By Dr. Sarathi Kalra

Stethoscopes are an integral part of acute and clinic patient care settings. In addition to routine physical exams, various medical conditions require thorough auscultation of the chest and abdomen for a comprehensive evaluation.

While some may argue that advancements in ultrasound and CT imaging provide superior clinical information, it is inappropriate to over-test patients, even when adequate healthcare resources are available. Additionally, due to financial feasibility and potential health risks from radiation exposure, it is not practical for the majority of hospitals to unnecessarily image all patients as radiation poses health risks. As such, the stethoscope has been, and will continue to be, an essential tool in patient care decision-making.

In acute care settings, the stethoscope is the “gateway” to choosing the appropriate imaging or procedure for a patient who is having difficulty breathing. Similarly, a child presenting with a detected heart murmur may prompt additional imaging, such as an echocardiograph. Without a stethoscope, there is the potential for significant delay in the identification of medical conditions. Over the last several decades, it has become evident that stethoscopes are vectors of infection. Several studies have shown that bacteria with the potential to cause fatal infections can be grown from different parts of the stethoscope.^1-3

Assuring an aseptic barrier is available to protect every patient is long overdue development – the AseptiScope DiskCover System provides an evidence-based “ray of hope.” Studies show the DiskCover aseptic barriers are effective in preventing patient exposure to harmful pathogens and contaminants while preserving sound quality for an optimal clinical experience.^4,5 Furthermore, it is easy to apply and remove new barriers, in seconds, between every patient exam.

As an Emergency Medicine physician who was recently diagnosed with COVID-19, I know any available barrier that may prevent infection transmission from clinician to patient is of utmost importance. SARS-CoV-2 has been detected on various hospital surfaces, including the stethoscope.⁶

For stethoscope infection barriers, the system must be easy to apply, aseptic and not impede the quality of auscultation. With the supportive evidence from clinical studies, the AseptiScope DiskCover System demonstrates these critical attributes and provides valuable protection to benefit patients and health care providers alike. Prevention is always better than cure, and the DiskCover System is a fast and simple solution that helps keep patients safe without impacting provider care.

1. Longtin Y, et al. Contamination of stethoscopes and physicians’ hands after a physical examination. Mayo Clin Proc. 2014;89(3):291-299. 

2. O’Flaherty, N.; Fenelon, L. The stethoscope and healthcare-associated infection: A snake in the grass or innocent bystander? J. Hosp. Infect. 2015, 91, 1–7.

3. Raghubanshi, BR, et al. Use of 90% ethanol to decontaminate stethoscopes in resource limited settings. Antimicrob. Resist. Infect. Control 2017, 6, 68.

4. Vasudevan R, et al. Aseptic Barriers Allow a Clean Contact for Contaminated Stethoscope Diaphragms. Mayo Clin Proc Innov Qual Outcomes. 2020;4(1):21-30. Published 2020 Feb 5. 

5. Data on file, AseptiScope. 

6. Pasquarella C, et al. Detection of SARS-CoV-2 on hospital surfaces. Acta Biomed 2020; Vol. 91, Supplement 9: 76-78.

Dr. Sarathi Kalra is an Assistant Professor and Research Director for the Department of Emergency Medicine at University of South Alabama in Mobile, AL. He has been closely involved with the department leadership in building the residency program and research curriculum for emergency medicine residents. 

Third Hand Vector series spotlights the clinician’s third hand and the risks that contaminated stethoscopes pose to clinicians, patients and healthcare systems. The series features leading experts in infection control, patient care and quality measures raising awareness of the importance of aseptic barriers in reducing transmission of infectious diseases.

The post OP ED #7: A Ray of Hope appeared first on The DiskCover System.

