Physician Cleanse thyself and thy equipment too!

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It s common knowledge that a doctor s hands should be cleaned with either a disinfectant gel or soap and water between patients, but now we have learned that their stethoscopes are also likely to carry a significant number of disease-causing bacteria. A recently published study in the Mayo Clinic Proceedings found that doctors equipment may be nearly as contaminated as their hands.

It has been shown that drug-resistant bacteria present an increasingly dangerous threat to hospitalized patients. So more than ever, it is crucial, especially in intensive-care units (ICUs), that all modes of bacterial transmission be monitored and avoided. Dr. Yves Longtin of the Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals, Geneva, Switzerland, and colleagues examined the extent to which physicians stethoscopes were contaminated, and compared that to contamination of those doctors hands.

The study involved standardized physical exams of 83 inpatients at a Swiss university hospital. The hands and stethoscopes of their physicians, who wore sterile gloves or were bare-handed, were evaluated for bacterial contamination after one examination. The researchers found that the greater the degree of contamination of a physician s hands, the more contaminated his stethoscope was likely to be.

The investigators also found that the doctors fingertips were the most highly contaminated, and that the diaphragms of their stethoscopes (the part that touches the patient s skin) were the next most contaminated more so than other parts of the physicians hands. This result is worrisome, as the stethoscope is probably the most routinely used equipment in a physician s armamentarium.

The authors noted patient-to-patient transmission of microorganisms is a major threat to hospitalized patients and causes significant morbidity and mortality. In light of their results they concluded Failing to disinfect stethoscopes could constitute a serious patient safety issue akin to omitting hand hygiene. Hence, 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.

ACSH s Dr. Gil Ross had this comment: Over the past decade or so, hygienic practices and the neglect thereof of hospital staff, both professional and support workers, has come under increasing scrutiny, wisely so. Nosocomial infections have claimed tens of thousands of hospitalized patients each year. Some of these are not preventable, especially among severely immunocompromised and end-stage patients. But many, attributable to indwelling catheters and IV lines mixed with sloppy hand-washing and general sanitary oversights, can and must be prevented. Thanks to this simple study, perhaps some consciousness-raising about cleaning not just hands but stethoscopes will lead to a reduction however small in preventable, resistant infections.