DIRTY STETHOSCOPES

Say you provided an intensive education program that had visual reminders, provided the supplies and gave ongoing feedback, and the outcome was no change.

This was the result in a pilot study in a teaching hospital on stethoscope hygiene.

Not one person in the study was observed undertaking stethoscope hygiene.

Yet hand hygiene occurred at approximately the same rates after the same education intervention.

The stethoscope is an extension of a clinician’s hands.

Since the mid 1800’s it has been known that there is a link between handwashing and the spread of disease.

The formula is no handwashing between patients increases hospital acquired patient infections.

So scrupulous hand washing is the best defence against the transmission of bacteria.

So why aren’t stethoscopes, as extension of the clinician’s hands, treated in the same manner?

Failing to disinfect stethoscopes is a major fail no different to omitting to wash hands after each patient.

Similar reasons for why regular handwashing does not occur also applies to stethoscope hygiene.

It is because there is a lack of time, lack of disinfecting materials and lack of visual reminders.

A lot of time, money and energy is spent reinforcing the importance of proper hand hygiene.

It is time to strengthen that message with the addition of stethoscopes into the message. 

The message should start with the story about the neonatal ICU worker with chronic otitis externa and MRSA (Methicillin-Resistant Staphylococcus Aureus) who infected two neonates when the earpieces of their stethoscopes were placed in the hands after auscultation.

It could then be followed up with the physicians who auscultated MRSA-colonized patients with pre-sterilized stethoscopes had contaminated fingertips and stethoscope diaphragms in over three quarters of the time.

The first thing any nurse should do is get your own stethoscope and clean it yourself.

You will then know where the stethoscope is and where it has been.

Regular cleaning with appropriate isopropyl-alcohol or ethanol-based products diminishes the possibility of patient cross-infection.

The stereoscope diaphragms, tubing and earpieces should be decontaminated between each patient.

There is a 84% reduction in bacterial growth using these techniques.

Don’t think that cleaning your hands and your stethoscope at the one time is OK.

Disinfecting with hand rub is less effective than using alcohol because mechanical friction when using an alcohol pad is more effective.

That is really the easy part.

It is a lot harder to change behaviours.

One study found that nurses and others acknowledged that stethoscopes were a vector for infection but only 24% disinfected the stethoscope after each use.

Reasons why this occurred were

  1. time restraints
  2. absence of disinfecting material
  3. insufficient visual reminders.

Another study was more successful than the zero result study from earlier.

It reduced contamination rates from 68.9% to 27.6% using an educational intervention on the contamination rates of stethoscopes and the knowledge, attitudes, and practices regarding stethoscope use of healthcare providers.

The intervention consisted of a lecture-demo, performance feedback, handouts and flyers.

Another study asked how regularly clinicians cleaned their stethoscopes.

The answers varied from I don’t’ clean my stethoscope regularly to after every patient contact. 

The median answer was ‘weekly”.

When asked clinicians why they did not clean stethoscopes , the responses identified limited teaching, poor availability of cleaning material, poor role modelling and a need to raise awareness.

These reason are similar to why hand washing did not occur as it should between each patient.

If changed attitudes towards hand washing can occur, then so can attitudes about stethoscopes.

Every effort should be made to eliminate a very significant source of hospital acquired infection.

So clean your stethoscope today.

To learn more about dirty stethoscopes,

Breen, Anne E., and Amanda J. Hessels. “Stethoscopes: Friend or fomite?.” Nursing Management 48.12 (2017): 9-11.

Burrie, N. A. “Stethoscopes as vectors of infections.” Australian Medical Student Journal 2 (2011): 32-35.

Holleck, Jürgen L., et al. “Can education influence stethoscope hygiene?.” American Journal of Infection Control 45.7 (2017): 811-812.