Tuesday, 28 August 2018

Transmission of Infection Through the Use of a Stethoscope

Transmission of Infection Through the Use of a Stethoscope Introduction Nosocomial infections have been regarded for over decades as both a leading cause of the increased cost of health care, mortality and morbidity and a critical issue impacting the quality of healthcare. A stethoscope is an important instrument in the medical profession and because of its wide range of uses, it may be the carrier of microorganisms that lead to nosocomial infections. Daily, stethoscopes come into contact with different patients, therefore their disinfection after use is necessary (Alvarex, Ruiz, & Mosqueda, 2016). However, based on my observations as an ER nurse, my coworkers never disinfect their stethoscopes after work. Research article In this paper, the article that will be used is “Decontamination of stethoscope membranes with chlorhexidine: Should it be recommended?” by Alvarez, Ruiz, Mosqueda, Leon, Arreguin, Macias, and Macias (2016). The article outlines various chemicals used for decontamination. The article also evaluates the differences in the recontamination of the membranes of the stethoscope after cleaning it with alcohol, triclosan or chlorhexidine. Purpose statement: This paper will summarize and analyze the article in order to find out the various ways of preventing transmission of infections by stethoscopes. Research Questions This study has several research questions which are based on the differences in the various methods and chemicals used in the decontamination of the stethoscope to prevent cross-infection. The research questions for this study are; After cleaning with alcohol, triclosan, or chlorhexidine, what are the differences in the recontamination of the membranes of the stethoscope? Which is the best chemical that can be used in the decontamination of stethoscopes? Stethoscopes are among the major causes of nosocomial infections; therefore, it is necessary to perform cleaning of the stethoscope each time it has been used, or sooner if it becomes contaminated with blood. However, compliance with this recommendation is very low. As an ER nurse, I have seen my coworkers ignoring the recommendation, they do not disinfect their stethoscopes at all (Alvarex, Ruiz, & Mosqueda, 2016). Disinfecting with alcohol is very effective but it gets recontaminated again because alcohol evaporates fast. Disinfecting with other antiseptics such as triclosan and chlorhexidine shows substantivity (the ability of the disinfectant to remain linked to fatty acids or skin cells. These two disinfectants tend to have a prolonged bactericidal capacity; therefore, the surface of the skin stays free from organisms, a situation is known as a residual effect (Alvarex, Ruiz, & Mosqueda, 2016). In the case of a stethoscope, organic matter quickly contaminates its surface, where even isopropyl alcohol cannot remove the organic matter. Research design The research design of the study is experimental where randomized, and a blinded attempt was carried out. The aim of the experiment was to evaluate the differences in the rates of recontamination of the membranes of the stethoscope. The membranes of the stethoscope were cleaned with 1% w/v triclosan in 70% volume/volume isopropyl alcohol, 70% volume/volume isopropyl alcohol, or 1% volume/volume chlorhexidine in 70% volume/volume isopropyl alcohol. The study was conducted first in hospital A and it was reproduced in hospital B (Alvarex, Ruiz, & Mosqueda, 2016). The trial which had 5 arms was used to measure recolonization of stethoscopes. Strengths: the research design of the study is very good because and suitable for this study because there is a need for experimenting the three antiseptics in order to identify their differences in recontamination of the membrane of the stethoscope. Other methods could not be used such as observation or interviewing because the study involves antiseptic and stethoscope membranes. Weaknesses: The research design of this study could not give precise results because of the contamination of the disinfectants. Also, the design used the trial method with five arms, which could also be not reliable. Research Sample The sample size of this was 5 trials, where 3 were for intervention itself and 2 controls. The sample size was adequate for the study because it could give precise, reliable and valid results. The number of participants in the study was adequate since the experiment involved only the test using stethoscope membranes and the three disinfectants. It was an experimental study, not an interviewing study. Data collection The data collection method that was used in this study was a microbiologic method where the stethoscope membranes were kept in contact with agar plate and the plates were incubated for about 24 hours at a temperature of about 35 degrees Celsius. In order to obtain results, various antibiotic susceptibility tests were carried out with the agar disk diffusion method. The tests results were collected and recorded. In the data analysis, Kruskal-Wallis rank test with 4 degrees of freedom and non-normal distribution were performed in order test for differences among the data. Post hoc test was used to identify the differences. No ethical considerations were considered because it was an experimental study (Alvarex, Ruiz, & Mosqueda, 2016). Limitations Some of the limitations of the study are the failure to present the number of contacts that each stethoscope had, or the users of the stethoscope, there was no any reported factual mechanism in which an infection could be caused by contamination. Time restrictions were the limitation within the study where there was not enough time to conduct further study on the transmission of infections by stethoscope (Alvarex, Ruiz, & Mosqueda, 2016). Importance of limitations: It is important to list down the limitations of a study in order to interpret the validity of the study and the credibility of the scientific work. Findings 31 stethoscopes were colonized in the baseline control arm. In the isopropyl alcohol immediate-effect arm, there was no colonization found. 18 stethoscopes from the residue effect of the triclosan arm and the isopropyl alcohol arm were colonized. When the stethoscopes were disinfected using chlorhexidine, four stethoscopes were colonized. After disinfection, chlorhexidine obstructed the recontamination of the membrane of the stethoscope for at least 4 hours. This is due to the fact that the resulting load of bacteria was considerably lower compared with that of isopropyl alcohol and that of the triclosan. Furthermore, there was no considerable difference between the contamination in the isopropyl alcohol immediate effect group and the chlorhexidine group. The study answered the research questions because differences were identified between the three disinfectants and the best disinfectant of the stethoscope is chlorhexidine. The results of the study are credible because there are minimum limitations and the sample size is also small. Summary The paper has summarized an article about the disinfecting stethoscopes after use in order to prevent transmission of infections. The research questions of this paper are; After cleaning with alcohol, triclosan, or chlorhexidine, what are the differences in the recontamination of the membranes of the stethoscope? Which is the best chemical that can be used in the decontamination of stethoscopes? The research design of this study is an experimental study. The sample of the study involved five trials, 2 controls, and 3 interventions. The study found out that chlorhexidine is the best disinfectant because it prevented recontamination for the longest time than the other two disinfectants. In conclusion, chlorhexidine can hinder the recontamination of stethoscope membranes and it can help in the prevention of transmission of infections.   References Alvarex, J. A., Ruiz, S. R., & Mosqueda, J. L. (2016). Decontamination of stethoscope membranes with chlorhexidine: Should it be recommended? American Journal of Infection Control, 44(11), 205-209.

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