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Dirty stethoscopes 'spread bugs', warns study

Dirty stethoscopes may be helping to spread dangerous bugs around GP surgeries and hospital wards, a study suggests.

One of the instruments was found to be more contaminated with bacteria than the palm of a doctor’s hand after being used to examine 71 patients.

Among the microbes spreading from patients was the potentially deadly superbug MRSA (methicillin-resistant Staphylococcus aureus).

“The stethoscope should be regarded as an extension of the physician’s hands and be disinfected after every patient contact”

Dr Didier Pittet

They study, published in the journal Mayo Clinical Proceedings, was led by Dr Didier Pittet, from the World Health Organization Collaborating Centre on Patient Safety at University of Geneva Hospitals in Switzerland.

He said: “By considering that stethoscopes are used repeatedly over the course of a day, come directly into contact with patients’ skin, and may harbour several thousands of bacteria (including MRSA) collected during a previous physical examination, we consider them as potentially significant vectors of transmission.”

Dr Didier Pittet

Dr Didier Pittet

He added: “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.”

Dr Pittet’s team conducted a study in which 71 patients were examined by one of three doctors using sterile gloves and a stethoscope.

After each examination, the tube and diaphragm of the stethoscope and four regions of the physician’s hands were checked for bacteria.

Dirty stethoscopes 'spread bugs'

The stethoscope’s diaphragm, the part of the instrument that is pressed onto a patient’s skin, was more heavily contaminated than all regions of the hand except the fingertips.

In addition the stethoscope tube was covered in more bugs than the back of the doctor’s hand.

 

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Readers' comments (27)

  • ... and we still can't even get the basic rights!

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  • of course they should. it shouldn't even need an article. in the 1970s when i trained we took swabs of our choice on the wards and one of the biggest colonies of staph aureus to grow on the Petri dishes was from stethoscopes. the earpieces also need careful disinfection to protect the staff.

    Like the photo, he was once a houseman on my ward! What fun we had in those days putting Oropax in the earpieces or parafilm behind the diaphragm and watching as five or six medics on the Professor's ward round bent over a poor patient to auscultate their chest and the Prof. would question them on the different heart sounds and if they could hear them and watch all the heads nodding knowing full well that one of them could hear absolutely nothing!

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  • Bit obvious really. After eliminating kipper ties and lab coats it should have been obvious to the thickest of people that the piece of rubber and metal draped around the necks of poseurs across the country (since ER hit the screens) and before that right next to those bacteria infested ties could be a bit grimy.

    Mine was always cleaned - medi-swabbed as well - before. inbetween and after patient contact. I am flabberghasted that anyone would consider not cleaning it.

    Roll on the Star Trek medical tricorder.....

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  • They banned flowers at bedsides years ago and it has taken them all this time to realise this. It didn't need a study its absolute basic common sense. What about blood pressure cuffs too? that will get them going !!

    God help us.

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  • michael stone

    Oh heck !

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  • Not rocket science, this was standard practice 20 years ago in the units in which I worked.

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  • Anonymous | 28-Feb-2014 1:36 pm

    how much would we get paid for writing an article on the disinfection of blood pressure cuffs, and I am sure we could add more to the list - pay by item!

    Anonymous | 28-Feb-2014 6:02 pm

    I don't think the do things the way they did 20 years ago anymore, sadly!

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  • eileen shepherd

    I have to admit I was not taught to swab stethoscopes and I trained over 30 years ago. They used to get a weekly weekend clean. It does make sense to clean them but does it actually happen in practice?
    We are challenged to provide evidence based care and perhaps this paper is important as it feeds into the body of knowledge about infection risk.

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  • michael stone

    eileen shepherd | 1-Mar-2014 11:31 am

    I was reading a book a while ago, and the author pointed out that although it isn't possible to calculate the [quantum mechanical] wave equation for the whole universe, or even for something like a cat, it is nonetheless still possible to reason about certain properties they must possess.

    Requiring 'evidence' that 'germ on skin to stethoscope, same uncleaned stehoscope to next patient's skin, might perhaps move germ to next patient's skin', isn't exactly a rational position: it is not something that should need proving before you change behaviour - it makes obvious sense to assume it is probably right, until it has been proven not to be the case !

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  • eileen shepherd | 1-Mar-2014 11:31 am

    we all bought our own as we were more in fear the risk of ear infections from our colleagues. On the occasions I used a ward one I always disinfected both the ear pieces and the hearing trumpet bit! Not sure how often the doctors did theirs though although we were always reminding them to disinfect their hands or wash them between patients!

    Do you like the photo of my ex-colleague. He was a very well liked and respected member of our interdisciplinary team. Later when he became head of 'Infectiologie' and eventually Prof., nurses from his department came around to examine our handwashing techniques and gave us little flacons of gel to put in our pockets and on the notes trolley for our medical/nurses rounds which eventually developed into the Geneva Model of hand washing which I believe was also published in NT. I only discovered he had become a Professor when he was spoke about hand hygiene a Swiss French TV news show.

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  • Agree with the other posters, surely its common sense. We've been cleaning them for years along with other equipment that touches multiple patients. (though wasn't trained to years ago.

    Sadly the seriously unhygienic practice some staff have of licking their fingers to turn pages is still prevalent. Hopefully the newish study proving pathogens can be active for up to 7 days on paper will spur the infection control brigade to finally come out against this disgusting and filthy habit.

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  • Blimey. Next you'll be telling me that Benedict chap who lives in the Vatican is a Catholic!

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  • Anonymous | 1-Mar-2014 10:01 pm

    send them round the wards taking swabs as we did as students in the 1970s. I have never forgotten the results. we could choose where to take them and out of our choice the largest colonies grown in the lab on the Petri dishes were from the telephone mouth piece, stethoscope ear pieces (staph aureus) and soap, surround areas and flannels (pseudomonas). the most sterile was the inside of a bed sheet which at that time were laundered at 90 degrees C.

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  • Talk about stating the obvious. All the tick boxing has taken away common sense!!

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  • are there also tick boxes to indicate every time this is done? how would we know or even remember otherwise?

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  • I started my training in 1978, we were encouraged to buy our own stethoscopes, partly because they were in short supply/broken and also because of the infection risk to ourselves, we were also encouraged to clean them with mediswabs in between patients, so the issue is not new, training across the NHS was obviously inconsistent.
    As for flowers, my first post in 1981 was in ICU, flowers were banned due to the risk of pseudomonas, I am not aware how long that rule had been in place up to then, but it took more than 20 years after that for the general wards to ban them.

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  • Okay so just find a solution to the problem. We have hand gels so have tubs of antibacterial wipes everywhere too. I'm afraid it's a case of 'out of sight out of mind' because if the germs were visible then patients themselves would be quite rightly saying "Ew, don't put that near me". However, in the obvious absence of that we need professionals to be vigilant on patients behalf.

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  • So what about BP cuffs?

    I admit I have never cleaned one and never seen one cleaned. Is it a case of ignoring what we don't want to address, like a lot of things in the NHS at all levels.

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  • Anonymous | 4-Mar-2014 10:04 am

    you could always initiate a study on them!

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  • 'We are challenged to provide evidence based care and perhaps this paper is important as it feeds into the body of knowledge about infection risk'

    Frankly there are many areas without an evidence base and it is daft to say we need a basis for this. I would assume that any of the seminal articles on disinfection would provide evidence. BP cuffs cannot be cleaned due to velcro etc in modern kit and we should really be using single patient cuffs....same with saturation probes [especially the filthy plaster wrap ones which are often used until they no longer stick...]


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