In the healthcare industry, sterility of equipment is of utmost importance to preclude life-threatening blood borne infections or transfer of microbes between patients. Several measures are taken to reinforce good hygiene practices in hospitals and clinics through infection control programs, which can be incorporated in both training and medical school teaching.

Why sterility of equipment is essential

The results of a new study published in the American Journal of Infection Control further underscore the importance of consistent hygiene principles and good disinfection of medical equipment.

Despite the importance of hand cleanliness being continually stressed throughout professional training – the study has revealed that, “Microbiology data have shown that stethoscope contamination after a single exam is comparable to that of the physician's dominant hand.” Organisms that are frequently procured from contaminated equipment include Staphylococcus aureus and Clostridium difficile, which are microorganisms commonly implicated in skin infections and gastrointestinal infections.

Stethoscopes are frequently used in clinical examinations for the purpose of monitoring irregularities in heart sounds and unusual lung sounds. However, this study found that healthcare professionals rarely ensure their stethoscopes are sufficiently clean before moving on to the subsequent patient. Medical equipment that does not need to be disposed of and can be used again needs to be as clean as possible as they are likely to be used for multiple patients.

Four-week pilot study monitoring stethoscope cleanliness

In order to observe stethoscope hygiene, researchers monitored a spectrum of healthcare professionals, such as resident doctors and medical students, over a period of four weeks.

The hygiene of stethoscopes can be maintained through a variety of mediums such as alcohol gel or disinfecting wipes. The research involved doctors from Yale University and the Veteran Affairs Connecticut Healthcare System in West Haven. The researchers observed that none of the doctors involved in the study disinfected their stethoscopes between consecutive patient encounters. The pilot project also involved observation of hand hygiene, which can be implemented through the usage of alcohol gel or soap and water.

Over a total of 128 observations, not a single instance of disinfecting stethoscopes was recorded. Despite the importance of hand hygiene being emphasised throughout professional training, disinfection of hands was also carried out at a relatively low rate of 58%.

The research team then underscored the value of consistent stethoscope hygiene – and its importance in clinical practice – via mediums such as an informative presentation slides and brochures. It was expressed that there would be a follow-up period to monitor whether stethoscope hygiene would be implemented following education of clinicians. However, during the follow up period, no instances of maintaining stethoscope hygiene were observed.

Poor stethoscope hygiene can lead to medical complications

The importance of cleaning the stethoscopes between patient encounters is elaborated upon by Linda Greene, president of the Association for Professionals in Infection Control and Epidemiology (APIC). She iterated that “Stethoscopes are used repeatedly throughout the day, and become contaminated after each patient exposure. Therefore, they must be treated as potential vectors of transmission. Failing to disinfect stethoscopes could constitute a serious patient safety issue similar to ignoring hand hygiene.”

Some notable shortcomings of this study include the fact that the observations were conducted outside of patient rooms. This means that stethoscope hygiene could have been ensured before the physician left the patient room; or right after an examination was carried out. Researchers involved in this study suggested accountability as a way to overcome this issue – “by designating a team member, such as a senior resident physician, to be the team leader or champion to remind and ensure that stethoscope and hand hygiene are performed.”

Since resistant microorganisms are especially prevalent in hospital environments – and can be very fastidious and difficult to treat – it is essential to ensure both stethoscope and hand hygiene are consistently ensured, in order to minimise risk of infection and other medical complications. MIMS

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