Clinical Cooties: They Only Kill 100 People a Day, So Who Really Cares?

So which nifty little item commonly used in healthcare is most likely to carry nasty boogies from one sick patient to another?

STETH COOTIES

Trust us: Sloppy medical professional hygiene sickens 1,000 patients each day, and kills 10% of them. Go ahead. You do the math.

Why, the stethoscope, of course. Ask practically anybody in a lab coat (which incidentally also carries ten tons of cooties) and you’ll get the quick answer that – just like grubby doctor hands – stethoscopes can – and do – transmit millions of invisible critters, all over the hospital, every damned minute of the day.

So according to a recent study, how many doctors do you suppose bother to clean their stethoscopes between patients?

None.

Not a one. And that fact was determined to be true even after educational intervention was instituted, about how essential stethoscope hygiene actually is, in preventing infections.

Doctor Covering His Ears Over White Background

“I’m too busy to listen to facts!”

So a big fat “zero” number of doctors bother to wipe their stethoscopes with antiseptic pads between patient encounters, according to a study published in this month’s issue of the American Journal of Infection Control.

The investigation team – staffed by MDs from Yale University School of Medicine and the V/A in West Haven Connecticut – reported they already suspected the results would be poor.

But they were outright stunned to discover NO doctors were disinfecting their stethoscopes. After all, the Centers for Disease Control  guidelines mandate that reusable medical equipment must undergo disinfection between patients. That’s called a law with no teeth.

So physicians resist obeying the rules. Who knew?

The rotten study findings were especially confounding to the organizers, because second-year med students are taught early on, the importance of compliance, as one step of several that evaluate history & physical performance competency.

“Stethoscopes are used repeatedly throughout the work shift and become contaminated after patient contact. They must be treated as potential germ transmitters. Failing to disinfect stethoscopes can constitute a serious patient safety issue similar to ignoring hand hygiene.” (APIC President Linda Greene, RN)

A recent Swiss study found that stethoscopes were capable of transmitting lethally resistant bacteria, including methicillin-resistant Staphylococcus aureus (MRSA). Pathogens cultured from stethoscopes include Staphylococcus aureus, Pseudomonas aeruginosa, Clostridium difficile and vancomycin-resistant enterococci. 

The doctors underwent a quality improvement project in which they were supposed to follow standard hygiene, using alcohol swabs or disinfectant wipes, at a teaching hospital. Most of them washed their hands. No one bothered with stethoscope cleanliness.

At the mid-point in the study, the investigators stepped in and reiterated the importance of stethoscope hygiene between patient encounters. They underscored the safe practices expectation, that the physicians follow proper protocols. It didn’t matter what they were taught, the doctors in a real-time, real-patient environment, simply refused to clean their stethoscopes. 

Results

Hand hygiene rates were lower than anticipated, 58% initially and 63% post-intervention, which was not statistically significant. Stethoscope hygiene never occurred during the 128 initial and 41 post intervention observations (see Table 1)

Table 1       Stethoscope and hand hygiene before and after the multimodal intervention
  Before   (performed) After (performed) P value
Hand Hygiene 73/126    (58%) 29/46      (63%) 0.55
Stethoscope Hygiene 0/128      (0%) 0/41        (0%)

The authors ended the study by stating that the project demonstrates routine education may not be the answer to the problem of stubborn doctors, and stronger efforts may be necessary to change the careless culture and careless habits.

To which we at Medical Miscreants say, “No shit, Sherlock.”

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