Archive September 2017 XVIII, No. 9

Infection Prevention: Are Those Stethoscopes Clean?

You may be ignoring this common source of pathogens.

Linda Greene

BIO

stethoscope DUAL DISINFECTION Think of stethoscopes as part of a hand hygiene bundle. When one's disinfected, the other should be, too.

You're delighted when you see your anesthesia providers vigorously scrubbing their hands for a full 15 seconds. You can be confident that those all-too-common vectors of disease are now spotless. But how many pathogens are still clinging to the stethoscopes hanging from their necks? Or to the stethoscope in recovery — the one that's about to contact the skin of your next patient?

As healthcare providers, we're frequently reminded of the importance of hand hygiene. But we hear relatively little about the dangers posed by the bacteria that hitch rides on stethoscopes. The issue apparently barely registers a blip in the minds of most providers. At least, that is, if a recent study is representative. The study, published in the American Journal of Infection Control, involved 2 hospitalists who served as secret shoppers at an academic teaching hospital (osmag.net/no9ddz). They set out to covertly record incidents of stethoscope hygiene carried out by med students, residents and attending physicians, as they moved from patient to patient over a period of one week. The observers documented 169 opportunities for stethoscope disinfection. The students and physicians batted zero.

That's right. Not one of the 169 opportunities was seized. And making it even more surprising, 41 of those opportunities occurred after the residents and physicians were shown a PowerPoint presentation about stethoscope hygiene — a presentation that concluded with the sentence, "We may be monitoring intermittently." The observers emphasized to the study subjects that both alcohol swabs and hand sanitizers, which were readily available outside patient rooms, were acceptable and generally equivalent means of disinfecting stethoscopes.

The usual suspects
How big a deal is this? This was a relatively small study, but we know from previous studies that many of the microorganisms that live on patients' skin can adhere to inanimate objects. That's well supported in the literature. Studies have found Staphylococcus aureus, Pseudomonas aeruginosa, Clostridium difficile and vancomycin-resistant enterococci, among other potential pathogens, living on stethoscopes (osmag.net/jjec7j and osmag.net/7xqpyk). Stethoscope contamination after one patient exam has been shown to be comparable to the contamination on a physician's dominant hand.

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