Patient safety and stethoscopes

Abstract

BackgroundIt has been suggested that the use of stethoscopes may transmit infection between patients and yet stethoscope cleaning protocols lack consistency of guidance as to where, when and how stethoscopes should be cleaned. We have assessed the difference in microbiological colonisation between non-dedicated and patient dedicated stethoscopes and between the stethoscope diaphragm and neck. MethodsAn observational study over an 8-day period at a secondary care hospital. We analysed 104 samples comprising matched diaphragm and neck data for each of 26 non-dedicated and 26 patient dedicated stethoscopes. The diaphragm and neck of each stethoscope were swabbed and processed using standard microbiology techniques. Results98% of stethoscopes were colonised. There was a lack of evidence for a true difference in colonisation levels between the stethoscope diaphragm and neck (n = 104, p = 0.752(OR1.000 95%CL (0.230–4.345)) Cohen's effect size index = 0.000) or between dedicated and non-dedicated stethoscopes (n = 104, p = 1.000(OR3.118 95%CL (0.121–80.190))). ConclusionsImportance in maintaining the hygiene of stethoscopes is underplayed. An effective patient safety culture will not merely respond to recognised risk but will identify and mitigate potential risk. These data suggest the entirety of the stethoscope will become colonised regardless of its environment. A good patient safety intervention will make doing the right thing the easy thing. Here we argue for cleansing the entirety of the stethoscope before and after patient contact.