The Prevalence of MRSA Transmission by Stethoscope

[mobey]

The Prevalence of MRSA Transmission by Stethoscope

* Keith Wesley, MD, FACEP

* Street Science

* 2009 Mar 9

Merlin MA, Wong ML, Pryor PW: "Prevalence of methicillin-resistant Staphylococcus aureus on the stethoscopes of emergency medical services providers." Prehospital Emergency Care. 13(1):71-4, 2009.

The Science

The authors of this study swabbed 50 stethoscopes of EMS providers presenting to their emergency department (ED) with patients. The swabs were then cultured to detect the presence of methicillin-resistant staph aureus (MRSA). They found 16 (32%) colonized with MRSA. When asked, none of the 16 (32%) could recall the last time their stethoscope had been cleaned.

Reported periods of time for cleaning were grouped as follows: Reported length of time since last cleaning was grouped into six categories: one to seven days, eight to 14 days, 15 to 30 days, 31 to 180 days, 181 days to 365 days and unknown. The median time frame reported since the last cleaning was one to seven days. In the model, an increase from one time category to the next increased the odds of MRSA colonization by 1.86 (odds ratio=1.86, p=0.038). That means that if a stethoscope hadn't been cleaned for 31-180 days it was virtually guaranteed to have MRSA.

The authors conclude that MRSA colonization of EMS stethoscopes may represent a significant vector for transmission of this virulent agent to the patients we treat.

The Street

I have reviewed similar articles and am encouraged to see continued interest in this issue. Although there's debate as to the actual significance of MRSA transmission by healthcare, I believe strongly that it's just one of many virulent agents that we have let down our guard on. We've become complacent with body-substance isolation by donning gloves at the beginning of a call and not removing them until after we've completed the paper work. All the while, we're spreading germs throughout the ambulance, its equipment -- and even other staff.

We'll never be able to get the nursing homes to inform us of the patients who are MRSA positive, so we must assume that all nursing home patients are MRSA positive and treat them accordingly. This means cleaning the rigs between each transport as if they were.

We have made great strides in creating significant exposure plans to deal with blood-borne pathogens but pay little heed to the most simple of strategies to prevent the spread of contagion. I challenge you all to look at your service and examine the availability of waterless cleansing agents for your hands and your stethoscope. Anything you touch with your gloved hand should be cleaned between transports, and everything that comes into direct skin contact with a patient must either be single use or cleanable.

Do it for your safety. Do it for your family's safety. But most importantly, do it for your patients.

Dr. Wesley is the State EMS Medical Director for Minnesota and the medical director for Health East Medical Transport in Minnesota. He can be reached at drwesley@charter.net.

[fireflymedic]

Good article to give us thought ! With all the nasty bugs out there, we really need to be vigilant about keeping ourselves and our patients and safe and healthy as possible and not spreading the little critters around. I mean truthfully, how long does it take to wipe down the scope after each patient? Not long, I know many of us (myself included) are an every shift person. However, the one thing I've found that keeps the gunk down in addition to wiping it down is to cut the finger off the tip of a glove (nitrile remember for those latex allergy patients or unknowns) and cover the bell of it. Then just simply remove and throw away after each patient. Also - think about those cool looking stethoscope covers. The cloth can't be cleaned between patients, so just a thought to think about. They may harbor little critters as well. Just thoughts going through my head - best bet avoid latex and buy the good stuff and cover those bells and let's wipe 'em down between patients ! It's all good ! Great find mobey !

[mobey]

Thx Fire_911

Tis funny, we carry a container of those disinfectant wipes behind the drivers seat of our rig for the steeringwheel/radio. It would take no time at all for me to wipe down my scope after each call..... Sometimes I just need to read this stuff to remind me there is always more I could be doing.

[Arizonaffcep]

Boy! Hadn't given that much thought! Well, I can tell you what I'm going to change next shift!

[kristo]

Interesting.

Here, if our patients have been in a medical facility abroad in the preceding 6 months, they are quarantined and tested to find out whether they're carriers for MRSA. Once it's been confirmed by a culture from a nose swab that they are not, they are let out of the quarantine.

This obviously only goes for hospitalised patients.

[Katiebug]

www.safesealdiaphragm.com

[fiznat]

Good point. This is something that I don't do nearly as often as I should. Another thing that I think providers often overlook cleaning is their pens. I always end up touching my pen both with gloves on and off, during patient care as well as after. I should definitely be cleaning that thing much more often.

Edited March 11, 2009 by fiznat

[VentMedic]

Interesting.

Here, if our patients have been in a medical facility abroad in the preceding 6 months, they are quarantined and tested to find out whether they're carriers for MRSA. Once it's been confirmed by a culture from a nose swab that they are not, they are let out of the quarantine.

This obviously only goes for hospitalised patients.

We haven't done quarantine for MRSA in a long time. Even trach patients aren't isolated anymore.

We will do selective isolation precautions depending on where the MRSA is located. If it is isolated to a wound, contact precautions will usually suffice. Many of the patients you come across will be colonized with MRSA or some bacteria.

Since EMS transports these patients, it is difficult for even the NH to know of every bacteria or virus that the patient has and usually if general precautions are taken, it is not an issue. The exception would be airborne bacteria and viruses. Unfortunately, if the RN at the LTC or hospital doesn't spell it out clearly to the EMS providers, it may be assumed the patient is free of all harmful bacteria. Then, some get upset if they read the patient has been colonized with something or the decubitus ulcer has MRSA. Some will also shortcut their cleaning process if they believe the patients will come with big flags for infections.

It would also be interesting to do nare swabs on EMS providers as is occasionally done on hospital employees.

Edited March 11, 2009 by VentMedic

[brentoli]

Interesting.

What else do we not pay enough attention in cleaning too?

Pens

Shoes

Glasses/Sunglasses

Uniforms

Steering Wheel

BP Cuffs

Pulse Ox Probes

All of these are places that are commonly touched in the process of paitent care. Does anyone take the time to worry about them?

[rock_shoes]

I suspect I'm the exception to the rule. The bell gets cleaned between every patient. The entire scope gets cleaned every shift. My pen gets cleaned every shift. It may be a cliche but this is a clear case of "If you're not part of the solution. You're part of the problem." Call me crazy but I make a concerted effort not to bring things home to my family or spread them among patients.

Interesting.

What else do we not pay enough attention in cleaning too?

Pens

Shoes

Glasses/Sunglasses

Uniforms

Steering Wheel

BP Cuffs

Pulse Ox Probes

All of these are places that are commonly touched in the process of paitent care. Does anyone take the time to worry about them?

Don't forget one of the most horrendous of all offenders. The car cell-phone!

Edited March 12, 2009 by rock_shoes