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A “Solution” for Infectious Stethoscopes?

      To the Editor:
      Although the article by Longtin et al
      • Longtin Y.
      • Schneider A.
      • Tschopp C.
      • et al.
      Contamination of stethoscopes and physicians' hands after a physical examination.
      published in the March 2014 issue of Mayo Clinic Proceedings is an important contribution, it does not offer a solution to the infectivity of stethoscopes. An article by my colleagues and me,
      • Lecat P.
      • Cropp E.
      • McCord G.
      • Haller N.A.
      Ethanol-based cleanser versus isopropyl alcohol to decontaminate stethoscopes.
      which was cited by Longtin et al, documented that ethanol-based hand sanitizer effectively cleans stethoscope surfaces as well as the hands. The simple maneuver of concurrently wiping stethoscope surfaces and cleaning hands with sanitizer is proven to be effective in reducing colony counts of known pathogens and requires virtually no additional time. We found no difference in effectiveness on stethoscope diaphragms between use of this solution and the recommended isopropyl alcohol pad.
      We were disappointed that the behavioral aspects of our study were generally not understood or implemented, although the article by Longtin et al revealed that this maneuver could considerably affect patients. Anecdotally, we were told by several of our study participants that the 2 behaviors were mutually reinforcing, ie, cleaning the stethoscope was a reminder to clean hands and vice versa.
      Although damage to stethoscope tubing is cited as a problem with cleaning the stethoscope, given a tubing replacement cost of less than $50, and a new stethoscope generally less than $200, can we afford not to replace our stethoscopes for the sake of protecting our patients?
      As stated by the Centers for Disease Control and Prevention,

      Centers for Disease Control and Prevention (CDC). Hand Hygiene in Healthcare Settings-Core [PowerPoint presentation]. http://www.cdc.gov/handhygiene/download/hand_hygiene_core.pdf. Accessed May 16, 2014.

      Centers for Disease Control and Prevention; Infectious Disease Society of America; American Society of Blood and Marrow Transplantation
      Guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients.
      “Clean hands are the single most important factor in preventing the spread of pathogens and antibiotic resistance in healthcare settings.” If this is so, and stethoscopes bear nearly the same number of bacteria, how important is it to sanitize our stethoscopes simultaneously, using the now ubiquitous ethanol-based sanitizers? We have documented this to be an immediate, simple, and effective “solution.”

      References

        • Longtin Y.
        • Schneider A.
        • Tschopp C.
        • et al.
        Contamination of stethoscopes and physicians' hands after a physical examination.
        Mayo Clin Proc. 2014; 89: 291-299
        • Lecat P.
        • Cropp E.
        • McCord G.
        • Haller N.A.
        Ethanol-based cleanser versus isopropyl alcohol to decontaminate stethoscopes.
        Am J Infect Control. 2009; 37: 241-243
      1. Centers for Disease Control and Prevention (CDC). Hand Hygiene in Healthcare Settings-Core [PowerPoint presentation]. http://www.cdc.gov/handhygiene/download/hand_hygiene_core.pdf. Accessed May 16, 2014.

        • Centers for Disease Control and Prevention; Infectious Disease Society of America; American Society of Blood and Marrow Transplantation
        Guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients.
        MMWR Recomm Rep. 2000; 49 ([published correction appears in MMWR Recomm Rep. 2004;53(19):396]) (CE1-7): 1-125

      Linked Article

      • Contamination of Stethoscopes and Physicians' Hands After a Physical Examination
        Mayo Clinic ProceedingsVol. 89Issue 3
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          To compare the contamination level of physicians’ hands and stethoscopes and to explore the risk of cross-transmission of microorganisms through the use of stethoscopes.
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        Open Access
      • In reply—A “Solution” for Infectious Stethoscopes?
        Mayo Clinic ProceedingsVol. 89Issue 9
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          We thank Dr Lecat for his interest in our article on contamination of stethoscopes after a physical examination. We agree that our study was not designed to identify the optimal decontamination strategy. Numerous articles have examined potential decontamination strategies, including ethanol wipes,1 isopropyl alcohol swabs,2-6 isopropyl wipes,7,8 sodium hypochlorite,9 benzalkonium chloride swabs,9 regular detergent,10,11 antiseptic soap,11 and ethanol-based hand rub solution.12 All these disinfectants were found to substantially reduce the microbial burden on stethoscopes.
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