By Dr. Alan Maisel

For years, hospital infection control committees have endorsed the integration of single-use or “patient dedicated” stethoscopes as a means to mitigate stethoscope contamination. Support for these stethoscopes arose because disinfecting diaphragms between every patient as a standard of care was simply viewed as untenable in high workflow environments. While, conceptually, single-use stethoscopes seemed a reasonable alternative in high acuity care, in practice their use has been costly in three important ways:

1. Single-use stethoscopes cross-contaminate and remain a vector for infection. More aptly named “single-patient” stethoscopes, they remain in the patient’s room and are used by every clinician who examines that patient. Whittington et al. demonstrated that these stethoscopes are unprotected from pathogens, exposed to contaminants in the patient’s room, and handled by many clinicians. The diaphragms become and remain contaminated,¹ thus defeating their value in infection prevention.

2. Single-use stethoscopes cross-contaminate at both ends of the stethoscope. The earbuds of single-use stethoscopes become contaminated as they move in and out of the ears of multiple clinicians, essentially sharing the contents of one clinician’s ears with the next examining clinician’s ears¹ – and so on.

3. Single-use stethoscopes compromise our examination of the patient. Stethoscopes are incredibly fundamental tools; literally functioning as our third hand in evaluating patients. In high acuity care we rely on the ability to leverage heart, lung, and abdominal sounds to identify and manage clinical pathologies. The sound dampening of these inferior products is obvious to anyone who has used them; they confound accurate diagnosis and compromise patient management².

As infection prevention efforts intensify, and as effective auscultation remains essential for clinical care, it is time to reduce reliance on “single-patient” stethoscopes. Instead, stethoscope cross-contamination should be prevented with an aseptic and high-fidelity barrier that is applied in a touch-free fashion to our personal stethoscope diaphragms – to protect our patients, ourselves and the effectivity of our most valued clinical tool.

1. Whittington AM. Bacterial contamination of stethoscopes on the intensive care unit. Anaesthesia, 2009, 64: 620–624.

2.  Mehmood M.  Comparing the auscultatory accuracy of health care professionals using three different brands of stethoscopes on a simulator.  Medical Devices: Evidence and Research 2014:7 273–281.

Dr. Maisel is Professor of Medicine Emiritus, University of California, San Diego. He was director of the Coronary Care Unit and Heart Failure Program at the VA San Diego Healthcare System for 35 years. As a cardiologist, Dr. Maisel is considered a global expert in the application of cardiovascular biomarkers and has led multinational clinical trials that have paved the way for new care standards in diagnosis and management of acute cardiovascular conditions. He has published over 500 peer reviewed articles and original investigations. In 2001, the New England Journal of Medicine published his “Breathing Not Properly (BNP) Multinational Study” that signaled a clinical breakthrough that improved the diagnosis and risk stratification of heart failure. Dr. Maisel continues to advocate for the implementation of novel products that assist acute patient care.

Third Hand Vector series spotlights the clinician’s third hand and the risks that contaminated stethoscopes pose to clinicians, patients and healthcare systems. The series features leading experts in infection control, patient care and quality measures raising awareness of the importance of aseptic barriers in reducing transmission of infectious diseases.

The post OP ED #6: Hearing is Believing appeared first on The DiskCover System.

A novel, aseptic barrier system from AseptiScope prevents pathogen transmission 

June 29, 2020 San Diego, California – An article in the new issue of The American Journal of Medicine highlights the practical and symbolic importance of the stethoscope and its key role in assessment of COVID-19 patients.  Despite continuous advances in the diagnosis of disease, the stethoscope remains a mainstay in patient evaluation in the 200 years since its invention.  Today, given the respiratory dysfunction and cardiovascular co-morbid manifestations characteristic of COVID-19, the thorough assessment of patients with a stethoscope is critical, as is the need to maintain a pathogen-free stethoscope diaphragm surface.  An automated, clinically validated and aseptic single-use barrier system from AseptiScope holds promise to fill a significant gap in stethoscope hygiene practices.

