Infection control: What is the best practice for stethoscopes?

We can’t avoid the presence of germs on our stethoscopes. It is just a part microbiology and the world we live in. Unfortunately, in the process of caring for multiple patients we have the potential to carry these contaminants between patients. Potentially causing an infection that could have otherwise been prevented. The stethoscope becomes a fomite in this setting, an object on which disease is carried and transmitted. For any healthcare provider this becomes a major concern.

A quick review of PubMed reveals numerous current studies on the prevalence of bacteria on stethoscopes and efficacy of cleaning efforts. In the study The stethoscope and healthcare-associated infection: a snake in the grass or innocent bystander?  the authors highlight that there as of yet there has not been a definitive association found between stethoscopes and healthcare acquired infection. The study does acknowledge that there is documented proof of the ability to transmit bacteria via stethoscope and patient.
As our communities use healthcare facilities as a means to get well, we should all be very concerned about the possibility of causing illness with the tools of our trade. Healthcare acquired infections and post-op complications are major expenses for healthcare systems worldwide, and there is a strong focus on prevention. Many different approaches have been used to tackle this issue. Some facilities issue each patient with a stethoscope and ban staff from utilizing their own, others isolate specific patients and issue disposable stethoscopes, while others issue guidelines on RME cleaning and delegate this task to the individual member of the healthcare team.

The CDC remains the authority of disease prevention in the United States. As part of its guidelines for healthcare facilities it recommends that:

“In acute care hospitals and long-term care and other residential settings, use disposable noncritical patient-care equipment (e.g., blood pressure cuffs) or implement patient-dedicated use of such equipment. If common use of equipment for multiple patients is unavoidable, clean and disinfect such equipment before use on another patient.” (CDC Contact Precautions)

As a nurse one of my biggest frustrations with facility issued disposable stethoscopes is that they are always of poor quality. Single use stethoscopes cannot compete with the models available for retail purchase. This make senses due to the economics of the situation. A health facility cannot afford to spend $100 on every patient for their own quality stethoscope, as such we end up with lower quality variants in many of our isolation carts. The question becomes how to you balance accurate and effective assessment with infection control. The truth is you simply cannot hear effectively with disposable stethoscopes.

Classic characteristics of disposable or single patient use stethoscopes:
• Poor quality tubing which is often of awkward length
• Hard plastic ear pieces
• Poor headset tension
• Single side chestpiece with low quality non-tunable diaphragm

Medical, nursing, and allied health staff must approach infection control and risk management staff at their healthcare organizations and come to a mutual agreement on the benefits of disposable stethoscopes in care of patients. It does no service to a patient to eliminate a useful diagnostic tool on the basis of distrust in staff cleaning abilities between patients. If using a quality stethoscope can provide an accurate diagnosis then its use should be considered over use of a lower quality disposable stethoscope.

We recommend contacting infection control staff at your organization to verify what the practices are for cleaning of stethoscopes at your facility, and where use of disposable equipment is a best practice.

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