Failures in stethoscope hygiene can lead to patient infections

Hand hygiene has received much more attention than stethoscope hygiene, but microbiology data shows that stethoscope contamination after a single exam is comparable to that of the physician’s dominant hand. Infection control guidelines from the CDC state that re-usable medical equipment, such as stethoscopes, must undergo disinfection between patients with alcohol swabs, alcohol gel, or disinfectant wipes.

Can education influence stethoscope hygiene? That is the question raised by a new quality improvement project published in the July issue of the American Journal of Infection Control. Linda Greene, RN, MPS, CIC, FAPIC, and 2017 president of APIC said, “Stethoscopes are used repeatedly throughout the day and become contaminated after each patient exposure, so they must be treated as potential vectors of transmission.” Failure to disinfect stethoscopes is as serious as ignoring hand hygiene.

A quality improvement pilot project was launched to observe stethoscope hygiene compliance among medical students, resident physicians, and attending physicians at a tertiary care academic teaching hospital. The baseline observation of stethoscope hygiene among staff found zero occurrences. That’s right. Not one medical profession wiped off their stethoscope between patient encounters.

The observation team followed up with the clinicians by reviewing the importance of stethoscope hygiene, and reminding them of hospital expectations. Clinicians were to perform stethoscope hygiene between each patient encounter. During the follow-up phase, the same population was monitored again but the result was the same: zero occurrences of stethoscope sanitation. The team went into the study anticipating a poor result, but were still surprised that no one performed stethoscope hygiene, despite the fact that it is on the checklist for second-year medical students demonstrating competency in patient exams for their final evaluation.

Study organizers were quoted. “Standard education may not be the answer to this problem. Behavioral and cultural modification to improve hand hygiene still remains a challenge, despite being studied in large randomized trials.” Start today to make stethoscope hygiene part of your infection control program.