“The stethoscope is the most prominent and enduring symbol of the interaction and bond between the physician and the patient. This is even more important in the COVID-19 era,” said Alan Maisel, MD, Professor Emeritus at the University of California San Diego, co-author, and co-founder of AseptiScope, Inc.  “The stethoscope is truly the clinician’s third hand and is at the heart of all physical examinations.  Its ability to provide rapid diagnostic and prognostic information is unsurpassed.”

The authors point out that common pathogens found on clinicians’ hands are also likely present on their “third hand,” the stethoscope, and often at a significantly greater magnitude.  In the light of the COVID-19 pandemic, current guidelines and practices related to stethoscope hygiene have understandably come into the spotlight.  Current CDC guidelines call for stethoscope cleaning but fail to recommend a standard cleaning frequency, ranging from between-patients to once weekly.  Given the reported ability of pathogens like COVID-19 to linger on surfaces, this lack of specificity for hygiene frequency may no longer be adequate.  Moreover, despite CDC guidelines, the authors cite observational studies of clinicians in everyday practice that show a very low frequency of stethoscope cleaning, ranging from 13% to 24%.

“With the emergence of COVID-19, and in its wake, the difficulties in stethoscope hygiene have become disturbingly clear,” said Robert Gaynes, MD of the Division of Infectious Diseases at Emory University and co-author.  “Just as clear is the persistent importance of the stethoscope and, so, the need to establish new approaches for its safe use.”   

The authors emphasize that common stethoscope cleaning practices, such as alcohol wipes, bleach, and hydrogen peroxide, even when used effectively, produce mixed results in reducing pathogen transmission risk.  Additionally, the authors cite studies finding that single-patient disposable stethoscopes offer compromised auscultation quality and present a concerning cross-contamination risk for the clinicians who share them.  

The article concludes that a promising solution for infection protection for the stethoscope is the use of aseptic disposable diaphragm barriers.  The authors cite a recent study of the AseptiScope DiskCover barriers (Mayo Clin Proc Innov Qual Outcomes. 2020. doi:10.1016 / j.mayocpiqo.2019.10.010), which concluded that barrier use provided protection against common hospital-associated pathogens including MRSA, VRE, and E. Coli. 

“The application of single-use aseptic stethoscope barriers is emerging as the first practical solution to this long-standing challenge,” said Scott Mader, CEO and President of AseptiScope.  “The upcoming launch of the touch-free DiskCover System will allow healthcare providers to safely and confidently use their most frequently employed medical device, the stethoscope, at a time when infection control is the paramount priority.”

About AseptiScope, Inc.

AseptiScope is a privately funded San Diego, California based, clinical innovation company, formed in early 2016. The organization is founded and led by clinical innovation experts, leading medical researchers and practicing physicians. The AseptiScope mission is to design, develop, manufacture and commercialize novel solutions that ensure “Infection Protection for Clinician & Patient.” The company will introduce the first true and practical solution for the longstanding challenge of stethoscope contamination in the summer of 2020: The AseptiScope DiskCover System. Visit www.aseptiscope.com for more information.

AseptiScope, DiskCover, and related logos are trademarks of AseptiScope, Inc.

MEDIA CONTACT
Irene Mulonni
irene@mulonni.com
858-859-7001

DOWNLOAD PDF

The post American Journal of Medicine Article Highlights the Promise of Aseptic Barriers for Stethoscope Hygiene in the COVID-19 Era appeared first on The DiskCover System.

By Dr. Alpesh N. Amin

Hand hygiene is a proven safety practice in health care. Unfortunately, hand hygiene is underperformed on a routine basis, leading to the transmission of pathogens and spread of infection from patient to patient. Similarly, stethoscopes – the clinician’s third hand – pose the risk of carrying pathogens and spreading infection from patient to patient. Like hands, stethoscopes can be effectively decolonized using alcohol. Yet, despite effective means to decolonize stethoscopes, our study in the Journal of Hospital Medicine showed only 16% of physicians or student trainees employed stethoscope hygiene prior to patient contact.¹ In non-isolation rooms, the issue was exacerbated – we found only 4% of patients received care involving stethoscope hygiene.¹

As patients are alarmingly exposed to unclean stethoscopes, stethoscope transmission of pathogens from patient to patient can undermine the efforts of hand hygiene programs. Effectively promoting hand and “third hand” hygiene best practices could reduce infection rates. In turn, infection control can decrease healthcare costs (including reducing antibiotic use and complications) while improving the patient experience – cornerstones of the Institute for Healthcare Improvement’s “Triple Aim.”

