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Contemporary stethoscope cleaning practices: What we haven't learned in 150 years

Published:November 02, 2018DOI:https://doi.org/10.1016/j.ajic.2018.08.005

      Highlights

      • Stethoscopes were disinfected in 72 of 400 observed encounters (18%).
      • Only 15 of the observed disinfections (3.8% of 400 encounters) were compliant with US Centers for Disease Control and Prevention guidelines.
      • No stethoscopes were disinfected before use near open chest or abdominal wounds.
      • Hands were cleaned before and after encounters only 27 times (6.8% of 400).
      • Hands were not cleaned at all in 58% of encounters, although gloves were often worn.

      Background

      Stethoscopes can be microorganism reservoirs. The US Centers for Disease Control and Prevention (CDC) has published medical equipment disinfection guidelines to minimize infection transmission risk, but studies of guideline adherence have been predominately survey based, with little direct observation of disinfection practices.

      Methods

      We performed an observational, cross-sectional, anonymous study of patient-provider interactions, assessing practitioners’ frequency and methods of stethoscope and hand disinfection practices.

      Results

      Stethoscopes were disinfected in 18% of 400 observed interactions, with less than 4% verified as conforming to CDC guidelines. None was disinfected before patient examinations involving open chest or abdominal wounds, as recommended by the CDC. Hands were cleaned before and after encounters 27 times (6.8%) but were not cleaned at all in 231 (58%) encounters, although gloves were worn in 197 (85.3%) of these cases.

      Discussion

      Stethoscope disinfection is grossly overlooked, possibly jeopardizing patient safety, particularly in acute care interactions. Periodic stethoscope disinfection, although inconvenient, helps reduce bacterial contamination and may reduce health care–associated infections.

      Conclusions

      Stethoscopes were disinfected per CDC guidelines in less than 4% of encounters and were not disinfected at all in 82% of encounters. Although hands were rarely cleaned (6.8%) per CDC guidelines, gloves were usually worn, but no convenient stethoscope equivalent exists. Stethoscope cleanliness must be addressed.

      Key Words

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      References

        • Magill SS
        • Edwards JR
        • Bamberg W
        • Beldavs ZG
        • Dumyati G
        • Kainer MA
        • et al.
        Multistate point-prevalence survey of health care-associated infections.
        N Engl J Med. 2014; 370: 1198-1208
      1. Centers for Disease Control and Prevention. Healthcare-associated infections. Available from: https://www.cdc.gov/hai/data/archive/archive.html. Updated October 9, 2018. Accessed October 21, 2018.

        • Longtin Y
        • Schneider A
        • Tschopp C
        • Renzi G
        • Gayet-Ageron A
        • Schrenzel J
        • et al.
        Contamination of stethoscopes and physicians' hands after a physical examination.
        Mayo Clin Proc. 2014; 89: 291-299
        • O'Flaherty N
        • Fenelon L
        The stethoscope and healthcare-associated infection: a snake in the grass or innocent bystander?.
        J Hosp Infect. 2015; 91: 1-7
        • Leprat R
        • Minary P
        • Devaux V
        • de Wazière B
        • Dupond JL
        • Talon D
        Why, when and how to clean stethoscopes.
        J Hosp Infect. 1998; 39: 80-82
        • Núñez S
        • Moreno A
        • Green K
        • Villar J
        The stethoscope in the emergency department: a vector of infection?.
        Epidemiol Infect. 2000; 124: 233-237
        • Whittington AM
        • Whitlow G
        • Hewson D
        • Thomas C
        • Brett SJ
        Bacterial contamination of stethoscopes on the intensive care unit.
        Anaesthesia. 2009; 64: 620-624
        • Mangi RJ
        • Andriole VT
        Contaminated stethoscopes: a potential source of nosocomial infections.
        Yale J Biol Med. 1972; 45: 600-604
        • Merlin MA
        • Wong ML
        • Pryor PW
        • Rynn K
        • Marques-Baptista A
        • Perritt R
        • et al.
        Prevalence of methicillin-resistant Staphylococcus aureus on the stethoscopes of emergency medical services providers.
        Prehosp Emerg Care. 2009; 13: 71-74
        • Bandi S
        • Conway A
        Does regular cleaning of stethoscopes result in a reduction in nosocomial infections?.
        Arch Dis Child. 2012; 97: 175-177
        • Kerr J
        • Martin H
        • Chadwick M
        • Edwards A
        • Hodson M
        • Geddes D.
        Evidence against transmission of Pseudomonas aeruginosa by hands and stethoscopes in a cystic fibrosis unit.
        J Hosp Infect. 2002; 50: 324-326
        • Breathnach AS
        • Jenkins DR
        • Pedler SJ
        Stethoscopes as possible vectors of infection by staphylococci.
        BMJ. 1992; 305: 1573-1574
        • Semmelweis IP
        Die aetiologie, der begriff und die prophylaxis des kindbettfiebers.
        Hartleben, Leipzig, Germany1861
        • Bloomfield SF
        • Aiello AE
        • Cookson B
        • O'Boyle C
        • Larson EL
        The effectiveness of hand hygiene procedures in reducing the risks of infections in home and community settings including handwashing and alcohol-based hand sanitizers.
        Am J Infect Control. 2007; 35: S27-S64
      2. Rutala WA, Weber DJ, Weinsten RA; the Healthcare Infection Control Practices Advisory Committee (HICPAC). Guideline for disinfection and sterilization in healthcare facilities, 2008. Available from: https://www.cdc.gov/infectioncontrol/pdf/guidelines/disinfection-guidelines.pdf. Updated February 15, 2017. Accessed September 13, 2017.

