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A New Normal for The Clinician's Third Hand: Stethoscope Hygiene and Infection Prevention

Published:November 06, 2022DOI:https://doi.org/10.1016/j.ajic.2022.10.005
      Health care associated infections (HAI) are a substantial problem in contemporary health care. With an estimated annual US cost of 147 billion dollars, HAIs represent avoidable adverse events, the consequence of which are increased health care costs, longer length of stays, with higher rates morbidity and mortality. This is especially true in hematology-oncology practices, as patients are commonly immunocompromised, many are neutropenic, non-intact skin is frequent due to skin graft versus host disease, and broad-spectrum antimicrobial exposure is common, all which increases the risk of iatrogenic complications.
      • Ariza-Heredia EJ
      • Chemaly RF.
      Update on infection control practices in cancer hospitals.
      When HAI are evaluated as to their possible source, the caregiver's hands represent an easily modifiable risk. Consequently, extensive efforts to mitigate this source of potential HAI have been enacted. These include medical staff education as to the importance of hand hygiene, reminder charts and posters throughout the clinical care area, the placement of alcohol-based hand rub (ABHR) dispensers and sinks with hand soap in every room, the ubiquitous placement of disposable gloves, consistent environmental disinfecting procedures, and ultimately, observers to determine the rates of health care workers and visitors hand hygiene compliance.

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      References

        • Ariza-Heredia EJ
        • Chemaly RF.
        Update on infection control practices in cancer hospitals.
        CA Cancer J Clin. 2018; 68 (SepdoiEpub 2018 Jul 9. PMID: 29985544; PMCID: PMC7162018): 340-355https://doi.org/10.3322/caac.21462
      1. https://www.cdc.gov/handhygiene/campaign/index.html, accessed 5/25/2022