An easy to use and reliably effective method that improves stethoscope hygiene could help facilitate achieving the Triple Aim.

1. Jenkins IH, et al. Low Rates of Stethoscope Hygiene. J. Hosp. Med 2015;7;457-458. 

Alpesh N. Amin is Professor of Medicine at the School of Medicine, Chair of the Department of Medicine, and Executive Director for the Hospitalist Program at the University of California, Irvine.  He specializes in hospital, internal and perioperative medicine with research interests including patient care and quality improvement in the acute setting.

Third Hand Vector series spotlights the clinician’s third hand and the risks that contaminated stethoscopes pose to clinicians, patients and healthcare systems. The series features leading experts in infection control, patient care and quality measures raising awareness of the importance of aseptic barriers in reducing transmission of infectious diseases.

The post OP ED #5: Achieving The Triple Aim With Our Third Hand appeared first on The DiskCover System.

By Cynthia Cadwell, RN, ANP-BC, CNS

In the 1840s, Ignaz Semmelweis proved that handwashing reduced death in childbirth. Providers have since strived to prevent cross contamination, including the use of environmental sanitization between patients. The point of “care” is to apply life-saving science while doing no harm. Yet, insidious infections occur and can be potentially lethal, particularly in the immunocompromised patients, even among meticulous providers.

Despite the abundance of studies showing the need for cleaning frequently touched items such as cell phones, keyboards, patient care areas and other items to prevent the cross contamination, it is difficult to ensure compliance. Providers know the importance of cleaning their stethoscope before use on a patient. However, when observing stethoscope hygiene in practice, busy providers who see multiple patients in a fast-paced environment frequently forget… because humans can and will make errors!¹

Effective quality techniques are exemplified by routine, simple methods implemented in standard workflows. Best practices are those that are easily applied by multiple staff without work-arounds.²  Technologies to help eliminate human error are the most effective – ensuring providers do the right thing, each and every time. Hand sanitizer and gloves immediately visible at the entrance of patient rooms enhance routine use. Adding a touch-free stethoscope barrier dispenser in these locations will decrease stethoscope contamination. Goal: “Do No Harm.” 

1. Institute of Medicine (US) Committee on Quality of Health Care in America; Kohn LT, Corrigan JM, Donaldson MS, editors. Washington (DC): National Academies Press (US); 2000.

2. Crossing the Quality Chasm: A New Health System for the 21st Century. Institute of Medicine (US) Committee on Quality of Health Care in America. Washington (DC): National Academies Press (US); 2001.

Cynthia Cadwell, Principal Consultant at Cadwell Consulting, is a Nurse Practitioner with over 25 years of clinical and biotech experience focused on lean initiatives and quality improvement for patient care and healthcare systems.  As an RN, CNS, CPHQ, and Clinical Educator, her clinical experience spans SNF/PAC, advanced wound care, occupational health, critical care and cardiovascular disease.

Third Hand Vector series spotlights the clinician’s third hand and the risks that contaminated stethoscopes pose to clinicians, patients and healthcare systems. The series features leading experts in infection control, patient care and quality measures raising awareness of the importance of aseptic barriers in reducing transmission of infectious diseases.

The post OP ED #4: Protect Your Patient appeared first on The DiskCover System.

By W. Frank Peacock, IV, MD, FACEP, FACC, FESC

Standard of Care?

