I just finished two weeks on the inpatient internal medicine service. When we round on the service every morning, I insist on 100% hand hygiene and 100% stethoscope hygiene but one of these targets is far easier to achieve than the other. As Mike
mentioned last year, almost 50% of stethoscopes are contaminated with pathogens including
S. aureus and MRSA. Despite this level of contamination, hospitals have done almost nothing to make cleaning them quick and easy. Like many (? all) hospitals, we have hand rub dispensers every few feet but nothing easily available to clean our stethoscopes. I usually end up "bothering" nurses to give us a few alcohol prep pads, but this uses up their daily supply and generally seems like an unnecessary barrier. Why can't we have wipes next to the hand rub dispensers outside of every room? That way we can actually achieve 100% stethoscope hygiene. If we don't develop good systems, we can't expect good results. How do you guys practice stethoscope hygiene at your hospital?
I get a lot of alcohol hand sanitizer on my hands and scrub the stethoscope diaphragm and tube up and down a couple of times. I do that every time after seeing a patient.
ReplyDeleteDo you have issues with emollient build-up? I find the scopes get pretty sticky and worry that even more bacteria stick. Has anyone studied this process? Would like to determine how effective it is. (should we put in a grant??)
DeleteThis is actually ineffective way to clean your stethoscope. It is 50% less effective than using an alcohol wipe. I'm a student looking for best practices implementing a stethoscope cleaning protocol. Just wanted to share best practices with you all.
DeleteReference: Mehta AK, Halvosa JS, Gould CV and Steinberg JP. (2010) Efficacy of Alcohol‐Based Hand Rubs in the Disinfection of Stethoscopes. Infection Control Hospital Epidemiology;31:870-872.
Where is the baseline research on *quantities* of microbes present on stethoscopes? Show me the data on microbial counts in the moist interstices around fingernails, compared to those on palmar surfaces, that would be a good start. Thanks.
ReplyDeleteAll good questions.
DeleteBuy a box of alcohol pads and keep a bunch in your bag; I found that foam eventually breaks down the glue that holds the rubber ring on the diaphragm
ReplyDeleteWe have looked at this issue here, where I work (outside the USA), and we recommend the little alcohol pads as used for venipuncure. As mentioned above, emollient buildup would be a concern when using hand rubs. They usually contain pure alcohol (mostly isopropanol) without emollients and cost about 1 cent per piece. I do not think that any hospital should shy away from providing these widely. I also just checked with the local representative of a major stethoscope manufacturer, and it is also their officially recommended way of cleaning between patients. However, having said/written that, getting people to do this consistently is an entirely different matter.
ReplyDelete