The Daily Use of Disposable Acoustic Diaphragms Prevents Costly Cross-Contamination, Nosocomial Infections and Medical Legal Pro

The sudden awareness of what could have happened still makes me feel very uncomfortable. The patient that I was about to examine, had just come out of the operating room, still on a respirator, after a successful coronary artery bypass grafting operation otherwise a young, healthy-looking man in his mid 40s, no different from the thousands who undergo similar procedures in the world every day. However, this time was different, because the previous patient that I had just examined had pneumonia, purulent sputum, chills, fever, leukocytosis, etc.; the patient was a teaching case for third-year medical students during their Infectious Diseases rotation. I was expected to check the position of the endotracheal tube after the transferring from the OR to ICU a common procedure done daily but to do so, I had to use my stethoscope, the very same one that I had just used on the man with pneumonia! This man s sternum had just been closed, barely less than an hour before. Those of us who have witnessed an infected sternum have never forgotten it. The possibility of cross-contamination was both significant and real. I disassembled my stethoscope, the one that I have used since 1963, removed all of its parts, cleaned them with alcohol, reassembled it and proceeded with the examination. However, several facts became obvious at that time: I could have hurt this man, even caused his death by infecting him with my contaminated stethoscope. Unintentionally, I must have contaminated many other patients during my years of practicing medicine. It is not practical to have to disassemble a stethoscope each time after finishing an examination, as it should be done. I realized I was part of the problem of costly, hospital-acquired infections.

Research

Armed with curiosity, I searched for the literature. I contacted the University of North Texas Medical Library and gathered some information on this topic. Since 1972, the suspicion and confirmation of stethoscope contamination has been documented, and recent articles published have provided information on cultures of both Methicillin- and Vancomycin-resistant bacteria. The recommendations have been to either disassemble the stethoscope in between patients and clean it with alcohol, or use a disposable system to prevent costly cross-contaminations. However, another aspect of this problem was the cost of nosocomial infections. The findings reported are not clear. There are reports that specify that to our Medicare program alone, the cost for hospital-acquired infections is more than 6 billion dollars a year! Other reports, though there are some variations in the numbers, also establish the fact that hospital-acquired infections are very costly, regardless of who pays for them: Medicare, insurance companies, HMO organizations or privately. I cannot imagine the cost of those infections to the society at large when we consider loss of working days to the patient, to his/her company and to the clients of those companies, antibiotics, etc. but it would obviously have to be a staggering sum. It is estimated that stethoscopes are used more than 20,000,000 times a day in the U.S. alone. If only half of 1% of the examined people get infected, the number is still quite high, in addition to any economical losses.

The Design

A peculiar challenge was that the design demanded to be simple, yet the diagnostic capabilities of the stethoscope needed to be preserved. For many years, this useful diagnostic tool has saved many lives, when used properly. The acoustic capabilities had to remain the same, and the new diaphragm must not interfere with the daily activities of the doctors and the allied medical team. There were many prototypes. In my patented version, the new acoustic characteristics were improved, since the disposable diaphragm was thinner. Simultaneously, it would not be used as a stethoscope cover, because the increased thickness of the 2 diaphragms would reduce the acoustic characteristics of the diagnostic instrument in a significant, measurable way. Acoustic studies performed in California demonstrated and measured those changes. Again, acoustic diaphragms must not be stethoscope covers. When the patent was requested, it was specified that the surface of the disposable acoustic diaphragm was also going to be used as educational material or even as a promotional device. The Patent. To license my patent, I had to find corporations who were able to develop, market and distribute this tool needed to serve our patients. This proved to be very difficult. I dared to see the possibility of producing disposable acoustic diaphragms by myself in the US. The costs were overwhelming. Many banking organizations and government programs to assist small business, that help in the development of business, have yet to return my calls. I talked to some of our friends and acquaintances and proposed the concept of producing disposable acoustic diaphragms. After many presentations, I had two investors. There were companies that did offer to join when the company reached 10,000,000 dollars in sales. Since I am bilingual and live near Mexico, where there is such a thing as the NAFTA treaty. I asked my friends whether they wanted me to return their investment, since I did not reach the number of needed investors, or whether they would trust my judgment and allow me to proceed with what we had. Later I arrived in Monterrey, Mexico and began the search for plastic engineers, paper printer companies, designers, packing companies, adhesive experts, transportation, customs, etc.

Present Day

Today, disposable acoustic diaphragms for stethoscopes by LUB DUB Corporation (Lub Dubs, registered tradename) are a reality. We are constantly introducing them to the Joint Commission for Hospital Accreditation, the Medicare program, the Center for Disease Control and Prevention, the Military, schools, nurses associations, EMTs, the World Health Organization, large pharmaceutical companies, hospitals, nursing homes, and home healthcare services. The day will come when we will not tolerate the use of contaminated stethoscopes in American hospitals or doctor's offices, with the same concern for our health and for our loved ones, much in the same way the antismoking campaign has been so successful. Isolation instructions, or the ones that the patient needs the most, should read as follows: Immediate plans. Education, education and more education this is not a crusade, since those events were characterized by pillage and abuse, nor is it a campaign of anything, since such a term also implies a militaristic enforcing. No, this is a program oriented to the betterment of the patients that we serve, to reduce costly acquired diseases. Equally important, it is the reduction of medical or legal problems.

Lesson

A fascinating lesson has been relearned throughout all this events: It is quite difficult to introduce an innovation, but very likely it is much more difficult to change the old ideas and creeds that perpetuate ignorance and the damage produced by that ignorance. Historically, that is a fact. Our search for both investors and customers continue daily. Familiar and natural. We already wash our hands before meals, brush our teeth, and food handlers wear disposable gloves we should expect our doctors and nurses to use clean, disposable gloves, tongue depressors, earpieces for the othoscope, etc. We have innumerable ways that have become part of our lives, that are familiar to us, and their protecting function has saved lives and increased our longevity. The introduction of disposable acoustic diaphragms is simply natural and necessary, it is a continuation of our learning, of our progress, and of our respect for life. All of which are manifestations of protecting ourselves, our families, and our society.

The Future

Lub Dub's disposable acoustic diaphragms will be non-toxic and biodegradable; subsequently, they will carry flower seeds, so that when they degrade, they will be seeding flowers that we all so badly need! I have patented a stethoscope with marked acoustic improvements, has no mobile parts and uses only disposable diaphragms but that is another coming event. In the meantime, I will ask you: Are you Lub Dub compliant? I have done nothing extraordinairy, there are hundreds of very talented people that have contributed to the betterment of our life and planet. I am humbly indebted to them for their contributions and concepts, as well as to those around me who have been tolerant of my enthusiasm for a clean stethoscope, of all things.