A prospective, randomised, double-blind study of comparative efficacy of immediate versus daily cleaning of stethoscope using 66% ethyl alcohol.

OBJECTIVE: Studies have demonstrated frequent contamination of stethoscope and usefulness of different disinfectants. Albeit, studies on the precise mode of cleaning and frequency of cleaning are lacking. This study was carried out to determine efficacy of 66% ethyl alcohol as disinfectant, rate of recontamination without cleaning and benefits of daily versus immediate cleaning. METHODOLOGY: Prospective, randomised, double blind study of 100 stethoscopes. Four cultures were obtained: before cleaning (Group A), immediately after cleaning with 66% ethyl alcohol (Group B), at the end of 4 days without cleaning (Group C) and at the end of 4 days after cleaning once a day (Group D). Samples were analysed using standard microbiological methods and Colony-forming unit (CFU) count and residual microorganism was computed for all the positive cultures. Medical staff was asked about the cleaning practices. Statistical analysis was carried out using 95% confidence interval and Chi-square test. RESULTS: 90% of the stethoscopes were contaminated with one or more microorganisms. Immediate cleaning and daily cleaning were associated with a significant reduction in the rate of contamination to 28% and 25% respectively. CFU count in groups B and D dropped to less than 10 in 75% and 84.7%, while the mean residual rates were 5.2% and 3.65% respectively. Groups B and D showed no statistically significant difference in terms of efficacy of disinfection. CONCLUSIONS: 66% ethyl alcohol is an effective disinfectant. The effects of immediate cleaning and cleaning once a day on residual flora on the diaphragm of stethoscope is comparable.

Rapid diagnosis of meningitis using reagent strips.

OBJECTIVES: Identification of causative agent with estimation of cerebrospinal fluid (CSF) glucose, protein, cells is necessary for accurate diagnosis of meningitis. Unfortunately, even these facilities are not available in many areas. Reagent strips that measure glucose and protein in blood and urine can serve this task but have been used with varying results in the past. This study was carried out to evaluate the utility and efficacy of Combur 10 strips in the diagnosis of meningitis. DESIGN, SETTINGS AND METHODS: A prospective clinical single blinded study of 63 children suspected to have meningitis undergoing CSF analysis. Each CSF sample was divided in to two and was utilised for reagent strip analysis in addition to standard laboratory evaluation and a correlation analysis were made. STATISTICAL METHOD USED: Results were analysed using standard statistical tests. Accuracy of the reagent strips as a screening tool was established using Godyn's test. RESULTS: The sensitivity, specificity of the reagent strips for the diagnosis of meningitis was 97.14%, 96.42%. The sensitivity, specificity for tuberculous meningitis and bacterial meningitis were 100%, and 96.55%. That for the aseptic meningitis was 70% and 96.55%. Accuracy for the diagnosis of meningitis as a whole, bacterial meningitis, tuberculous meningitis, and aseptic meningitis were 96.78%, 98.2%, 98.27% and 83.0% respectively. CONCLUSION: Combur10 strips thus can be used for the rapid CSF analysis and screening with good accuracy. In situations where facilities of routine laboratory testing are not available this can be of an immense help.