Since the time of Hippocrates, physicians listened directly to patients' chests as they tried to assess cardiac health. The inventor of the stethoscope, Rene Theophile- Hyacinthe Laennec, relied on this method, too. One day, when he needed to examine an obese young woman, Laennec hesitated to put his head to her chest. Remembering that you can hear a pin scraping one end of a plank by putting your ear to the other end, he came up with the idea for a stethoscope prototype. He rolled a stack of paper into a cylinder, pressed one end to the patient's chest, and held his ear to the other end. Laennec's first manufactured stethoscope was a simple wooden tube. A succession of different designs followed his, including, eventually, a "binaural" type with two ear pieces. In 1850, George Camman substituted rubber for stiffer materials and made a more comfortable model—the forerunner of today's stethoscopes. The use of the stethoscope led to better descriptions of heart sounds and improved ability to distinguish among various murmurs and rhythmic disturbances. It increased understanding of how blood moves through the heart in each cardiac cycle, under normal and abnormal conditions. From the time it was invented in 1816 until early this century, the stethoscope was the most reliable and informative tool available for diagnosing cardiovascular disease. Although other, more sophisticated diagnostic methods have come into use since then, the stethoscope has never been discarded. "At the turn of the century...diagnosis relied on taking a history and examining the heart with a stethoscope, and treatment consisted mainly of rest and a few standard oral medications." said W. Bruce Fye, a University of Wisconsin cardiologist and historian.

Nurses in the hospital consider stethoscope as an indispensable instrument utilized in the delivery of health care services to patients. Primarily for assessment, the stethoscope has been used in various procedures and its exposure to patients with different ailments increases the likelihood of contamination. In a study conducted in Hammersmith Hospital, London, United Kingdom by Whittington AM, Whitlow G, Hewson D, Thomas C, Brett SJ.(August 2009), it assessed how often bedside stethoscopes in the intensive care unit were cleaned and whether they became colonized with potentially pathogenic bacteria. On two separate days the 12 nurses attending the bed spaces were questioned about frequency of stethoscope cleaning on the unit and the bedside stethoscopes were swabbed before and after cleaning to identify colonizing organisms. Twenty-two health care providers entering the unit were asked the same questions and had their personal stethoscopes swabbed. All 32 non-medical staff cleaned their stethoscopes at least every day; however only three out of the 12 medical staff cleaned this often. Out of 24 intensive care unit bedside stethoscopes tested, two diaphragms and five earpieces were colonised with pathogenic bacteria. Methicillin- Resistant Staphylococcus aureus (MRSA) cultured from one earpiece persisted after cleaning. Three out of the 22 personal stethoscope diaphragms and five earpieces were colonized with pathogens. After cleaning, two diaphragms and two earpieces were still colonized, demonstrating the importance of regular cleaning. The authors of another study swabbed 50 stethoscopes, this time, of Emergency Medical Service providers presenting to their emergency department (ED) with patients. The swabs were then cultured to detect the presence of 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 (Keith Wesley, MD, FACEP, 2009).

The findings of another study conducted by Ariel Schroeder, Maryellen A.  Schroeder, MD, MPH and Frank  D’Amico,  PhD (2009) suggest that the use of alcohol-based hand foam to simultaneously sterilize the hands and a stethoscope head significantly reduces the number of bacterial colonies, including MRSA. The quantifiable risk of clinical infection with MRSA in patients through brief contact with a contaminated fomite such as a stethoscope is unknown. However, the transmission of the bacteria itself from contaminated surfaces and hands through brief contacts has been well established.

Staphylococcus aureusis a type of bacteria commonly carried on the skin, in the nares, and on the perineum of healthy people. It may cause superficial skin infections that can ordinarily be treated with skin care and appropriate antibiotics, such as beta-lactam inhibitors. Over time, however, some strains of S. aureushave become resistant to beta lactam inhibitors such as methicillin, once the drug of choice for this type of infection. The first cases of MRSA infections in the United States were reported in the 1960s. Today, 46 out of 1,000 patients have MRSA. Clinicians turned to vancomycin to treat MRSA, but several new strains of MRSA are now resistant to this drug as well; they’re known as vancomycin intermediate- resistant Staphylococcus aureus(VISA). Patients with VISA have severely limited treatment options.

Community-associated MRSA is a serious disease that tends to cause skin and soft-tissue infections, such as boils, blisters, abscesses, folliculitis, and carbuncles. These are accompanied by fever and local warmth, swelling, pain, and purulent drainage. What may look like a spider bite may actually be an early sign of a MRSA infection. According to the Centers Disease Control and Prevention definition, a diagnosis of CAMRSA requires that the patient have no medical history of MRSA or colonization and no risk factors associated with health care–associated MRSA.

Health care–associated MRSA is even more highly drug resistant than CA-MRSA and tends to cause more invasive infections, such as surgical site infection, endocarditis, osteomyelitis, bacteremia, or pneumonia. If infection develops in a wound or at a catheter or tube insertion site, redness, swelling, tenderness, or an abscess may be seen. At home and in the community, MRSA is transmitted person to person by sharing personal items such as clothing and towels and from close contact. In a health care facility, MRSA is transmitted largely from contaminated environmental surfaces or by staff members. Although colonized and infected patients are the chief reservoirs of MRSA, health care workers can also act as reservoirs, harboring the microorganism for many months. When health care workers do not follow appropriate infection control measures, their hands and clothing can easily become contaminated.