If you ask a doctor “How often do you clean your stethoscope?” you will likely hear “Oh, in about 30-40% of patient encounters.” If you would then ask “In those 30-40% of encounters, how do you clean your stethoscope?” they will commonly respond “I rub it with an alcohol swab.”

Unfortunately, self-reporting is not very accurate. And although everyone knows that the stethoscope is a strong vector for the transmission of disease, no one wants to admit they do something wrong all day long.

We recently published an observational study in the American Journal of Infection Control. The purpose of this important study was to uncover the facts about real-life stethoscope hygiene. For this investigation, we surreptitiously watched 400 patient-practitioner interactions (the staff didn’t know they were being observed) in high-risk hospital environments like the ER, ICU, and labor and delivery. No (zero) stethoscope hygiene was performed before the patient encounter in 82% of examinations.¹ A disgusting finding. And, even when stethoscope cleaning was performed, the quality almost never met the Centers for Disease Control (CDC) cleaning guidelines. In fact, stethoscopes were cleaned consistent with CDC guidance only 4% of the time.¹

Unfortunately, the apparent standard of care is to rub dirty contaminated stethoscopes on our patients.  This is because there has never – not in 150 years – been a system that efficiently and reliably provides a clean stethoscope while preserving its function.  This is not a call for a large investment in stethoscope washing, as others have shown that even guideline-compliant stethoscope washing is not effective at eliminating pathogens.  Rather, a disposable, aseptic barrier system for stethoscope diaphragms, one that completely prevents pathogen transmission, presents a strong opportunity for the medical community to improve patient safety.²

1. Boulée D, Kalra S, Haddock A, et al. Contemporary stethoscope cleaning practices: What we haven’t learned in 150 years.Am J Infect Control. 2018 Nov 2 Published online 2018 Nov 2.

2. Vasudevan R, Shin JH, Chopyk J, et al. Aseptic Barriers Allow a Clean Contact for Contaminated Stethoscope Diaphragms. Mayo Clin Proc Innov Qual Outcomes. 2020;4(1):21–30. 

W. Frank Peacock IV, MD, FACEP, FACC, FESC is a Professor of Emergency Medicine and Vice Chair for Research in the department of Emergency Medicine at Baylor College of Medicine, in Houston, Texas. With >600 publications, he is a two-time winner of the Best Research Paper of the Year Award from the American College of Emergency Physicians, and he was the 2019 recipient of the Ray Bahr Award for Excellence from the American College of Cardiology.  Finally, he is the founder of Comprehensive Research Associates, LLC, and Emergencies in Medicine, LLC.

Third Hand Vector series spotlights the clinician’s third hand and the risks that contaminated stethoscopes pose to clinicians, patients and healthcare systems. The series features leading experts in infection control, patient care and quality measures raising awareness of the importance of aseptic barriers in reducing transmission of infectious diseases.

The post OP ED #3: Stethoscope Contamination: What We Haven’t Learned in 150 Years appeared first on The DiskCover System.

By Sandra Sieck, RN

In the U.S., nearly 100,000 people die each year from healthcare-associated infections¹ (HAIs)—infections acquired in a hospital or health care facility unrelated to whatever health issue took the patient there in the first place.

This is equivalent to a large commercial airliner falling out of the sky with no survivors, each and every day.

Roughly 1.7 million HAIs occur annually in acute-care hospitals¹, which result in total costs (direct, indirect and non-medical) estimated at up to $147 billion². Dramatic efforts are employed to improve hand hygiene in hospitals, and the effort has demonstrated a favorable impact.

Despite these efforts, HAI rates remain unacceptably high. One gap in our hygiene protocols, which could be contributing to the problem is hygiene for “the clinician’s third hand,” the stethoscope. Several recent studies have demonstrated that stethoscopes are highly contaminated, yet are cleaned between patients less than 10% of the time. Furthermore, even when stethoscopes are cleaned, the contamination level is reduced but not eliminated.

A validated aseptic barrier system could rapidly and effectively resolve the risks posed by stethoscope contamination. Imagine the impact on mortality and costs if a stethoscope barrier system were to be introduced into our hospital infection control procedures.