        • Uneke CJ
        • Ogbonna A
        • Oyibo PG
        • Onu CM
        Bacterial contamination of stethoscopes used by health workers: public health implications.
        J Infect Dev Ctries. 2010; 4: 436-441
      3. Centers for Disease Control and PreventionHow to remove gloves. Available from: https://www.cdc.gov/vhf/ebola/pdf/poster-how-to-remove-gloves.pdf. Accessed September 13, 2017.

      4. Centers for Disease Control and Prevention. Guideline for hand hygiene in health-care settings. Available from: https://www.cdc.gov/mmwr/pdf/rr/rr5116.pdf. Accessed September 13, 2017.

        • Muniz J
        • Sethi RKV
        • Zaghi J
        • Ziniel SI
        • Sandora TJ
        Predictors of stethoscope disinfection among pediatric health care providers.
        Am J Infect Control. 2012; 40: 922-925
        • Jenkins IH
        • Monash B
        • Wu J
        • Amin A
        The third hand: low rates of stethoscope hygiene on general medical services.
        J Hosp Med. 2015; 10: 457-458
        • Holleck JL
        • Merchant N
        • Lin S
        • Gupta S
        Can education influence stethoscope hygiene?.
        Am J Infect Control. 2017; 45: 811-812
        • Gastmeier P
        • Groneberg K
        • Weist K
        • Rüden H.
        A cluster of nosocomial Klebsiella pneumoniae bloodstream infections in a neonatal intensive care department: identification of transmission and intervention.
        Am J Infect Control. 2003; 31: 424-430
        • Thom K
        • Rock C
        • Jackson S
        • Johnson J
        • Srinivasan A
        • Madger L
        • et al.
        Factors leading to transmission risk of Acinetobacter baumannii.
        Crit Care Med. 2017; 45: e633-e639
        • Schneider A
        • Tschopp C
        • Longtin Y
        • Renzi G
        • Gayet-Ageron A
        • Schrenzel J
        • et al.
        Predictors of stethoscope contamination following a standardized physical exam.
        BMC Proc. 2011; 5: 304
        • Tschopp C
        • Schneider A
        • Longtin Y
        • Renzi G
        • Schrenzel J
        • Pittet D
        Predictors of heavy stethoscope contamination following a physical examination.
        Infect Control Hosp Epidemiol. 2016; 37: 673-679
        • Adams AS
        • Soumerai SB
        • Lomas J
        • Ross-Degnan D
        Evidence of self-report bias in assessing adherence to guidelines.
        Int J Qual Health Care. 1999; 11: 187-192
        • Coughlin SS
        Recall bias in epidemiologic studies.
        J Clin Epidemiol. 1990; 43: 87-91
        • Haas JP
        • Larson EL
        Measurement of compliance with hand hygiene.
        J Hosp Infect. 2007; 66: 6-14