Micro - Policy Paper

Healthcare Use of Sterilized Stethoscopes

Submitted By: Samantha Fritsch and Amanda Schwingler Joint Healthcare Disease Control Committee
Iowa Healthcare Association

The concern of aseptic practices in healthcare settings is crucial to prevent nosocomial infections and to assure quality of patient care. Although healthcare settings require standard precautions related to patient care, equipment used in multiple patient cares heightens the risk of spreading virulent bacteria. The use of the stethoscope is a primary example a medical instrument that a reservoir for bacterial growth. The direct contact of the diaphragm or bell of the stethoscope to a patient’s skin could harbor a mode of transmission of virulent bacterium from client to another. In Kiernan’s research (1995) stethoscope cleanliness was observed with 150 medical professionals. Results found that an estimated 75 percent did not clean stethoscopes daily; of the stethoscopes, not disinfected 89 percent were contaminated with the species Staphylococcus. Within the 89 percent, 19 percent were contaminated with Staphylococcus aureus may potentially cause serious infections. The above is an example as to why a standard of stethoscope asepsis should be made universal.

In order to decrease the amount of nosocomial infections within healthcare settings it is proposed by the Iowa Healthcare Association to mandate the use of a standard stethoscope isolation system and alcohol-based foam washing of the stethoscope. Also, the program would mandate required alcohol wipe dispensing stations.
By making this procedure mandatory it will significantly reduce the transfer of virulent bacteria found on the stethoscope from one patient to another. In a single-blinded study 92 stethoscopes were tested in pre-wash period and a post-wash period where colony counts were much lower after being cleansed with an alcohol based foam. An additional note, three Methacillian Resistan Staphylococcus Areaus (MRSA) were found before washing the stethoscopes, all MRSA strains were killed by the foam. “Simultaneously using [alcohol-based] hand foam to clean hands and stethoscope heads reduces bacterial counts on stethoscopes” (Schroeder, et. al., 2009). The washing procedure will be required before and after every shift change.
The second part of implementation would include the usage of stethoscope isolation system. This system involves the use of a disposable sleeve encasing the diaphragm and the tubal body of the stethoscope. The makeup of the sleeve is a clear plastic that is resistant to the transmission of bacteria, viruses, and fluid onto the stethoscope (Gilbert, patent 5466898). The disposable covers will come in a sterile bag and be required of all healthcare professionals for use with every new patient. Training for the use of disposable covers will be a mandatory education requirement of healthcare employees every six months and upon hire.
Alcohol wipe dispensing stations built onto the walls of hallways in which patient care is administered, nursing stations, and in emergency response vehicles. By providing the alcohol wipes healthcare professionals and emergency response personal will clean stethoscopes regularly throughout the shift further decreasing bacterial transfer ( Merlin, et. al. 2009).

The state of Iowa healthcare association will periodically visit healthcare establishments and review the use of the cleaning and barrier procedure. The enforcement and repercussions of the mandated standard cleaning and barrier procedure of the stethoscope will be subject to monetary penalties that coincide with the Occupational Safety and Health Administration (OSHA) regulations. “Each citation issued caries a specific monetary penalty, up to $7,000 for serious violations, and up to $70,000 for repeat violations” (Guglielmo, 2004).

( Note: references will be provided in the final paper)

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