      2. CDC's 2019 Antibiotic Resistance Threats Report. www.cdc.gov/DrugResistance/Biggest-Threats.html, accessed 3/30/2022

      3. https://www.cdc.gov/hai/organisms/acinetobacter.html

        • Rehman R
        • Ahmed K
        • Shaikh S.
        Stethoscope as a Vector for Nosocomial Bacterial Infections.
        J Coll Physicians Surg Pak. 2019; 29 (JunDoiPMID: 31133166): 592https://doi.org/10.29271/jcpsp.2019.06.592
        • Vasudevan RS
        • Bin Thani K
        • Aljawder D
        • Maisel S
        • Maisel AS.
        The stethoscope: a potential vector for COVID-19?.
        Eur Heart J. 2020; 41 (Sep 21DoiPMID: 33045743; PMCID: PMC7665447): 3393-3395https://doi.org/10.1093/eurheartj/ehaa657
        • Paduszyńska K
        • Rucińska LG
        • Pomorski L.
        Physician as an infective vector at a department of surgery.
        Pol Przegl Chir. 2015; 86 (Feb 3DoiPMID: 25719282. (In Polish)): 511-517https://doi.org/10.2478/pjs-2014-0091
        • Zúniga A
        • Mañalich J
        • Cortés R.
        ¿Estetoscopio o estafiloscopio?: Potencial vector en las infecciones asociadas a la atención de la salud [Stethoscope or staphyloscope?: Potential vector in nosocomial infections].
        Rev Chilena Infectol. 2016; 33 (FebSpanishDoiPMID: 26965873. (In Spanish)): 19-25https://doi.org/10.4067/S0716-10182016000100003
        • Youngster I
        • Berkovitch M
        • Heyman E
        • Lazarovitch Z
        • Goldman M.
        The stethoscope as a vector of infectious diseases in the paediatric division.
        Acta Paediatr. 2008; 97 (SepDoiEpub 2008 Jun 12. PMID: 18554272): 1253-1255https://doi.org/10.1111/j.1651-2227.2008.00906.x
        • Vasudevan RS
        • Horiuchi Y
        • Torriani FJ
        • Cotter B
        • Maisel SM
        • Dadwal SS
        • Gaynes R
        • Maisel AS.
        Persistent Value of the Stethoscope in the Age of COVID-19.
        Am J Med. 2020; 133 (OctDoiEpub 2020 Jun 19. PMID: 32569591; PMCID): 1143-1150https://doi.org/10.1016/j.amjmed.2020.05.018
        • Zuliani Maluf ME
        • Maldonado AF
        • Bercial ME
        • Pedroso SA
        Stethoscope: a friend or an enemy?.
        Sao Paulo Med J. 2002; 120 (Jan 3DoiPMID: 11836547): 13-15https://doi.org/10.1590/s1516-31802002000100004
        • Baeza-Trinidad R
        • Brito-Diaz AY
        • Mosquera-Lozano JD
        • Azcona-Gutierrez JM.
        Could the stethoscope be a SARS-CoV-2 vector?.
        Enferm Infecc Microbiol Clin. 2021; (Jul 31:S0213-005X(21)00233-0. English, SpanishDoiEpub ahead of print. PMID: 34400022. (In Spanish))https://doi.org/10.1016/j.eimc.2021.07.012
        • Datta P
        • Kaur M
        • Rawat S
        • Gupta V
        • Stethoscope Chander J.
        the friendly foe" - A study to evaluate bacterial contamination of stethoscopes and disinfection practices.
        J Infect Dev Ctries. 2018; 12 (Oct 31DoiPMID: 32004158): 887-893https://doi.org/10.3855/jidc.10128
        • Núñez S
        • Moreno A
        • Green K
        • Villar J.
        The stethoscope in the Emergency Department: a vector of infection?.
        Epidemiol Infect. 2000; 124 (AprDoiPMID: 10813148; PMCID: PMC2810906): 233-237https://doi.org/10.1017/s0950268800003563
        • Russell A
        • Secrest J
        • Schreeder C.
        Stethoscopes as a source of hospital-acquired methicillin-resistant Staphylococcus aureus.
        J Perianesth Nurs. 2012; 27 (AprDoiPMID: 22443920): 82-87https://doi.org/10.1016/j.jopan.2012.01.004
        • Lee R
        • Choi SM
        • Jo SJ
        • Han S
        • Park YJ
        • Choi MA
        • Kong BK.
        A quasi-experimental study on stethoscopes contamination with multidrug-resistant bacteria: Its role as a vehicle of transmission.
        PLoS One. 2021; 16 (Apr 22DoiPMID: 33886664; PMCID: PMC8062016)e0250455https://doi.org/10.1371/journal.pone.0250455
        • Alali SA
        • Shrestha E
        • Kansakar AR
        • Parekh A
        • Dadkhah S
        • Peacock WF.
        Community hospital stethoscope cleaning practices and contamination rates.
        Am J Infect Control. 2020; 48 (NovDoiEpub 2020 Apr 29. PMID: 32360747): 1365-1369https://doi.org/10.1016/j.ajic.2020.04.019
        • Kalra S
        • Amin A
        • Albert N
        • Cadwell C
        • Edmonson C
        • Gaynes R
        • Hand M
        • Marinella M
        • Morely C
        • Sieck S
        • Vasudevan RS.
        Stethoscope hygiene: A call to action. Recommendations to update the CDC guidelines.
        Infect Control Hosp Epidemiol. 2021; 42 (JunDoiEpub 2021 May 19. PMID: 34009112): 740-742https://doi.org/10.1017/ice.2021.115
        • Jones JS
        • Hoerle D
        • Riekse R.
        Stethoscopes: a potential vector of infection?.
        Ann Emerg Med. 1995; 26 (SepDoiPMID: 7661417): 296-299https://doi.org/10.1016/s0196-0644(95)70075-7
        • Haddad F
        • Bousselmi J
        • Mrabet A
        • Ben Fadhel K
        Are our stethoscopes contaminated?.
        Tunis Med. 2019; 97 (NovPMID: 32173822. (In Turkish)): 1224-1228
        • Davullu S
        • Burger S
        • Kessler B
        • Meunier O.
        La contamination bactérienne des stéthoscopes à l'hôpital [Bacterial contamination of stethoscopes in hospital].
        Ann Biol Clin (Paris). 2015; 73 (Nov-DecFrenchDoiPMID: 26635052. (In French)): 723-727https://doi.org/10.1684/abc.2015.1105
