If you ever read or watched the Sherlock Holmes books, movies or the TV series you will recall the line “Elementary, my dear Watson”. It was the explanation that Sherlock Holmes gave to his assistant, Dr. Watson, when explaining deductions he had made. Science, like solving murders, is all about deduction and solving mysteries and puzzles.
The same can certainly be said with infection prevention and trying to find out who or what are transmitting infections and how. In recent years, there has been a huge push on improving hand hygiene rates. There has also been a focus on improving cleaning and disinfection processes, particularly when it comes in environmental surfaces. Studies have looked at different types of disinfectant actives, different cleaning processes, changing frequency of disinfection, increasing staff (or decreasing staff), and implementing verification methods to ensure that cleaning and disinfection has in fact occurred. Several studies have shown that changing products, processes and including a validation program could in fact improve cleaning and disinfection showing a direct link to reducing HAIs.
Regardless of the implementation of hand hygiene programs or improving environmental surface disinfection, HAIs were not eliminated. Improved hand hygiene and enhanced cleaning certainly showed a reduction in HAIs, but HAIs still occurred. Several years ago after conducting a cleaning audit at a facility that was in the midst of an outbreak one of the observations I made was that I never saw any cleaning and disinfection of patient care equipment by nursing staff.
Don’t jump to conclusions. I’m not saying that nurses are to blame for outbreaks, but the thought came back in flash after reading a study that hoped to improve both hand hygiene and stethoscope hygiene. The researchers’ intervention sought to educate staff regarding the importance of stethoscope hygiene. Expectations were set that stethoscopes needed to be disinfected between each patient encounter due to the fact that they are repeatedly used throughout the day and can become contaminated after contact with patients. This repeated use throughout the day and between multiple patients make stethoscopes a key fomite that can transmit pathogens from patient to patient. Unfortunately for the researchers (and maybe the patients) of the 128 initial observations disinfection of the stethoscopes never occurred. Post-intervention, an additional 41 observations found that even with an education intervention to discuss the importance of disinfection of the stethoscopes, no stethoscope hygiene was performed.
Do I hear crickets chirping?
I wonder just how wide spread the lack of stethoscope hygiene is? I know the next time I’m at my doctor’s I’m going to ask when the last time she disinfected her stethoscope was and may just offer to clean it for her myself!