听诊器卫生的代价与卫生失败的代价

IF 1.2 4区 医学 Q3 EMERGENCY MEDICINE
W. Frank Peacock MD, FACEP, FACC, FESC
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引用次数: 0

摘要

背景听诊器是公认的传播媒介,建议使用酒精棉签擦洗听诊器 60 秒钟。2024 年美国疾病预防控制中心的新指南要求在每位患者之间清洗听诊器。遗憾的是,对指南失效的描述很少,尤其是在免疫力低下的癌症患者中。因此,我们建立了一个模型,利用听诊器感染两种病原体(耐甲氧西林金黄色葡萄球菌 (MRSA) 和艰难梭菌感染 (CDI))在免疫力低下和免疫力正常患者中传播的概率和成本,对听诊器卫生的费用进行了研究。变量定义为:中型急诊室听诊次数/天=90(30/医师,3 名医师/24 小时),听诊器清洁时间=60 秒,急诊室医师年薪=352,000.00 美元,已公布的 MRSA 和 CDI 听诊器污染率分别为 7.4% 和 5%,已公布的 MRSA 和 CDI 医院感染成本分别为 38,561.00 美元和 24,205 美元。免疫功能低下率定义为 2.7%,免疫功能正常和免疫功能低下患者接触后发生感染的估计概率分别按 1-3% 和 10-30% 的范围进行分析。结果根据上述定义估算,急诊室每年的听诊次数为 32,850 次/年,相当于急诊医生每年清洁听诊器的时间为 547 小时;按工资比例计算,急诊室每年的成本为 115,940.00 美元/年。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The Cost of Stethoscope Hygiene vs. the Cost of Hygiene Failure

Background

Stethoscopes, well established as vectors, are recommended to be cleaned by alcohol swab scrubbing for 60 seconds. The new 2024 CDC guidelines mandate stethoscope cleaning between every patient. Unfortunately, guideline failure is poorly described, especially in immunocompromised cancer patients. We thus performed a model examining the expense of stethoscope hygiene using the probabilities and costs of stethoscope infection transmission from 2 well described pathogens; Methicillin Resistant Staphylococcus Aureus (MRSA) and Clostridioides difficile infection (CDI), in both immunocompromised and immunocompetent patients.

Methods

We performed an economic analysis of pathogen transmission costs and consequences in immunocompromised and immunocompetent ED patients. Variables were defined as auscultations/day in a medium sized ED =90 (30/physician, 3 physicians/24 hours), stethoscope cleaning time =60 seconds, annual ED physician salary =$352,000.00, published stethoscope contamination rates of MRSA and CDI =7.4% and 5%, respectively, and published hospital acquired infection costs for MRSA and CDI =$38,561.00 and $24,205, respectively. The immunocompromised rate was defined as 2.7%, and the estimated probability of infection occurring after exposure in immunocompetent and immunocompromised patients is analyzed by ranges of 1-3% and 10-30%, respectively.

Results

Using the above definitions provides an estimation of 32,850 auscultations/year/ED, which equates to 547 annual hours of emergency physician stethoscope cleaning; prorated by salary, results in an annual ED cost of $115,940.00/yr.

Conclusions

Cleaning personal stethoscope costs $115,940.00/yr, but its failure may cost up to $4.98 million/yr/hospital.

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来源期刊
Journal of Emergency Medicine
Journal of Emergency Medicine 医学-急救医学
CiteScore
2.40
自引率
6.70%
发文量
339
审稿时长
2-4 weeks
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
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