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New Scope for the Stethoscope

      Health care–associated infections have steadily increased over the last several decades. The annual cost of such infections is more than 25 billion dollars.
      • Scott R.D.
      The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention.
      While gloves and hand hygiene have prevented spreading of infections from physical contact, stethoscope still exists as a potential vector.
      • Breathnach A.S.
      • Jenkins D.R.
      • Pedler S.J.
      Stethoscopes as possible vectors of infection by staphylococci.
      • Garner T.K.
      • Rimland D.
      Stethoscopes and infection.
      • Gordin F.M.
      • Schultz M.E.
      • Huber R.A.
      • Gill J.A.
      Reduction in nosocomial transmission of drug-resistant bacteria after introduction of an alcohol-based handrub.
      There have been several articles which concluded that stethoscopes are known vectors of transmitting infections such as methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus faecium, and various other micro-organisms that respond to only a narrow spectrum of antibiotics.
      • Gordin F.M.
      • Schultz M.E.
      • Huber R.A.
      • Gill J.A.
      Reduction in nosocomial transmission of drug-resistant bacteria after introduction of an alcohol-based handrub.
      • Boulée D.
      • Kalra S.
      • Haddock A.
      • Johnson T.D.
      • Peacock W.F.
      Contemporary stethoscope cleaning practices: what we haven't learned in 150 years.
      • Knecht V.R.
      • McGinniss J.E.
      • Shankar H.M.
      • et al.
      Molecular analysis of bacterial contamination on stethoscopes in an intensive care unit.
      For nearly the last century, stethoscopes continue to be of prime importance in making patient care decisions, especially in fast-paced settings such as the emergency department and intensive care units.
      • Núñez S.
      • Moreno A.
      • Green K.
      • Villar J.
      The stethoscope in the emergency department: a vector of infection?.
      These settings require heavy decision making from clinical exams. The use of the stethoscope is vital in such situations. For example, the stethoscope can be used to determine if a patient in respiratory distress is breathing fast because of a pneumothorax, pneumonia, or congestive heart failure. If the patient who had been involved in a recent motor vehicle crash has pneumothorax or hemothorax, the use of a stethoscope would add useful information beneficial to immediate management for that patient. Being a physician’s companion around their neck and more readily available than x-rays, computed tomography scans, and ultrasound machines, stethoscopes will continue to be the mainstay in critical care situations.
      Except for the introduction of digital stethoscopes, not a lot has been modified in the basic design of stethoscopes. Some physicians opt for disposable stethoscopes and some prefer sanitizing their personal stethoscopes with alcohol wipes or Oxivir wipes, but the vast majority have been unable to clean their stethoscope between every patient evaluation. Centers for Disease Control and Prevention guidelines recommend using a US Environmental Protection Agency–registered disinfectant for stethoscopes not contaminated with blood and for a tuberculocidal agent or a 1:100 dilution of a hypochlorite solution for stethoscopes with visible contamination of blood; however, these solutions still require a few minutes to clean the stethoscope.
      Centers for Disease Control
      Recommendations for preventing transmission of infections among chronic hemodialysis patients.
      ,
      • Guinto C.H.
      • Bottone E.J.
      • Raffalli J.T.
      • Montecalvo M.A.
      • Wormser G.P.
      Evaluation of dedicated stethoscopes as a potential source of nosocomial pathogens.
      Although a few authors in the past have suggested diaphragm covers in scientific literature, most of those studies lacked a robust design and methodology.
      • Wood M.W.
      • Lund R.C.
      • Stevenson K.B.
      Bacterial contamination of stethoscopes with antimicrobial diaphragm covers.
      A potential solution to the problem has been suggested by Vasudevan et al in their manuscript, where a disposable aseptic diaphragm barrier was noted to remain sterile at 24 hours. The authors concluded that barriers prevented the growth of anaerobes, antibiotic-resistant bacteria, yeasts, and body samples. Since the diaphragm is the main part of the stethoscope that comes in contact with the patient, the ease of application and removal of aseptic barriers on the diaphragm offers a ray of hope to this unresolved problem.

      References

        • Scott R.D.
        The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention.
        Centers for Disease Control and Prevention, Atlanta, GA2009 (March):13
        • Breathnach A.S.
        • Jenkins D.R.
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        Stethoscopes as possible vectors of infection by staphylococci.
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        • Rimland D.
        Stethoscopes and infection.
        JAMA. 1982; 248: 310
        • Gordin F.M.
        • Schultz M.E.
        • Huber R.A.
        • Gill J.A.
        Reduction in nosocomial transmission of drug-resistant bacteria after introduction of an alcohol-based handrub.
        Infect Control Hosp Epidemiol. 2005; 26: 650-653
        • Boulée D.
        • Kalra S.
        • Haddock A.
        • Johnson T.D.
        • Peacock W.F.
        Contemporary stethoscope cleaning practices: what we haven't learned in 150 years.
        Am J Infect Control. 2019; 47: 238-242
        • Knecht V.R.
        • McGinniss J.E.
        • Shankar H.M.
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        Molecular analysis of bacterial contamination on stethoscopes in an intensive care unit.
        Infect Control Hosp Epidemiol. 2018; 18: 1-7
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        • Moreno A.
        • Green K.
        • Villar J.
        The stethoscope in the emergency department: a vector of infection?.
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        • Centers for Disease Control
        Recommendations for preventing transmission of infections among chronic hemodialysis patients.
        MMWR. 2001; 50: 1-43
        • Guinto C.H.
        • Bottone E.J.
        • Raffalli J.T.
        • Montecalvo M.A.
        • Wormser G.P.
        Evaluation of dedicated stethoscopes as a potential source of nosocomial pathogens.
        Am J Infect Control. 2002; 30: 499-502
        • Wood M.W.
        • Lund R.C.
        • Stevenson K.B.
        Bacterial contamination of stethoscopes with antimicrobial diaphragm covers.
        Am J Infect Control. 2007; 35: 263-266

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