How Clean is Your Stethoscope?

Most practitioners do not give the cleanliness of their stethoscopes much thought, but the results of a new study from the American Journal of Infection Control (AJIC) are going to want to make them rethink their disinfection practices.

Hand hygiene remains the main focus of many infection control and prevention programs; however, according to the AJIC study, “microbiology data have shown that stethoscope contamination after a single exam is comparable to that of the physician's dominant hand.” The types of bacteria the scope could be contaminated with can include: Staphylococcus aureus, Pseudomonas aeruginosa, Clostridium difficile, and even vancomycin-resistant enterococci.

Previous studies have shown that hand sanitizer used to clean clinicians’ hands between encounters is also able to effectively clean stethoscopes. Still, “healthcare providers rarely perform stethoscope hygiene between patient encounters, despite its importance for infection prevention, [and the fact that] the Centers for Disease Control and Prevention state that re-usable medical equipment, such as stethoscopes, must undergo disinfection between patients,” according to a recent email press release on the study. In fact, a previous study the researchers highlight found that stethoscope hygiene was performed in, “an observed rate of 4.6% of trainees at 3 academic medical centers for nonisolation rooms over an 11-month period.”

With this history in mind, the researchers on the AJIC study deployed a “quality improvement pilot project in which they observed stethoscope hygiene [in the form of ] (alcohol swabs, alcohol gel, or disinfectant wipes) at the start of a 4-week rotation for medical students, resident physicians, and attending physicians at tertiary care Department of Veterans Affairs hospital academic teaching hospital,” according to the press release. The observers were attending hospitalists who were not involved in the clinical care of the patients, and observations were made from the hallways outside of patient rooms. The results showed that none of the clinicians observed in the project performed stethoscope hygiene (128 initial observations).

The clinicians were then educated on the importance of stethoscope hygiene between patient encounters through an interactive PowerPoint presentation, a resident report with the attendings, nursing staff meetings, and laminated reminder flyers posted at the nursing units. Clinicians were advised that, “either alcohol swabs or hand sanitizer were acceptable and equivalent (excluding Clostridium difficile) [and] was the expectation for stethoscope hygiene between each encounter,” study authors write.

Despite the education efforts, the availability of disinfection products, and advising the clinicians that there would be additional monitoring, the researchers found that during the follow-up phase, none of the clinicians performed stethoscope hygiene (41 postintervention observations).

The researchers noted that the study was not without limitations, such as the fact that observations were made outside of patient rooms, and the number of postintervention observations was low. Despite these limitations, however, the researchers believe the results highlight an “often overlooked infection control issue by discovering how rarely stethoscope hygiene is done.” To this end, they suggest that, “perhaps accountability can be increased by designating a team member, such as a senior resident physician, to be the team leader and champion to remind and ensure that stethoscope and hand hygiene are performed. It would be interesting to see if adding stethoscope and hand hygiene to the end-of-rotation provider evaluations makes a difference.”