Stethoscope Cleaning CDC: Non critical - each patient or once daily or once weekly Semicritical – disinfected before patient use As per Spaulding criteria, stethoscope are normally considered non critical device, disinfect with low level disinfectant, eg alcohol/quad wipes.

Study design Units: Emergency department (ED) Surgical Intensive Care Unit ( SICU) Labor and Delivery ( L and D) Interaction: Semi critical - open thoracic or abdominal wound; surgery Non critical Study subjects: Attending physicians, fellows and residents RNs, PAs, medical students and other medical personnel Observation, cross-sectional study. Study conducted in large teaching hospital in Houston, Texas, level one trauma center. Observation encounter began on the clinician entry the room or after the manual contact with non index pt/surface. And ended on clinicians exit the room or after manual contact. Some providers were aware of observation, but the reason was not revealed.

Data recorded Practitioner category Location Trauma status Presence of precaution Hand Hygiene Stethoscope disinfection before and after encounter Methods of disinfection Data recorder include: Attending physicians, fellows and residents; RNs, PAs, medical students and other medical personnel; 2. SICU, ED, L&D; method of disinfection – alcohol; quad wipe

Results 72/400 = 18% encounters 8/72 (2%) – before encounter 65/72 (16%) – after 1 encounter – before and after encounter on non critical 15/288 – non critical interaction 57 /112 – semi critical , no stethoscope disinfected before encounter, but inspected after encounter Residents – highest disinfection rate (greatest exposure to body fluids) Physicians RNs During 73 observations of disinfection, providers used germicidal wipes more then alcohol pads and disinfected diaphragms more then tubing, and most spent less then 15 seconds on the disinfection process. Of 400 observation, only 15/3.8% could comply with CDC standards.

Discussions: Hand Hygiene: Less then half of encounters 82% worn gloves 8.5% encounters – neither cleaned or gloved 6.8% - CDC compliant Stethoscopes disinfection: Inconvenient Not a priority In the article, it is mentioned about hand hygiene, that HH, but we will concentrate to stethoscope disinfection. It could be inconvenient because you need to find extra time to wear gloves, to find a wipe, difficult to remove from the container. Not a priority when it is emergency.

Strengths and Limitation Study Design Strengths: Blinded design Staff being observed often did not know about study A few staff knew they were being observed but did not know why; most did not know they were being watched No recall bias; not based on self-report, unlike most other studies on this topic Studied staff practice in three distinct clinical areas of varying intensity of service Used Spaulding criteria to help define appropriate practice Study Limitations Observers could not often see if a stethoscope actually touched non-intact skin in “semi-critical”patients Could not see if stethoscopes were contaminated by handling after cleaning Could not see if “non-critical” stethoscopes were cleaned at other times (thus complaint with “daily” or “weekly” cleaning) Not mentioned limitation – study did not state existing facility policy Not mentioned limitation – study did not state how they chose to designate some patients as semi-critical and others as non- critical (e.g., presence of open wound where stethoscope would be used)

Conclusion Stethoscope disinfection must not continue to be overlooked, especially in acute care interactions, in the open wounds near auscultation. Although gloves help to protect both providers and patients from manual contact exposures, no such equivalent exist for stethoscopes. CDC compliant stethoscope disinfection rates were observed to be rare., occurring only in 4% (15/400) of encounters, and were non existent in semi critical interaction.