Background: Although healthcare workers’ hands are the main source of bacterial transmission in hospitals, physicians’ stethoscopes appear to play a role. To explore this question, investigators at the University of Geneva Hospitals assessed the level of bacterial contamination on physicians’ hands and stethoscopes following a single physical examination. The study appears in the March issue of Mayo Clinic Proceedings.
Didier Pittet, MD, MS: By considering that stethoscopes are used repeatedly over the course of a day, come directly into contact with patients’ skin, and may harbor several thousands of bacteria (including MRSA) collected during a previous physical examination, we consider them as potentially significant vectors of transmission,” said lead investigator Dr. Didier Pittet, Director of the Infection Control Program and WHO Collaborating Centre on Patient Safety at the University of Geneva Hospitals. “From infection control and patient safety perspectives, the stethoscope should be regarded as an extension of the physician’s hands and be disinfected after every patient contact.”
The Evidence: 71 patients were examined by one of three physicians using sterile gloves and a sterile stethoscope. After they completed the examination, two parts of the stethoscope (the tube and diaphragm) and four regions of the physician’s hands (back, fingertips, and thenar and hypothenar eminences) were measured for the total number of bacteria present.
The stethoscope’s diaphragm was more contaminated than all regions of the physician’s hand except the fingertips. Further, the tube of the stethoscope was more heavily contaminated than the back of the physician’s hand. Similar results were observed when contamination was due to methicillin-resistant S.aureus (MRSA) after examining MRSA-colonized patients.
My Take: Contamination levels of a stethoscope are substantial after a single physical examination, and comparable to the contamination of parts of the physician’s dominant hand. Ask your healthcare provider to wipe down her stethoscope with an alcohol wipe. I’m Dr. Michael Hunter.
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