        • Cohen HA
        • Amir J
        • Matalon A
        • Mayan R
        • Beni S
        • Barzilai A.
        Stethoscopes and otoscopes–a potential vector of infection?.
        Fam Pract. 1997; 14 (DecDoiPMID: 9476074): 446-449https://doi.org/10.1093/fampra/14.6.446
        • Baeza-Trinidad R
        • Brito-Diaz AY
        • Mosquera-Lozano JD
        • Azcona-Gutierrez JM.
        Could the stethoscope be a sars-cov-2 vector?.
        Enferm Infecc Microbiol Clin. 2021; (Jul 31DoiEpub ahead of printPMID: 34366529; PMCID: PMC8324402. (In Spanish))https://doi.org/10.1016/j.eimc.2021.07.012
        • Carducci A
        • Cargnelutti M
        • Tassinari F
        • Bizzarro A
        • Cordio G
        • Carletti S
        • Maccarini L
        • Pelissero G.
        What's growing on General Practitioner's stethoscope?.
        Ann Ig. 2016; 28 (Sep-OctDoiPMID: 27627668): 367-372https://doi.org/10.7416/ai.2016.2117
        • Knecht VR
        • McGinniss JE
        • Shankar HM
        • Clarke EL
        • Kelly BJ
        • Imai I
        • Fitzgerald AS
        • Bittinger K
        • Bushman FD
        • Collman RG
        Molecular analysis of bacterial contamination on stethoscopes in an intensive care unit.
        Infect Control Hosp Epidemiol. 2019; 40 (FebDoiEpub 2018 Dec 12. PMID: 30560753; PMCID: PMC6581638): 171-177https://doi.org/10.1017/ice.2018.319
        • Arroyo JC
        • Harrison K
        • Birgenheier R.
        The stethoscope - a vector of infection?.
        Infect Control. 1983; 4 (Jul-AugDoiPMID: 6554242): 189https://doi.org/10.1017/s0195941700058173
        • Alleyne SA
        • Hussain AM
        • Clokie M
        • Jenkins DR.
        Stethoscopes: potential vectors of Clostridium difficile.
        J Hosp Infect. 2009; 73 (OctDoiEpub 2009 Aug 28. PMID: 19716204): 187-189https://doi.org/10.1016/j.jhin.2009.05.014
        • Bernard L
        • Kereveur A
        • Durand D
        • Gonot J
        • Goldstein F
        • Mainardi JL
        • Acar J
        • Carlet J.
        Bacterial contamination of hospital physicians' stethoscopes.
        Infect Control Hosp Epidemiol. 1999; 20 (SepDoiPMID: 10501265): 626-628https://doi.org/10.1086/501686
        • Vajravelu RK
        • Guerrero DM
        • Jury LA
        • Donskey CJ.
        Evaluation of stethoscopes as vectors of Clostridium difficile and methicillin-resistant Staphylococcus aureus.
        Infect Control Hosp Epidemiol. 2012; 33 (JanDoiEpub 2011 Nov 11. PMID: 22173532): 96-98https://doi.org/10.1086/663338
        • Breathnach AS
        • Jenkins DR
        • Pedler SJ.
        Stethoscopes as possible vectors of infection by staphylococci.
        BMJ. 1992; 305 (Dec 19-26DoiPMID: 1286393; PMCID: PMC1884699): 1573-1574https://doi.org/10.1136/bmj.305.6868.1573
        • Stethoscopes: source of infection?
        Emerg Nurse. 1996; 3 (Feb 1DoiPMID: 27237859): 27https://doi.org/10.7748/en.3.4.27.s12
        • Guinto CH
        • Bottone EJ
        • Raffalli JT
        • Montecalvo MA
        • Wormser GP.
        Evaluation of dedicated stethoscopes as a potential source of nosocomial pathogens.
        Am J Infect Control. 2002; 30 (DecDoiPMID: 12461514): 499-502https://doi.org/10.1067/mic.2002.126427
        • Marinella MA
        • Pierson C
        • Chenoweth C.
        The stethoscope. A potential source of nosocomial infection?.
        Arch Intern Med. 1997; 157 (Apr 14DoiPMID: 9125011): 786-790https://doi.org/10.1001/archinte.157.7.786
        • Thakur M
        • Alhmidi H
        • Cadnum JL
        • Jencson AL
        • Bingham J
        • Wilson BM
        • Donskey CJ.
        Use of viral DNA surrogate markers to study routes of transmission of healthcare-associated pathogens.
        Infect Control Hosp Epidemiol. 2021; 42 (MarDoiEpub 2020 Sep 30. PMID: 32993827): 274-279https://doi.org/10.1017/ice.2020.443
        • Alhmidi H
        • Li DF
        • Cadnum JL
        • et al.
        Use of simulations to evaluate the effectiveness of barrier precautions to prevent patient-to-patient transfer of healthcare-associated pathogens.
        Infect Control Hosp Epidemiol. 2020; (Doi)https://doi.org/10.1017/ice.2020.1215
        • Longtin Y
        • Schneider A
        • Tschopp C
        • Renzi G
        • Gayet-Ageron A
        • Schrenzel J
        • Pittet D.
        Contamination of stethoscopes and physicians' hands after a physical examination.
        Mayo Clin Proc. 2014; 89 (MarDoiPMID: 24582188): 291-299https://doi.org/10.1016/j.mayocp.2013.11.016
        • Boulée D
        • Kalra S
        • Haddock A
        • Johnson TD
        • Peacock WF.
        Contemporary stethoscope cleaning practices: What we haven't learned in 150 years.
        Am J Infect Control. 2019; 47 (MarDoiEpub 2018 Nov 2. PMID: 30396696): 238-242https://doi.org/10.1016/j.ajic.2018.08.005
        • Vasudevan RS
        • Mojaver S
        • Chang KW
        • Maisel AS
        • Frank Peacock W
        • Chowdhury P
        Observation of stethoscope sanitation practices in an emergency department setting.
        Am J Infect Control. 2019; 47 (MarDoiEpub 2018 Nov 8. PMID: 30415805): 234-237https://doi.org/10.1016/j.ajic.2018.08.028
      4. https://www.cdc.gov/infectioncontrol/guidelines/disinfection/healthcare-equipment.html Accessed 10/2/2022.

