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Advancing High Value Health Care|Articles in Press

Our Third Hand: Stethoscope Hygiene in the Era of Alcohol-Resistant Organisms

Published:February 03, 2023DOI:https://doi.org/10.1016/j.amjmed.2023.01.026
      The stethoscope is one of the oldest tools in the physician's armamentarium. To this day, it persists as a highly visible image in the practice of medicine; it is used actively and is recommended in most health care encounters and is expected by patients.
      • Fuster V.
      The stethoscope's prognosis: very much alive and very necessary.
      Yet, while health care workers have been taught for more than150 years,
      • Newsom SW.
      Pioneers in infection control. Ignaz Philipp Semmelweis.
      and more recently are mandated to perform the World Health Organization (WHO) 5 moments of hand hygiene between every single patient,
      • Newsom SW.
      Pioneers in infection control. Ignaz Philipp Semmelweis.
      stethoscope hygiene practices are only marginally adopted.
      • Boulée D
      • Kalra S
      • Haddock A
      • Johnson TD
      • Peacock WF.
      Contemporary stethoscope cleaning practices: what we haven't learned in 150 years.
      ,
      • Vasudevan RS
      • Mojaver S
      • Chang KW
      • Maisel AS
      • Frank Peacock W
      • Chowdhury P
      Observation of stethoscope sanitation practices in an emergency department setting.
      This persists despite that the stethoscope diaphragm carries the same quantity and diversity of pathogens associated with health care. Moreover, many of the most virulent pathogens are resistant or have evolved resistance to alcohol. In this context, alcohol has direct relevance in the era of multidrug resistant organisms (MDROs). This article provides context on how stethoscope hygiene is a critical component of effective prevention of infections associated with health care.
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      References

        • Fuster V.
        The stethoscope's prognosis: very much alive and very necessary.
        J Am Coll Cardiol. 2016; 67: 1118-1119https://doi.org/10.1016/j.jacc.2016.01.005
        • Newsom SW.
        Pioneers in infection control. Ignaz Philipp Semmelweis.
        J Hosp Infect. 1993; 23: 175-187https://doi.org/10.1016/0195-6701(93)90023-s
        • Boulée D
        • Kalra S
        • Haddock A
        • Johnson TD
        • Peacock WF.
        Contemporary stethoscope cleaning practices: what we haven't learned in 150 years.
        Am J Infect Control. 2019; 47: 238-242https://doi.org/10.1016/j.ajic.2018.08.005
        • Vasudevan RS
        • Mojaver S
        • Chang KW
        • Maisel AS
        • Frank Peacock W
        • Chowdhury P
        Observation of stethoscope sanitation practices in an emergency department setting.
        Am J Infect Control. 2019; 47: 234-237https://doi.org/10.1016/j.ajic.2018.08.028
        • Zachary KC
        • Bayne PS
        • Morrison VJ
        • Ford DS
        • Silver LC
        • Hooper DC.
        Contamination of gowns, gloves, and stethoscopes with vancomycin-resistant enterococci.
        Infect Control Hosp Epidemiol. 2001; 22: 560-564https://doi.org/10.1086/501952
        • Núñez S
        • Moreno A
        • Green K
        • Villar J.
        The stethoscope in the emergency department: a vector of infection?.
        Epidemiol Infect. 2000; 124: 233-237https://doi.org/10.1017/s0950268800003563
        • Smith MA
        • Mathewson JJ
        • Ulert IA
        • Scerpella EG
        • Ericsson CD.
        Contaminated stethoscopes revisited.
        Arch Intern Med. 1996; 156: 82-84
        • Jenkins IH
        • Monash B
        • Wu J
        • Amin A.
        The third hand: low rates of stethoscope hygiene on general medical services.
        J Hosp Med. 2015; 10: 457-458https://doi.org/10.1002/jhm.2359
        • Longtin Y
        • Schneider A
        • Tschopp C
        • et al.
        Contamination of stethoscopes and physicians' hands after a physical examination.
        Mayo Clin Proc. 2014; 89: 291-299https://doi.org/10.1016/j.mayocp.2013.11.016
        • Vajravelu RK
        • Guerrero DM
        • Jury LA
        • Donskey CJ.
        Evaluation of stethoscopes as vectors of Clostridium difficile and methicillin-resistant Staphylococcus aureus.
        Infect Control Hosp Epidemiol. 2012; 33: 96-98https://doi.org/10.1086/663338
        • Alhmidi H
        • Li DF
        • Cadnum JL
        • et al.
        Use of simulations to evaluate the effectiveness of barrier precautions to prevent patient-to-patient transfer of healthcare-associated pathogens.
        Infect Control Hosp Epidemiol. 2021; 42: 425-430https://doi.org/10.1017/ice.2020.1215
      1. Rutala WA, Weber DJ, and the Healthcare Infection Control Practices Advisory Committee (HICPAC). Guideline for disinfection and sterilization in healthcare facilities, 2008. Centers for Disease Control and Prevention website. https://www.cdc.gov/infectioncontrol/pdf/guidelines/disinfection-guidelines-H.pdf. Updated May 2019. Accessed December 15 2022.

