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The Unseen Threat of Stethoscopes to Infection Control and Possible Solutions

Within the realm of modern medical practice, the stethoscope has staked its claim as a critical and indispensable tool. Aptly referred to as the ‘third hand’, this instrument is used on a daily basis by an expansive range of healthcare providers, performing more than 5.5 billion auscultations annually in the United States alone. Despite the advent of alternative diagnostic methods, the indomitable stethoscope remains steadfast at the patient’s bedside. Alarmingly though, these instruments are often used on consecutive patients without significant protective measures.

Among observed practices, disinfection of stethoscopes occurred merely between 18% to 55% of the time, with only a fraction of these instances complying with the most recent guidelines from the Centers for Disease Control and Prevention (CDC). It is now affirmed that the microbial burden — both in terms of variety and volume — that a stethoscope may carry parallels that found on a practitioner’s hands, even post-disinfection.

This microbial load includes not just an array of infection-causing germs, but also spores and more robust organisms such as multidrug-resistant bacteria, viruses, and emerging resistant fungi like Candida Auris. The current common practice involving stethoscope hygiene remains varied, inadequately detailed, inconsistently applied, and ultimately, likely ineffective. Isopropyl alcohol, while easily accessible in US hospitals as an antiseptic, undeniably falls short against infectious agents such as Clostridioides difficile spores and norovirus. It could also inadvertently increase the probability of hospital-acquired infection (HAI) spread by boosting the sporulation rate of C. difficile and escalating tolerance against multidrug-resistant organisms like Enterococcus faecium and Acinetobacter baumannii. Thus, merely washing, or cleaning the stethoscope with bleach or alcohol swabs might not be sufficient in preventing its role as a vector in the spread of these organisms. An option considered is the use of a dedicated or disposable stethoscope, however, critical questions arise regarding their functional adequacy and potential for misdiagnosis, which can be between 11-33%.

The 2022 hand hygiene recommendations by the Society for Healthcare Epidemiology of America, Infectious Diseases Society of America, and Association for Professionals in Infection Control and Epidemiology are key in the prevention of many HAIs. However, these guidelines largely overlook the stethoscope.

The underwhelming hygiene practices connected to stethoscope utilization and the subsequent gaps in infection prevention translate to a major risk to patient safety and medical results. This could potentially undermine the vast strides within hand hygiene practices implemented with the primary objective of reducing the morbidity and mortality related to HAIs.

So what could be potential constitute solutions? One approach is the deployment of a disposable stethoscope barrier, particularly over the diaphragm – the primary part that comes into contact with the patient. The efficacy of these barriers in preventing bacterial and yeast growth and transmission that could contaminate stethoscope diaphragms has been proven in a study, causing no disruption to the workflow of practitioners and enhancing perceived patient safety.

As regulations around antimicrobial stewardship tighten, advancements in stethoscope hygiene are anticipated to progressively evolve. This elevates the battle against rising antimicrobial resistance to the junction between clinical practice, infection control, laboratory innovation, antimicrobial stewardship, and patient satisfaction. Prevention continues to be the fundamental pillar of infection control practices, and is quickly emerging as the centerpiece for antimicrobial stewardship initiatives. The opportunity for each patient auscultation to deter the spread of hospital-acquired organisms exists via the implementation of a barrier, similar to gowns and gloves, protecting the stethoscope.

Optimizing stethoscope hygiene, an often overlooked risk mitigating practice, could hold the key to our continued efforts against antimicrobial resistance.


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