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Stethoscope hygiene nonexistent even after educational intervention
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Stethoscope hygiene compliance remained nonexistent, even after a pilot educational intervention, according to recently published findings from the American Journal of Infection Control.
“Hand hygiene has traditionally received much more attention than stethoscope hygiene, but microbiology data have shown that stethoscope contamination after a single exam is comparable to that of the physician’s dominant hand,” Jurgen L. Holleck, MD, assistant professor in the department of internal medicine at Yale University School of Medicine, and colleagues wrote. “Potential pathogens cultured from stethoscopes include Staphylococcus aureus, Pesudomonas aeruginosa, Clostridium difficile and vancomycin-resistant enterococci.
Despite this evidence, Holleck and colleagues pointed out that stethoscope hygiene rates have been “abysmal” in recent studies.
“Many providers may not be aware of the current guidelines that noncritical medical equipment (including stethoscopes) undergo disinfection between patients,” they wrote.
The researchers documented the use of alcohol swabs or gel for stethoscope and hand hygiene at the beginning of a 4-week rotation of medical students, resident physicians and attending physicians in a tertiary care Veterans Affairs hospital. Hand sanitizer dispensers were available in hallways, and staff viewed a presentation on stethoscope hygiene. Furthermore, flyers were left in staff work spaces and in each nursing unit, along with alcohol swabs.
Holleck and colleagues reported no significant changes in hand hygiene compliance: 58% at baseline and 63% after the intervention. However, over the course of 128 pre-intervention and 41 post-intervention observations, the researchers reported no compliance whatsoever with stethoscope hygiene.
“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,” Holleck and colleagues wrote, adding that the presentation on stethoscope hygiene appeared to be well-received and included a notice that the hospital was planning to monitor compliance.
Researchers acknowledged that the study was limited by a small number of observations, particularly after the intervention was implemented.
“Despite limitations, we think this highlights an important, but often overlooked infection control issue by discovering how rarely stethoscope hygiene is done, and suggests that standard education may not be the answer,” they wrote. “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.” – by Andy Polhamus
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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The article by Holleck and colleagues emphasizes the importance of stethoscope cleaning and notes that this concern has been demonstrated in prior studies and is also consistent with infection prevention guidelines. The authors describe a pilot quality improvement project to improve hand hygiene and stethoscope cleaning. Despite education, flyers and provision of cleaning supplies, there was no significant change in hand hygiene rates, and stethoscope cleaning remained at zero as well. This project underscores two important issues in the infection prevention literature. The first is the importance of cleaning all equipment that goes from patient to patient. Other studies have demonstrated deficiencies in cleaning of other patient care equipment that goes between patients. The second important take away from this project is that education in the absence of other interventions does not change behavior. The authors suggest that stethoscope cleaning not only be included in all hand hygiene initiatives, but that accountability for both hand hygiene and stethoscope cleaning could potentially be included in resident evaluations. This quality improvement project identifies an opportunity for health care organizations to take a closer look at stethoscope cleaning and to develop accountability mechanisms for all care providers. There is also potential to expand hand hygiene into a bundled approach, which includes cleaning of stethoscopes and other nonpatient-specific care items that come in contact with a patient during a single health care encounter.
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