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Stethoscopes could spread hospital infections
On statistical comparison, the contamination level of the stethoscope diaphragm was significantly lower than the contamination level of the fingertips, but significantly higher than around the base of the thumb or little finger or the back of the hand.
In the second study, where 38 patients with MRSA were examined, the pattern of contamination was similar, though with lower colony levels. The most heavily contaminated region was the fingertips (12 CFUs/25cm2), followed by the stethoscope diaphragm (7 CFUs/25cm2), then around the thumb or little finger.
However, the stethoscope tube and back of the hand had no MRSA. There was also no significant difference between contamination of the stethoscope diaphragm and fingertips.
In both studies, the level of contamination on the stethoscope was related to the level of contamination on the fingertips.
How did the researchers interpret the results?
The researchers concluded that, "These results suggest that the contamination level of the stethoscope is substantial after a single physical examination and comparable to the contamination of parts of the physician's dominant hand."
This study demonstrates that after a patient examination with sterile hands and stethoscope, the part of a doctor's hands most highly contaminated with bacteria was the fingertips, followed by the diaphragm of the stethoscope.
This part of the stethoscope was more contaminated than other regions of the hand, including the skin around the base of the thumb and little finger, or the back of the hand. The pattern was similar when looking at MRSA and total bacterial count in general.
It must be acknowledged that this study was small, involving the examination of only 71 patients by just three doctors at a single Swiss hospital over a period of five months.
However, the scenario examined - where hands and stethoscope were sterilised prior to use, and the patients involved were in a stable medical condition and did not have an active skin infection - should mean they are fairly representative of the "best situation" that could be found if similar tests were carried out in hospitals elsewhere.
In other "less than best" situations, such as where doctors' hands and equipment haven't been completely sterilised prior to use, levels of contamination could be much higher than those seen here. As the researchers say, no piece of equipment used on patient wards can be fully sterile, and most objects in the healthcare environment will yield some micro-organisms when sampled.
However, what is difficult to say is the clinical significance of detecting these levels of contamination. This study didn't test whether transferring the level of bacteria contamination detected on fingertips and stethoscopes would result in infection if it was then transferred to another patient without sterilisation.
But it is plausible that if repeated examinations were conducted without sterilisation in-between, the contamination would get worse and may be more likely to pose an infection risk, particularly to vulnerable patients.
A useful follow-on to this study would be to investigate how effective different methods for decontaminating stethoscopes are at reducing bacterial counts. That is, while clear WHO guidance is in place informing the process by which hands need to be sanitised to make them "safe", similar guidance for other equipment, such as stethoscopes, is not available and would be useful.
Overall, this study serves as an important reminder for doctors and other health professionals about the potential risks of cross-contamination if hospital equipment and hands are not disinfected between one patient and the next.
"Stethoscopes 'more contaminated' than doctors hands," BBC News reports after new Swiss research has suggested that the much-used instrument may spread bacteria inside hospitals, including MRSA. The BBC reports on an observational study carried out at.
Links to Headlines
Stethoscopes 'more contaminated' than doctors' hands. BBC News, February 27 2014
Doctors' stethoscopes can be dirtier than their hands - and are helping to spread bugs such as MRSA. Mail Online, February 27 2014
Stethoscopes 'more contaminated' than doctor's hands. ITV News, February 27 2014
Links to Science
Longtin Y, Schneider A, Tschopp C, et al. Contamination of Stethoscopes and Physicians' Hands After a Physical Examination. Mayo Clinic Proceedings. Published online February 27 2014
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