Contemporary stethoscope cleaning practices: What we haven't learned in 150 years

Abstract

Background: Stethoscopes can be microorganism reservoirs. The US Centers for Disease Control and Prevention (CDC) has published medical equipment disinfection guidelines to minimize infection transmission risk, but studies of guideline adherence have been predominately survey based, with little direct observation of disinfection practices.

Methods: We performed an observational, cross-sectional, anonymous study of patient-provider interactions, assessing practitioners' frequency and methods of stethoscope and hand disinfection practices.

Results: Stethoscopes were disinfected in 18% of 400 observed interactions, with less than 4% verified as conforming to CDC guidelines. None was disinfected before patient examinations involving open chest or abdominal wounds, as recommended by the CDC. Hands were cleaned before and after encounters 27 times (6.8%) but were not cleaned at all in 231 (58%) encounters, although gloves were worn in 197 (85.3%) of these cases.

Discussion: Stethoscope disinfection is grossly overlooked, possibly jeopardizing patient safety, particularly in acute care interactions. Periodic stethoscope disinfection, although inconvenient, helps reduce bacterial contamination and may reduce health care-associated infections.

Conclusions: Stethoscopes were disinfected per CDC guidelines in less than 4% of encounters and were not disinfected at all in 82% of encounters. Although hands were rarely cleaned (6.8%) per CDC guidelines, gloves were usually worn, but no convenient stethoscope equivalent exists. Stethoscope cleanliness must be addressed.

Keywords: Cleaning; Disinfection; Hand; Infection; Observation; Stethoscope.