Image: Stethoscopes should be thoroughly cleaned between patients to prevent infection (Photo courtesy of MDF Instruments).
A new study reveals that healthcare providers rarely perform stethoscope hygiene between patient encounters, despite its importance for infection prevention.
Researchers at Yale University School of Medicine (New Haven, CT, USA) and the Veterans Affairs Connecticut Healthcare System (VACT; West Haven, USA) conducted a study to examine stethoscope hygiene practices both before and after implementing a multimodal intervention, which was timed to coincide with new staff and medical student rotations. The researchers first covertly recorded baseline observations of stethoscope and hand hygiene of medical students, resident physicians, and attending physicians during the first week of a 4-week rotation.
The subsequent intervention phase consisted of an interactive PowerPoint presentation on stethoscope hygiene during ward meetings. The point that either alcohol swabs or hand sanitizer were acceptable and equivalent (excluding Clostridium difficile) was emphasized, as was the expectation for stethoscope hygiene between each encounter. Laminated reminder flyers were placed in staff workspaces and at the entrance to each nursing unit, along with boxes of alcohol swabs. Follow-up observations of the same teams were made during the final week of the rotation.
The results revealed that the increase in hand hygiene rates was lower than anticipated, at 58% initially and 63% post-intervention, an outcome that was not statistically significant. Stethoscope hygiene, on the other hand, was never implemented during the 128 initial and 41 post-intervention observations, signifying a grand total of zero occurrences of sanitation. The study was published on July 1, 2017, in the American Journal of Infection Control.
“We anticipated low stethoscope hygiene rates, but were surprised that no one performed stethoscope hygiene, despite the fact that it is on the checklist for second-year medical students' final evaluation demonstrating competency in performing a complete history and physical at our institution,” concluded lead author Jürgen Holleck, MD, and colleagues of the VACT Healthcare System. “Stethoscope hygiene implementation will need more consistent efforts to change culture and habits. We believe that stethoscope hygiene should be included in all hospital hand hygiene initiatives, along with increased accountability.”
Since stethoscopes are used repeatedly during the day, come directly into contact with patients' skin, and may harbor several thousand bacteria (including MRSA) collected during a previous physical examination, they can form potentially significant vectors of transmission. Previous studies have shown that while the stethoscope's diaphragm has levels lower of contamination than fingertips, it is higher than the contamination level of the thenar eminence. Meanwhile, the tube of the stethoscope is more heavily contaminated than the back of the physician's hand.
Yale University School of Medicine
Veterans Affairs Connecticut Healthcare System