. METHODS A detailed review of patient demographic and clinical data was conducted. Clinical isolates underwent phenotypic antimicrobial susceptibility testing and WGS. Infection control practices were evaluated, and CRAB isolates obtained through environmental sampling were assessed by WGS. Genomic relatedness was measured by single-nucleotide polymorphism (SNP) analysis. RESULTS Four clinical cases spanning 4 months were linked to a single index case; isolates differed by 1-7 SNPs and belonged to a single cluster. The index patient and 3 case patients were admitted to the same room prior to their development of CRAB infection, and 2 case patients were admitted to the same room within 48 hours of admission. A fourth case patient was admitted to a different unit. Environmental sampling identified highly contaminated areas, and WGS of 5 environmental isolates revealed that they were highly related to the clinical cluster. CONCLUSIONS We report a cluster of highly resistant Acinetobacter baumannii that occurred in a burn ICU over 5 months and then spread to a separate ICU. Two case patients developed infections classified as community acquired under standard epidemiological definitions, but WGS revealed clonality, highlighting the risk of burn patients for early-onset nosocomial infections. An extensive investigation identified the role of environmental reservoirs.
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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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Efficacy of a wearable ultraviolet-C light device for semiautomated decontamination of stethoscopes between each use. Infect Control Hosp Epidemiol 2019; 41:244-246. [PMID: 31801644 DOI: 10.1017/ice.2019.324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Comparative assessment of the effectiveness of three disinfection protocols for reducing bacterial contamination of stethoscopes. Infect Control Hosp Epidemiol 2019; 41:120-123. [PMID: 31694732 DOI: 10.1017/ice.2019.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In a crossover study, 30 stethoscopes were assessed and disinfected using 3 protocols: isopropyl alcohol, a quaternary ammonia or biguanide disinfectant, and ultraviolet germicidal irradiation (UVGI). All protocols effectively reduced bacterial loads, but UVGI was less effective at higher contamination levels (P = .0004). The effectiveness of each intervention was short in duration.
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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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Staff Uniforms and Uniform Policy. PREVENTION AND CONTROL OF INFECTIONS IN HOSPITALS 2019. [PMCID: PMC7120458 DOI: 10.1007/978-3-319-99921-0_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/30/2022]
Abstract
Personnel in contact with patients or equipment and textiles should always use the hospital’s work attire. It includes anyone handling food, medicines, textile, waste or cleaning tools. By caring, treating, examining and transporting patients, there will be direct contact between own work clothes and the patient’s cloths/bedding or skin. The same is true when working with used patient equipment such as bedpans, toilet chairs, beds and other aids and working in patient rooms, toilets and bathrooms or when handling bedding and bandages, giving physiotherapy, etc. The work uniform is particularly exposed to organic matter and microbes, for example, in ambulances, in emergency services, in restless and anxious patients and children, during sampling and examination/treatment, etc. In acute wards, the staff is often exposed to splashes from patients, especially blood but also vomit, sputum, pus, faeces and urine. This chapter is focused on practical measures to prevent transmission of infections via contaminated staff uniforms.
