BACKGROUND

 

1 in 20 hospitalized patients will contract a hospital acquired infection (HAI).

 

According to CDC 1 in 20 hospitalized patients will contract a hospital-associated infection (HAI) - a major hazard and a threat to their safety. HAIs are an important cause of morbidity and mortality and they impose significant economic consequences on the nation’s healthcare system. 

 

Transmission of infections through contaminated stethoscopes has been demonstrated and they can harbour various organisms on their diaphragm surfaces.

 

While many of the pathogens can be transmitted by hand contamination, there are mechanisms in place to address this issue such as hospital-wide incentives reminding health care workers to wash hands before and after seeing each patient or conveniently available hand sanitizers which help to minimize these transmissions. A good example is World Health Organization’s My Five Moments for Hand Hygiene – a widely circulated strategy that defines the key moments when health-care workers should perform hand hygiene. Transmission of infections through contaminated medical devices such as stethoscopes has also been demonstrated and studies show that they can harbor various organisms on their diaphragm surfaces, including: coagulase negative staphylococci, Staphylococcus aureus, Corynebacterium spp., Bacillus spp., Neisseria spp., alpha-hemolytic streptococci, Micrococcus luteus, Enterococcus spp., Candida spp., Gram negative organisms (including Pseudomonas aureginosa; also non-fermenting gram negative bacilli, including Acinetobacteri spp and Stenotrophomanas maltophilia), Enterococcus faecalis, Escherichia coli, Aspergillus spp., Clostridium difficile, common viruses (e.g. enteroviruses and small round structured viruses), and norovirus. At least one organism has been demonstrated in 79% to 100% of stethoscope surfaces surveyed in various series.

 

MECHANISM OF HAI TRANSMISSION

 

Development of HAIs begins with exposure of patients to pathogenic bacteria which have colonized hospital equipment (such as stethoscopes).

 

The natural history of the development of HAIs appears to begin with exposure of patients to pathogenic bacteria which have colonized hospital equipment, skin, or nasopharynx of hospital personnel. Subsequently, colonization of the patients’ skin, gut, or other systems with hospital flora occurs and infections ensue when the normal body defenses are impaired through underlying diseases, administration of immunomodulating therapy or use of invasive devices. Following contact with infected skin, pathogens can attach and establish themselves on the diaphragms of stethoscopes and subsequently be transmitted to other patients during routine physical examination.

 

Even short periods of contact between a patient's skin and the stethoscope can result in transfer of bacteria and even exemplary hand hygiene cannot be expected to break the chain of infection when stethoscope surfaces are heavily contaminated.

 

Even short periods of contact between a patient’s skin and the stethoscope can result in transfer of bacteria. An obvious risk of lack of stethoscope disinfection practices is dissemination of multi-resistant organisms which are capable of initiating severe infections in a hospital environment. Therefore anything that depends on hands for functionality is at risk of contamination from a carrier’s strain; however evidence shows that even exemplary hand hygiene cannot be expected to break the chain of infection when the environment (including stethoscope surfaces) is heavily contaminated. Specifically, if a health care worker uses a wall-mounted hand disinfectant prior to and after each patient contact but they do not disinfect their stethoscope routinely, their clean hands could become contaminated again from touching the dirty stethoscopes and could potentially contaminate the patients. 

 

THE MISSING LINK

 

Routine disinfection of stethoscopes is not an established practice and some studies even suggest it is hardly ever undertaken.

 

Multiple studies confirm that surveyed physicians and other health care professionals rarely clean their stethoscopes on a regular basis and there is a lack of guidelines or advise being given to personnel on how or how regularly to disinfect stethoscopes. Routine disinfection of stethoscopes in between patients and before each patient contact is not an established practice and some studies even suggest that it is hardly ever undertaken.

 

Contaminated stethoscopes could be the missing link in the chain of HAI prevention; there are increasing reports of pathogenic organisms being transmitted via stethoscope surfaces.

 

Contaminated stethoscopes could be the broken link in the chain of HAI prevention. In fact, there are increasing reports of pathogenic organisms being transmitted via stethoscope surfaces. These organisms are capable of initiating severe infections in a hospital environment; patients with open wounds, such as those with burns or tracheostomies, may be colonized leading to infection at a later time. This may require contact isolation, adding additional cost to the overall patient care. Strict adherence to stethoscope disinfection practices by health workers could minimize cross-contamination and ensure improved patient safety in hospitals.