        • Parmar RC
        • Valvi CC
        • Sira P
        • Kamat JR.
        A prospective, randomised, double-blind study of comparative efficacy of immediate versus daily cleaning of stethoscope using 66% ethyl alcohol.
        Indian J Med Sci. 2004; 58 (OctPMID: 15523163): 423-430
      5. https://www.cdc.gov/cdiff/prevent.html, accessed 2/28/2022

        • Wilcox MH
        • Fawley WN.
        Hospital disinfectants and spore formation by Clostridium difficile.
        Lancet. 2000; 356 (Oct 14DoiPMID: 11073024): 1324https://doi.org/10.1016/S0140-6736(00)02819-1
        • Nkemngong CA
        • Chaggar GK
        • Li X
        • Teska PJ
        • Oliver HF.
        Disinfectant wipes transfer Clostridioides difficile spores from contaminated surfaces to uncontaminated surfaces during the disinfection process.
        Antimicrob Resist Infect Control. 2020; 9: 176https://doi.org/10.1186/s13756-020 00844-0
        • Edwards J
        • Patel G
        • Wareham DW.
        Low concentrations of commercial alcohol hand rubs facilitate growth of and secretion of extracellular proteins by multidrug-resistant strains of Acinetobacter baumannii.
        Journal of Medical Microbiology. 2007; 56: 1595-1599
        • Pidot SJ
        Increasing tolerance of hospital Enterococcus faecium to handwash alcohols.
        Sci. Transl. Med. 2018; 10: eaar6115
        • Kalra S
        • Garri RF
        • Shewale JB.
        Aseptic Disposable Stethoscope Barrier: Acoustically Invisible and Superior to Disposable Stethoscopes.
        Mayo Clin Proc. 2021; 96 (JanDoiPMID: 33413829): 263-264https://doi.org/10.1016/j.mayocp.2020.10.029
        • Whittington AM.
        Bacterial contamination of stethoscopes on the intensive care unit.
        Anaesthesia. 2009; 64: 620-624
        • Clare S
        • Rowley S.
        Implementing the Aseptic Non Touch Technique (ANTT®) clinical practice framework for aseptic technique: a pragmatic evaluation using a mixed methods approach in two London hospitals.
        J Infect Prev. 2018; 19 (JanDoiEpub 2017 Aug 4. PMID: 29317909; PMCID: PMC5753945): 6-15https://doi.org/10.1177/1757177417720996
        • Vasudevan R
        • Shin JH
        • Chopyk J
        • Peacock WF
        • Torriani FJ
        • Maisel AS
        • Pride DT.
        Aseptic Barriers Allow a Clean Contact for Contaminated Stethoscope Diaphragms.
        Mayo Clin Proc Innov Qual Outcomes. 2020; 4 (Feb 5DoiPMID: 32055768; PMCID: PMC7010972): 21-30https://doi.org/10.1016/j.mayocpiqo.2019.10.010
        • Peacock WF
        • Kalra S
        • Vasudevan RS
        • Torriani F.
        Aseptic Stethoscope Barriers Prevent C difficile Transmission In Vitro.
        Mayo Clin Proc Innov Qual Outcomes. 2021; 5 (Jan 13DoiPMID: 33718789; PMCID: PMC7930788): 103-108https://doi.org/10.1016/j.mayocpiqo.2020.10.002
        • Holleck JL
        • Merchant N
        • Lin S
        • Gupta S.
        Can education influence stethoscope hygiene?.
        Am J Infect Control. 2017; 45 (Jul 1DoiPMID: 28668135): 811-812https://doi.org/10.1016/j.ajic.2017.02.004
        • Peacock WF
        • Torriani F
        • Elliott LE
        • Killeen J
        • Kipper SB
        • Marinella M
        • Nunez D
        • Neath SX
        • Dadwal S.
        Stethoscope Hygiene, Workflow, and Patient Safety: The Crux of Healthcare Associated Infections.
        Antimicrobial Stewardship & Healthcare Epidemiology. 2022; 2 (VolumeIssueSHEA Spring 2022 Abstracts, JulyppDOI): s55-s56https://doi.org/10.1017/ash.2022.162
        • Lecat P.A
        "solution" for infectious stethoscopes?.
        Mayo Clin Proc. 2014; 89 (SepDoiPMID: 25192618): 1318https://doi.org/10.1016/j.mayocp.2014.06.010