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Molecular analysis of bacterial contamination on stethoscopes in an intensive care unit. Infect Control Hosp Epidemiol 2018; 40:171-177. [PMID: 30560753 DOI: 10.1017/ice.2018.319] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Culture-based studies, which focus on individual organisms, have implicated stethoscopes as potential vectors of nosocomial bacterial transmission. However, the full bacterial communities that contaminate in-use stethoscopes have not been investigated. METHODS We used bacterial 16S rRNA gene deep-sequencing, analysis, and quantification to profile entire bacterial populations on stethoscopes in use in an intensive care unit (ICU), including practitioner stethoscopes, individual-use patient-room stethoscopes, and clean unused individual-use stethoscopes. Two additional sets of practitioner stethoscopes were sampled before and after cleaning using standardized or practitioner-preferred methods. RESULTS Bacterial contamination levels were highest on practitioner stethoscopes, followed by patient-room stethoscopes, whereas clean stethoscopes were indistinguishable from background controls. Bacterial communities on stethoscopes were complex, and community analysis by weighted UniFrac showed that physician and patient-room stethoscopes were indistinguishable and significantly different from clean stethoscopes and background controls. Genera relevant to healthcare-associated infections (HAIs) were common on practitioner stethoscopes, among which Staphylococcus was ubiquitous and had the highest relative abundance (6.8%-14% of contaminating bacterial sequences). Other HAI-related genera were also widespread although lower in abundance. Cleaning of practitioner stethoscopes resulted in a significant reduction in bacterial contamination levels, but these levels reached those of clean stethoscopes in only a few cases with either standardized or practitioner-preferred methods, and bacterial community composition did not significantly change. CONCLUSIONS Stethoscopes used in an ICU carry bacterial DNA reflecting complex microbial communities that include nosocomially important taxa. Commonly used cleaning practices reduce contamination but are only partially successful at modifying or eliminating these communities.
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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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Transfer of pathogens to and from patients, healthcare providers, and medical devices during care activity-a systematic review and meta-analysis. Infect Control Hosp Epidemiol 2018; 39:1093-1107. [PMID: 30039774 DOI: 10.1017/ice.2018.156] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The transfer of pathogens may spread antimicrobial resistance and lead to healthcare-acquired infections. We performed a systematic literature review to generate estimates of pathogen transfer in relation to healthcare provider (HCP) activities. METHODS For this systematic review and meta-analysis, Medline/Ovid, EMBASE, and the Cochrane Library were searched for studies published before July 7, 2017. We reviewed the literature, examining transfer of pathogens associated with HCP activities. We included studies that (1) quantified transfer of pathogens from a defined origin to a defined destination surface; (2) reported a microbiological sampling technique; and (3) described the associated activity leading to transfer. For studies reporting transfer frequencies, we extracted data and calculated the estimated proportion using Freeman-Tukey double arcsine transformation and the DerSimonian-Laird random-effects model. RESULTS Of 13,121 identified articles, 32 were included. Most articles (n=27, 84%) examined transfer from patients and their environment to HCP hands, gloves, and gowns, with an estimated proportion for transfer frequency of 33% (95% confidence interval [CI], 12%-57%), 30% (95% CI, 23%-38%) and 10% (95% CI, 6%-14%), respectively. Other articles addressed transfer involving the hospital environment and medical devices. Risk factor analyses in 12 studies suggested higher transfer frequencies after contact with moist body sites (n=7), longer duration of care (n=5), and care of patients with an invasive device (n=3). CONCLUSIONS Recognizing the heterogeneity in study designs, the available evidence suggests that pathogen transfer to HCPs occurs frequently. More systematic research is urgently warranted to support targeted and economic prevention policies and interventions.
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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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Boudjema S, Brouqui P. World Health Organization “SAVE LIVES: Clean Your Hands” global campaign. Clin Microbiol Infect 2018; 24:442. [DOI: 10.1016/j.cmi.2017.10.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 10/24/2017] [Accepted: 10/30/2017] [Indexed: 11/29/2022]
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Sobolewska B, Buhl M, Liese J, Ziemssen F. Slit lamps and lenses: a potential source of nosocomial infections? Eye (Lond) 2018; 32:1021-1027. [PMID: 29379104 DOI: 10.1038/s41433-017-0004-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 08/08/2017] [Accepted: 11/30/2017] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The aim of the study was to evaluate the bacterial contamination level of contact surfaces on slit lamps and the grip areas of lenses. METHODS Within unannounced audits, two regions of the slit lamps (headrest and joystick), indirect ophthalmoscopy devices, and ultrasound probes were obtained with rayon-tipped swab. Non-contact lenses used for indirect fundoscopy were pressed on RODAC (Replicate Organism Detection and Counting) plates. One hundred and eighty-one surfaces were sampled. The total number of colony-forming units was assessed and bacterial species were identified. Spa-typing and antimicrobial susceptibility testing were performed from Staphylococcus aureus isolates. RESULTS Among the total bacterial isolates from ophthalmological equipment (lenses: 51 of 78, slit lamps: 43 of 88, ophthalmoscopy helmets: 3 of 8, ultrasound probes: 2 of 7), coagulase-negative staphylococci (CNS) was most frequently found, followed by Micrococcus spp. (lenses vs. slit lamps: P < 0.001 and P = 0.01, respectively). The bacterial contamination of lenses (76%) was significantly higher than that of slit lamps (54%) (P < 0.003). A significantly higher contamination with CNS was observed on lenses from residents vs. from consultants (78% vs. 35%, P = 0.01). A total of seven different spa-types of S. aureus were isolated. No correlation was found between S. aureus contamination of different ophthalmological equipments (Spearman's rank correlation coefficient, ρ = 0.04, P = 0.75). Methicillin-resistant S. aureus was not detected. CONCLUSION Bacterial species of the normal skin flora were isolated from the ophthalmological equipment. The bacterial contamination of the portable devices was significantly higher than that of slit lamps. Therefore, proper hygiene of the mobile instruments should be monitored in order to prevent transmission of bacteria in residents and consultants.