Alcohol-based hand sanitizers are a suitable substitute for hand washing when caring for patients with MRSA as long as the hands are not visibly soiled or grossly contaminated. Sinks and alcohol-based hand sanitizer dispensers must be easily accessible (Yamamoto, L. and M. Marten, 2007).

About one third of all nosocomial infections are preventable. For planning preventive actions, it is essential to identify the reservoirs of microorganisms that cause nosocomial infections. Hands of the hospital staff, medical equipment such as catheters, surgical instruments, implants, ventilators, endoscopes, thermometers, ultrasound probes and otoscopes may all serve as the reservoir for microorganisms. The stethoscope, a universal tool of medical profession is often used on multiple patients (Verghese D, and H. Patel, 1999).

In this regard, this has driven the researchers to conduct a study concerning the practices employed by nurses in the hospitals of Pampanga in the care of the stethoscope. This may serve as a basis for control of nosocomial infection. Various aseptic methods are utilized in hospitals to reduce to a minimum or much better, to totally eliminate pathogens that cause nosocomial infections to patients and members of the health care team. The use of stethoscope is closely associated with surfacing of Methicillin-Resistant Staphylococcus aureus infection, when the said instrument is not properly taken care of.

The study, therefore, is geared towards the determination of the practices employed by the nurses in different hospitals in Pampanga regarding care of the stethoscope, an instrument that is indispensable to their practice in rendering quality nursing care. It underpinned the problem specifically by answering the following:

Stethoscope use and care: owned

Utilization of stethoscope; and

Stethoscope care before and after use?

A descriptive quantitative research was applied in the study to describe the nursing phenomena. The study sought to describe the practices employed by nurses in different hospitals regarding the care of the stethoscope.

The study includes 5 secondary hospitals in Pampanga Province, Philippines as research settings/locales of the study. The inclusion criteria were established to determine respondent who are eligible to participate in the study. Such criteria include the following: a) nurses must be currently working as a bedside nurse; b) nurses must be using stethoscope in their area of practice; c) Nurses presently practicing in selected hospitals in Pampanga. A total of two hundred eleven (211) staff nurses were selected as respondents of the study.

A self-administered questionnaire (SAQ) was utilized to explore in detail the practices of the nurses regarding stethoscope care. Content and construct validation was accomplished by five (5) experts in the nursing profession to ensure validity of the questionnaire. Pilot testing was conducted to 30 staff nurse respondents.

The initial step performed in the data collection process is accomplished by seeking permission from the Medical Director of the hospital thru the Chief Nurse. After the approval or permission from the Chief Nurse, the self-administered questionnaire was provided to the staff nurse respondents who were willing to participate in the study. Signing of the informed consent by the selected respondents was also ensured prior data collection. The period of data gathering lasted from October 2017 to March 2018.

Frequency and percentage distribution were used in grouping and analyzing quantitative/ descriptive data. The data obtained in the study were organized using frequency and percentage distribution which included the respondent’s profile, stethoscope utilization and care.

A sense of ownership must be achieved by every nurse practicing in the hospital. It is in this regard that when one owns the stethoscope being used, personal responsibility concerning stethoscope care can be easily attained. The one most responsible in cleaning the stethoscope is none other than the health care provider who makes use of it. Every after patient contact with the stethoscope, the nurse has the greatest knowledge as to which part should be cleaned most meticulously. If this is practiced, it can be justified that the maintenance of the said instrument can be continued and nosocomial infection involving methicillin-resistant staphylococcus aureus can be eliminated.

It is surprising to note from the study that none of the parts of the stethoscope was correctly identified by all of the respondents in the research. In addition, the diaphragm and bell were the parts most commonly confused. If the parts were mistakenly identified, it is unfortunate to assume that nurses, to some instances, may not be able to justify correctly the intended purposes of using a bell and a diaphragm. In the same way, basic education concerning stethoscope parts, cleaning and storage be emphasized among nurses since the stethoscope is an indispensable instrument in the practice of nursing.

It is alarming to communicate the result of the study indicating that nurses infrequently clean the stethoscope before and after use. Some respondents even never cared to clean their stethoscopes after patient care on procedures like blood pressure taking, chest and abdominal auscultation. MRSA infection may occur if care of the stethoscope is not maintained. Care of the stethoscope is not solely confined on cleaning but storage as well. Storing stethoscopes in clean places is as important as cleaning the stethoscopes.

The study aimed at exploration of the practices employed by the nurses in different hospitals of Pampanga regarding the care of the stethoscope. The practices were identified concerning frequency, agent used, method utilized and parts of stethoscope cleaned. The study, however, did not undergo microscopic determination of microorganisms in the stethoscope. To establish connection of stethoscope care practices to the colonization of microorganisms in stethoscopes, descriptive identification of the pathogens may be useful.