        • Knecht VR
        • McGinniss JE
        • Shankar HM
        • et al.
        Molecular analysis of bacterial contamination on stethoscopes in an intensive care unit.
        Infect Control Hosp Epidemiol. 2019; 40: 171-177https://doi.org/10.1017/ice.2018.319
        • Parmar RC
        • Valvi CC
        • Sira P
        • et al.
        A prospective, randomised, double-blind study of comparative efficacy of immediate versus daily cleaning of stethoscope using 66% ethyl alcohol.
        Indian J Med Sci. 2004; 58: 423-430
        • Edwards J
        • Patel G
        • Wareham DW.
        Low concentrations of commercial alcohol hand rubs facilitate growth of and secretion of extracellular proteins by multidrug-resistant strains of Acinetobacter baumannii.
        J Med Microbiol. 2007; 56: 1595-1599https://doi.org/10.1099/jmm.0.47442-0
        • Wilcox MH
        • Fawley WN.
        Hospital disinfectants and spore formation by Clostridium difficile.
        Lancet. 2000; 356: 1324https://doi.org/10.1016/S0140-6736(00)02819-1
        • Becker B
        • Henningsen L
        • Paulmann D
        • et al.
        Evaluation of the virucidal efficacy of disinfectant wipes with a test method simulating practical conditions.
        Antimicrob Resist Infect Control. 2019; 8: 121https://doi.org/10.1186/s13756-019-0569-4
        • Kampf G.
        Efficacy of ethanol against viruses in hand disinfection.
        J Hosp Infect. 2018; 98: 331-338https://doi.org/10.1016/j.jhin.2017.08.025
      2. Centers for Disease Control and Prevention (CDC). Prevention and control - camps | cryptosporidium | parasites. Available at: Accessed December 31, 2022.

      3. Centers for Disease Control and Prevention (CDC). Prevent the spread of C. diff. Available at: https://www.cdc.gov/cdiff/prevent.html. Accessed October 22, 2022.

        • Alali SA
        • Shrestha E
        • Kansakar AR
        • Parekh A
        • Dadkhah S
        • Peacock WF.
        Community hospi1tal stethoscope cleaning practices and contamination rates.
        Am J Infect Control. 2020; 48: 1365-1369https://doi.org/10.1016/j.ajic.2020.04.019
        • Jones JS
        • Hoerle D
        • Riekse R.
        Stethoscopes: a potential vector of infection?.
        Ann Emerg Med. 1995; 26: 296-299https://doi.org/10.1016/s0196-0644(95)70075-7
        • Lee R
        • Choi SM
        • Jo SJ
        • et al.
        A quasi-experimental study on stethoscopes contamination with multidrug-resistant bacteria: Its role as a vehicle of transmission.
        PLoS One. 2021; 16e0250455https://doi.org/10.1371/journal.pone.0250455
        • Holleck JL
        • Merchant N
        • Lin S
        • Gupta S.
        Can education influence stethoscope hygiene?.
        Am J Infect Control. 2017; 45: 811-812https://doi.org/10.1016/j.ajic.2017.02.004
        • Kalra S
        • Garri RF
        • Shewale JB.
        Aseptic disposable stethoscope barrier: acoustically invisible and superior to disposable stethoscopes.
        Mayo Clin Proc. 2021; 96: 263-264https://doi.org/10.1016/j.mayocp.2020.10.029
        • Mehmood M
        • Abu Grara HL
        • Stewart JS
        • Khasawneh FA
        Comparing the auscultatory accuracy of health care professionals using three different brands of stethoscopes on a simulator.
        Med Devices (Auckl). 2014; 7: 273-281https://doi.org/10.2147/MDER.S67784
        • Whittington AM
        • Whitlow G
        • Hewson D
        • Thomas C
        • Brett SJ.
        Bacterial contamination of stethoscopes on the intensive care unit.
        Anaesthesia. 2009; 64: 620-624https://doi.org/10.1111/j.1365-2044.2009.05892.x