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Affiliation(s)
- Bianka Sobolewska
- Center for Ophthalmology, Eberhard-Karls University, Tuebingen, Germany.
| | - Michael Buhl
- Institute of Medical Mircrobiology and Hygiene, Eberhard-Karls University, Tuebingen, Germany
| | - Jan Liese
- Institute of Medical Mircrobiology and Hygiene, Eberhard-Karls University, Tuebingen, Germany
| | - Focke Ziemssen
- Center for Ophthalmology, Eberhard-Karls University, Tuebingen, Germany
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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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Clack L, Scotoni M, Wolfensberger A, Sax H. "First-person view" of pathogen transmission and hand hygiene - use of a new head-mounted video capture and coding tool. Antimicrob Resist Infect Control 2017; 6:108. [PMID: 29093812 PMCID: PMC5661930 DOI: 10.1186/s13756-017-0267-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 10/17/2017] [Indexed: 01/29/2023] Open
Abstract
Background Healthcare workers' hands are the foremost means of pathogen transmission in healthcare, but detailed hand trajectories have been insufficiently researched so far. We developed and applied a new method to systematically document hand-to-surface exposures (HSE) to delineate true hand transmission pathways in real-life healthcare settings. Methods A head-mounted camera and commercial coding software were used to capture ten active care episodes by eight nurses and two physicians and code HSE type and duration using a hierarchical coding scheme. We identified HSE sequences of particular relevance to infectious risks for patients based on the WHO 'Five Moments for Hand Hygiene'. The study took place in a trauma intensive care unit in a 900-bed university hospital in Switzerland. Results Overall, the ten videos totaled 296.5 min and featured eight nurses and two physicians. A total of 4222 HSE were identified (1 HSE every 4.2 s), which concerned bare (79%) and gloved (21%) hands. The HSE inside the patient zone (n = 1775; 42%) included mobile objects (33%), immobile surfaces (5%), and patient intact skin (4%), while HSE outside the patient zone (n = 1953; 46%) included HCW's own body (10%), mobile objects (28%), and immobile surfaces (8%). A further 494 (12%) events involved patient critical sites. Sequential analysis revealed 291 HSE transitions from outside to inside patient zone, i.e. "colonization events", and 217 from any surface to critical sites, i.e. "infection events". Hand hygiene occurred 97 times, 14 (5% adherence) times at colonization events and three (1% adherence) times at infection events. On average, hand rubbing lasted 13 ± 9 s. Conclusions The abundance of HSE underscores the central role of hands in the spread of potential pathogens while hand hygiene occurred rarely at potential colonization and infection events. Our approach produced a valid video and coding instrument for in-depth analysis of hand trajectories during active patient care that may help to design more efficient prevention schemes.
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Affiliation(s)
- Lauren Clack
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Manuela Scotoni
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Aline Wolfensberger
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Hugo Sax
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
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