We are going to explore the genus of micro-organisms known as Staphylococcus starting with coagulase negative staphylococci. Click below for the complete article

Stethoscopes have been the focus of several studies with some eye opening results. Cultures have resulted in 79.8% growth of gram-positive bacilli and 74.8% Staphylococcus from the diaphragms. Continued studies indicated recontamination occurring by the 5th use on alternate patients. AORN has concluded that cleaning of stethoscopes between each patient would likely be a good infection control practice. Additionally some common practices such as wearing one around your neck (thereby exposing your surgical attire and skin), fabric tubing covers ("Bacterial contamination of fabric stethoscope covers: the velveteen rabbit of healthcare? By Milam, Hall, and Pringle. ), and hanging objects onto stethoscopes should be discontinued.

Many of you have chosen AORN as one of your Nationally Recognized Authorities for your Infection Control Program. They have expanded their guidelines and recommendations for 2011. You will need to likely update your policies and procedures accordingly. We have done a cross walk for you to make that task a little easier and are presenting that information in upcoming webinars. Because of the nature of the information these webinars qualify for 1 Contact Hour for all who attend!! An example of one of the new recommendations is in regards to stethoscopes as discussed above.

With our fast-paced work environment, keeping up with the latest recommendations can be a challenge. We are going to review the CDC recommendations for Infection Control Practices recommended for lumbar puncture procedures which were added to Standard Precautions in the 2007 Guidelines for Isolation Precautions.

http://www.cdc.gov/hicpac/pdf/isolation/Isolation2007.pdf
In 2004, the CDC investigated 8 cases of post-myelography meningitis. In all 8 cases, the blood or cerebro-spinal fluid yielded a streptococcal species consistent with oro-pharyngeal flora. Products and equipment used during the procedures were excluded as the probable sources of contamination. Information available for 7 of the cases indicated that skin preparations were done and sterile gloves were worn but none of the clinicians wore a face mask which led to consideration that droplet transmission of oro-pharyngeal flora had occurred. There had been previous reports of bacterial meningitis following myelogram, lumbar puncture, spinal and epidural anesthesia and intrathecal chemotherapy. It is know that face masks are effective in limiting the dispersal of oro-pharyngeal droplets. One of the purposes for wearing a face mask by health care personnel is to protect patients from organisms in the health care workers mouth and nose during procedures requiring sterile technique.

The CDC recommends wearing a surgical mask when placing a catheter or injecting material into the spinal or subdural spaces such as during myelogram, lumbar puncture, and spinal or epidural anesthesia.

What does this mean for us in the ambulatory care industry? Cases of infections that may be related to not wearing a surgical mask during spinal procedures continue occur so clearly, there are lapses involved with this recommendation. As health care workers and infection preventionists, we have the obligation to provide for the safety of our patients. Clinicians we work with may not be aware of this CDC recommendation, so the education of everybody who works at your facility is especially important. Sometimes a clinician who is aware of this requirement may need to be reminded about adherence.

The question arises, which people present during the procedure need to wear a mask? The CDC guideline doesn't answer this. Certainly the person performing the procedure should be masked and anybody who may disperse droplets in proximity of the procedure equipment or the patient's procedure site should also wear a mask.