1. Patient Care Link. Healthcare-Acquired Infections. https://patientcarelink.org/improving-patient-care/healthcare-acquired-infections-hais/, accessed May 11, 2020.

2. Marchetti A, Rossiter R. Economic burden of healthcare-associated infection in US acute care hospitals: societal perspective. J Med Econ. 2013;16(12):1399‐1404.

Sandra Sieck, a registered nurse and healthcare business analyst, is the owner of Sieck Healthcare Consulting, specializing in healthcare business development, aligning hospital and physician services and public policy evaluation and strategies.

Third Hand Vector series spotlights the clinician’s third hand and the risks that contaminated stethoscopes pose to clinicians, patients and healthcare systems. The series features leading experts in infection control, patient care and quality measures raising awareness of the importance of aseptic barriers in reducing transmission of infectious diseases.

The post OP ED #2: HAI MORTALITY: Equal to an Airplane Crash with No Survivors, Every Day appeared first on The DiskCover System.

By Stuart B. Kipper, MD

My stethoscope, even more than my white coat, instantly identifies me as a physician. Without a word spoken, it establishes an immediate bond of trust between me and my patient.

Yet, while stethoscopes continue to serve as a ubiquitous and cornerstone tool for all healthcare professionals, its constant contact and use during our daily patient interactions is NOT without a significant risk. Just like a clinician’s hands, stethoscopes can, and DO, harbor dangerous contaminants and organisms. Unlike our two hands, there is no easy, rapid, or effective way to clean our “third hand.”

For nearly every device or surface that comes in contact with a patient – hands, thermometers, otoscopes, tongue depressors, culture swabs, needles, and even exam tables – there is a cover or disposable system that reduces or eliminates transmission of disease. Stethoscopes have been left exposed and vulnerable. Disposable stethoscopes have limited utility, provide poor quality, high expense, and offer no effective solution to reducing their spread of infection. Mitigation efforts, such as alcohol wipes, destroy acoustic performance, are tedious endeavors, time consuming, and often forgotten. Placing a glove over the scope’s diaphragm is cumbersome and falls short of the goal we seek – protecting our patient.

Stethoscope hygiene for the clinician’s ‘third hand’ would be resolved if there existed a rapid, easy to use, and cost-effective means to provide an aseptic barrier to cover the stethoscope’s diaphragm.

In the wake of a consistent series of studies in the medical literature¹, the New England Journal of Medicine Journal Watch joined a growing body of medical leaders and thinkers calling for stethoscope hygiene to be elevated to the level of hand hygiene in clinical care². With infectious diseases like COVID-19, S. aureus, C. difficile, MRSA, and so many other pathogens, it is finally time for the stethoscope, the clinician’s ‘third hand’, to take center stage as a target for improving infection control and better protecting our patients while adhering to our commitment to DO NO HARM.

1. Knecht VR, McGinniss JE, Shankar HM, et al. Molecular analysis of bacterial contamination on stethoscopes in an intensive care unit. Infection Control & Hospital Epidemiology. 2019;40(2):171-177.

2. Ellison III, RT. NEJM Journal Watch Infectious Diseases, January 7, 2019. https://www.jwatch.org/na48156/2019/01/07/stethoscope-contamination, Apr 22, 2020.

Stuart Kipper, a Board Certified physician in Internal Medicine, is owner of Stuart B. Kipper, MD and Associates in Encinitas, California and is affiliated with the Scripps Hospital System in San Diego, California.

Third Hand Vector series spotlights the clinician’s third hand and the risks that contaminated stethoscopes pose to clinicians, patients and healthcare systems. The series features leading experts in infection control, patient care and quality measures raising awareness of the importance of aseptic barriers in reducing transmission of infectious diseases.

The post OP ED #1: Infection Control and the Clinician’s Third Hand – a Long Standing Problem appeared first on The DiskCover System.