420 Standard of Care for Cleaning Stethoscopes Before Patient Evaluations

Abstract

Methods: An electronic screening system for severe sepsis was created in our EHR and implemented in our ED. A best practice advisory (BPA) notifies physicians and nurses of possible severe sepsis and prompts utilization of an order set when three criteria are met. These include: 2 or more modified SIRS criteria positive (Temp>38 C, HR>90, RR>20, SBP<90 or MAP<65, and WBC>12), evidence of end-organ dysfunction (hypotension or organ dysfunction lab values consistent with CMS measure definition) and suspected infection (either temperature > 38 C, antibiotics ordered for the indication of suspected infection, or documented physician suspicion of infection). We performed a retrospective manual chart review of all adult patient encounters with a triggered severe sepsis BPA over a 3-month period to determine whether the patient had potential or suspected severe sepsis at the time the BPA fired. A second reviewer reviewed the cases to determine agreement with a third used as a tiebreaker if disagreement. In addition, we reviewed patients over a 7-week period who received ICD-10 codes for severe sepsis or septic shock to determine if any cases were missed in the ED by our screening criteria.Results: 301 ED patient encounters (2.01% of all adult ED patient encounters) triggered the severe sepsis BPA alert in the 3-month study period. 295 of the 301 encounters were determined via chart review to have suspected severe sepsis or septic shock at the time that the alert fired. The remaining 6 encounters were determined not to have suspected severe sepsis or septic shock at the time of BPA alert and included: alcohol withdrawal, salicylate toxicity, transfusion reaction, GI bleed, and prophylactic antibiotics ordered without appropriately indicating intent. The observed kappa for interrater reliability was 0.854. The positive predictive value of our BPA alert for suspected severe sepsis is 98% (295/301). Over a 7-week period, 86 patients ultimately received ICD-10 codes for severe sepsis or septic shock. 71 met criteria for severe sepsis during their ED evaluation with 70 caught by our automated screening criteria, resulting in a sensitivity of 98.59% (CI 92.4-99.96%). The single case not caught by our BPA logic was due to antibiotics not administered in the ED.Conclusions: The development of an automated severe sepsis screen in the ED at our institution was found to have very high positive predictive value as well as high sensitivity for patients ultimately diagnosed with severe sepsis or septic shock.

Aseptic Barriers Allow a Clean Contact for Contaminated Stethoscope Diaphragms

“…23 Direct observational studies report much lower stethoscope hygiene, in the range of 11% to 16%. 24,25 Cited barriers to hygiene performance include lack of time and poor access to disinfecting materials. These barriers persist despite most providers being aware that stethoscopes can be colonized with microbes and potentially serve as a vector for transmission.…”

Aseptic Stethoscope Barriers Prevent C difficile Transmission In Vitro

“…4 Unfortunately, recent studies demonstrate dismal rates of stethoscope hygiene compliance in the clinical setting, with observed cleaning rates occurring in less than 10% of patient encounters. [5][6][7][8][9][10][11][12] Despite most providers understanding that the unsanitized stethoscope may be a microbial transmission vector, 13 poor stethoscope hygiene rates are persistent. When questioned, providers report barriers to hygiene performance that include the lack of time and poor access to disinfectants.…”