Stethoscopes have often been dubbed the ‘third arm’ of clinicians due to their indispensable role in everyday health care practice. Despite their frequent use, the infection prevention policies related to these instruments often overlook their potential to act as vectors for health care-associated infections (HAIs). In light of this, there is a growing need for a shift in mindset, one that views stethoscope hygiene with as much gravitas as hand hygiene. This transformation eventually requires more than mere provision of cleaning supplies. It calls for ingrained habits, clear instructions, effective products, and a culture prioritizing stethoscope hygiene.
A significant contribution to this discussion comes from the experience of a small 100-bed hospital in Lebanon during the tumultuous period of COVID-19. Upon the resurgence of an antibiotic-resistant strain of Acinetobacter, which the hospital had previously tackled, a comprehensive search was initiated to locate the source of the outbreak. The team investigated ventilation systems, staff clothing, masks, and environmental cultures. However, the most surprising revelation came from cultures obtained from inside a stethoscope. This resulted in immediate action of collecting, cleaning, disinfecting, sterilizing, and re-assembling all the stethoscopes in the hospital, effectively stopping the outbreak.
While the necessity of extensive cleaning is evident, this approach often conflicts with practical realities and time constraints faced by healthcare providers. Surface cleaning isn’t sufficient as the contamination is often not merely topical. Nevertheless, expecting healthcare providers to disassemble and clean stethoscopes after every use is unrealistic. More prevalent approaches such as ‘wipe and go’ often ignore the dwell time, the period a disinfectant must remain on a surface to achieve efficient disinfection. This lack of adherence to dwell time potentially results in ineffective disinfection and increased risk for patients.
As for supplementary technologies, options like UV devices for disinfection present their unique set of challenges. While they may offer thorough, quick, and consistent disinfection, their efficacy relies heavily on device type and usage behavior. Furthermore, UV light only affects surfaces it can reach, rendering it ineffective for internal contamination, such as noted in the aforementioned case study.
Single-use, disposable stethoscopes, though eliminating the need for instrument sharing, present questions related to cost, waste production, and quality. Layered on top of these issues is the fade outs of adherence due to human factor and gaps in training during medical education.
For enduring and effective change, building a culture of trust is crucial—the trust in the infection prevention guidance to protect the patients, staff, and their families. Besides trust, the need for a shift in culture is pivotal—stethoscope hygiene must become a reflexive habit, like hand-sanitation. Understanding this risk posed by stethoscopes might push for creating policies, products, and habits that cater to their risk profile.