{"title":"Stethoscopes no longer need to touch patients","authors":"W. Frank Peacock MD, FACEP, FACC, FESC","doi":"10.1016/j.jemermed.2024.03.025","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>It is clear that, while stethoscopes are commonly used in cancer patients, they are frequently contaminated with pathogens. Even 60 seconds of alcohol swab cleaning doesn't reliably provide sterile contact. Thus ultimately, stethoscopes are potential vectors that transmit pathogens when touching patients. A proposed draft of the new 2024 CDC guidelines mandates that if shared patient-care items are used (e.g., stethoscopes), they must be cleaned and disinfected between patients. This requires that the stethoscope must be cleaned and disinfected between every single patient contact, or a disposable option used. Unfortunately, studies demonstrate that disposable stethoscopes are inferior auscultation tools, vs. the personal stethoscope. Therefore, to be in compliance with 2024 CDC guidelines improvements in personal stethoscope hygiene are required. The DiskCover is a touch free applied single use disposable stethoscope barrier consistent with CDC guidelines. We performed an in vitro investigation the efficacy of the DiskCover (Asepticscope, Inc, San Diego, CA) in providing an aseptic patient auscultation.</p></div><div><h3>Methods</h3><p>This was a prospective, randomized evaluation of the ability of the DiskCover to prevent patient exposure to pathogens found on the stethoscope. Stethoscope diaphragms were inoculated with Candida Albicans (C. Albicans), Clostridioides Difficile (C. Diff), Extended- Spectrum B-Lactamase Producing Escherichia Coli (ESBL), Methicillin Resistant Staphylococcus Aureus (MRSA), Pseudomonas Aeruginosa (P. Aeruginosa), and Vancomycin- Resistant Enterococcus Faecium (VRE), then randomized to either DiskCover placement or control (no DiskCover). Stethoscope's then underwent aerobic or anerobic incubation.</p><p>Diaphragm cultures were obtained at 0.25, 0.5, 2, 4, and 24 hours of incubation, and placed on Blood, Chocolate, and MacConkey agar. Colony formation was subsequently manually counted.</p></div><div><h3>Results</h3><p>Stethoscope diaphragms with a DiskCover were sterile in 100% of cases, while those without Discover's had extensive pathogen contamination. Compared to all controls, for all species of pathogens, all DiskCover contacts were sterile (p<0.05 for all comparisons).</p></div><div><h3>Conclusions</h3><p>DiskCovers provided a sterile point of contact in all instances vs. control, which had large numbers of pathogenetic colonies.</p></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.2000,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Emergency Medicine","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0736467924001021","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"EMERGENCY MEDICINE","Score":null,"Total":0}
引用次数: 0
Abstract
Background
It is clear that, while stethoscopes are commonly used in cancer patients, they are frequently contaminated with pathogens. Even 60 seconds of alcohol swab cleaning doesn't reliably provide sterile contact. Thus ultimately, stethoscopes are potential vectors that transmit pathogens when touching patients. A proposed draft of the new 2024 CDC guidelines mandates that if shared patient-care items are used (e.g., stethoscopes), they must be cleaned and disinfected between patients. This requires that the stethoscope must be cleaned and disinfected between every single patient contact, or a disposable option used. Unfortunately, studies demonstrate that disposable stethoscopes are inferior auscultation tools, vs. the personal stethoscope. Therefore, to be in compliance with 2024 CDC guidelines improvements in personal stethoscope hygiene are required. The DiskCover is a touch free applied single use disposable stethoscope barrier consistent with CDC guidelines. We performed an in vitro investigation the efficacy of the DiskCover (Asepticscope, Inc, San Diego, CA) in providing an aseptic patient auscultation.
Methods
This was a prospective, randomized evaluation of the ability of the DiskCover to prevent patient exposure to pathogens found on the stethoscope. Stethoscope diaphragms were inoculated with Candida Albicans (C. Albicans), Clostridioides Difficile (C. Diff), Extended- Spectrum B-Lactamase Producing Escherichia Coli (ESBL), Methicillin Resistant Staphylococcus Aureus (MRSA), Pseudomonas Aeruginosa (P. Aeruginosa), and Vancomycin- Resistant Enterococcus Faecium (VRE), then randomized to either DiskCover placement or control (no DiskCover). Stethoscope's then underwent aerobic or anerobic incubation.
Diaphragm cultures were obtained at 0.25, 0.5, 2, 4, and 24 hours of incubation, and placed on Blood, Chocolate, and MacConkey agar. Colony formation was subsequently manually counted.
Results
Stethoscope diaphragms with a DiskCover were sterile in 100% of cases, while those without Discover's had extensive pathogen contamination. Compared to all controls, for all species of pathogens, all DiskCover contacts were sterile (p<0.05 for all comparisons).
Conclusions
DiskCovers provided a sterile point of contact in all instances vs. control, which had large numbers of pathogenetic colonies.
期刊介绍:
The Journal of Emergency Medicine is an international, peer-reviewed publication featuring original contributions of interest to both the academic and practicing emergency physician. JEM, published monthly, contains research papers and clinical studies as well as articles focusing on the training of emergency physicians and on the practice of emergency medicine. The Journal features the following sections:
• Original Contributions
• Clinical Communications: Pediatric, Adult, OB/GYN
• Selected Topics: Toxicology, Prehospital Care, The Difficult Airway, Aeromedical Emergencies, Disaster Medicine, Cardiology Commentary, Emergency Radiology, Critical Care, Sports Medicine, Wound Care
• Techniques and Procedures
• Technical Tips
• Clinical Laboratory in Emergency Medicine
• Pharmacology in Emergency Medicine
• Case Presentations of the Harvard Emergency Medicine Residency
• Visual Diagnosis in Emergency Medicine
• Medical Classics
• Emergency Forum
• Editorial(s)
• Letters to the Editor
• Education
• Administration of Emergency Medicine
• International Emergency Medicine
• Computers in Emergency Medicine
• Violence: Recognition, Management, and Prevention
• Ethics
• Humanities and Medicine
• American Academy of Emergency Medicine
• AAEM Medical Student Forum
• Book and Other Media Reviews
• Calendar of Events
• Abstracts
• Trauma Reports
• Ultrasound in Emergency Medicine