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ADVANCE Perspective: Nurses

MRSA, Stethoscopes & Elmo

Published March 25, 2009 3:13 PM by Adrianne OBrien

Clipped to the stethoscope of one of the physicians at the pediatric practice my family visits is a small Elmo. A small, grimy Elmo. The physician has mentioned on more than one occasion that he's had his furry friend since 1991. Looking at the worn Sesame Street character, I wasn't surprised. But I wasn't grossed out. I was actually pleased this doc made the extra effort to relate to and reassure kids. When your toddler is beset with ear infection after ear infection, as my son was a couple years ago, and you've got him in a near full nelson while the physician is examining his clogged ears with an otoscope, small distractions are wonderful.

Still, stethoscopes are tools where bacteria love to gather, particularly stethoscopes used in EDs. One in three stethoscopes from a sampling of emergency medical services (EMS) providers from New Jersey tested positive for methicillin-resistant Staphylococcus aureus (MRSA) in a recent UMDNJ study led by Dr. Mark Merlin, chair of the Mobile Intensive Care Unit Advisory Committee for the New Jersey Department of Health and Senior Services.

In the study, researchers swabbed 50 stethoscopes used by independent emergency medical service providers - including EMTs, nurses and paramedics - who visited a New Jersey hospital's ED with patients during a 24-hour period. Cultures were incubated for 72 hours and then analyzed by two emergency physicians and one microbiologist from UMDNJ.

Of the 50 stethoscopes, 16 had MRSA colonization, and the same number couldn't remember the last time their stethoscopes were cleaned. 

Stethoscopes are known potential transmitters for MRSA. Still, Merlin was surprised by this study's results. "I thought maybe one percent of stethoscopes would be infected," he said.

Researchers suspect the length of time between stethoscope cleanings may increase the possibility of transmission. According to the study, the median reported length of time between cleanings was 1-7 days. "The longer period of time between cleanings, the more likely it is you have this bacteria," said Merlin, who also is an assistant professor of emergency medicine and pediatrics at the UMDNJ-Robert Wood Johnson Medical School.

What's the solution? EMS providers should clean their stethoscopes more frequently to prevent transmission of MRSA, Merlin urged.

"Provide isopropyl alcohol wipes at hospital emergency room entrances so EMS professionals can clean their stethoscopes regularly," said Merlin.


If you would know how many cases I myself have treated for post-MRSA scars etc.................   wow.     My mother passed away in Florida after a knee replacement and developed MRSA.  It was too late~~~~~~   after they detected and started treament.

Barbara Harrington, multi - RN, Medical spa April 11, 2009 11:59 AM
Stafford VA

Please... please do not forget the consistent washing of hands between patients.  Not sure what it's going to take to get this easy step imbedded / ingrained into the healthcare workers' practice.  They continually resist this practice.  And that certainly includes private practice where office staff, more often than not, believe they are not bound by such rules.

Trish, Retired April 6, 2009 12:41 PM
Lake Geneva WI

Use alcohol swabs, using disposable baggies and or gloves increases the chances of extra noise which can hide even the slightest murmurs in busy rooms or active pediatric patients.  Minimizing the amount of clothing or layers between the skin and stethoscope enhances the audibility of the heartsounds.

Laura Alba April 2, 2009 12:03 PM

Put a disposable glove on your stethoscope for each use, then discard.  This is just like putting disposable gloves on your hands, and removing them immediately when done.

Donna April 2, 2009 12:23 AM

disposable ones are a great idea. It is more costly to treat a MRSA infection then to prevent one from happening. It should be protocol for most wards, just as it is in most ICU's. It is not just to protect patients but to protect the health care workers. Pretty soon Vanco - zoysn and others will be useless

ashley , RN March 26, 2009 12:46 PM
los angeles CA

MRSA is the "polio" of the 21st century and drastic measures are going to have to be made to stop this killer in its tracks.  Almost every patient admitted to the several facilities I work, comes IN with MRSA or VRE.  When the healthcare population starts to catch these killer microorganisms, who's going to care for them?

Susan, Med/Surg - RN, Agency work March 26, 2009 12:27 PM
Dallas-Ft.Worth TX

This is nothing new to be!! each and every patient has their own disposable one for infection control purposes!!

Janette Salgado, Med/Surg - LPN, Kindred March 26, 2009 11:30 AM
Northlake IL

I am not surprised by this. I try to clean mine with alcohol each time before I use it. Next thing you know we are going to have disposable ones that go home with the patient.

Angie DeGryse, Med/surg - RN, GMC-Illini March 26, 2009 11:20 AM
Silvis IL

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