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.
