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In reply—A “Solution” for Infectious Stethoscopes?

      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,
      • Parmar R.C.
      • Valvi C.C.
      • Sira P.
      • Kamat J.R.
      A prospective, randomised, double-blind study of comparative efficacy of immediate versus daily cleaning of stethoscope using 66% ethyl alcohol.
      isopropyl alcohol swabs,
      • Sanders S.
      The stethoscope and cross-infection.
      • Blydt-Hansen T.
      • Subbarao K.
      • Quennec P.
      • McDonald J.
      Recovery of respiratory syncytial virus from stethoscopes by conventional viral culture and polymerase chain reaction.
      • Cohen H.A.
      • Amir J.
      • Matalon A.
      • Mayan R.
      • Beni S.
      • Barzilai A.
      Stethoscopes and otoscopes—a potential vector of infection?.
      • Breathnach A.S.
      • Jenkins D.R.
      • Pedler S.J.
      Stethoscopes as possible vectors of infection by staphylococci.
      • Mangi R.J.
      • Andriole V.T.
      Contaminated stethoscopes: a potential source of nosocomial infections.
      isopropyl wipes,
      • Kennedy K.J.
      • Dreimanis D.E.
      • Beckingham W.D.
      • Bowden F.J.
      Staphylococcus aureus and stethoscopes.
      • Zachary K.C.
      • Bayne P.S.
      • Morrison V.J.
      • Ford D.S.
      • Silver L.C.
      • Hooper D.C.
      Contamination of gowns, gloves, and stethoscopes with vancomycin-resistant enterococci.
      sodium hypochlorite,
      • Marinella M.A.
      • Pierson C.
      • Chenoweth C.
      The stethoscope: a potential source of nosocomial infection?.
      benzalkonium chloride swabs,
      • Marinella M.A.
      • Pierson C.
      • Chenoweth C.
      The stethoscope: a potential source of nosocomial infection?.
      regular detergent,
      • Bernard L.
      • Kereveur A.
      • Durand D.
      • et al.
      Bacterial contamination of hospital physicians' stethoscopes.
      • Jones J.S.
      • Hoerle D.
      • Riekse R.
      Stethoscopes: a potential vector of infection?.
      antiseptic soap,
      • Jones J.S.
      • Hoerle D.
      • Riekse R.
      Stethoscopes: a potential vector of infection?.
      and ethanol-based hand rub solution.
      • Lecat P.
      • Cropp E.
      • McCord G.
      • Haller N.A.
      Ethanol-based cleanser versus isopropyl alcohol to decontaminate stethoscopes.
      All these disinfectants were found to substantially reduce the microbial burden on stethoscopes. However, because few comparative studies have been conducted, the optimal method of decontamination remains to be identified. In addition, other aspects such as ease of use, accessibility, and compatibility should also be considered when selecting a decontamination method.
      Regrettably, despite the publication of several studies on the infectious risks associated with stethoscopes, physicians still fail to comply with this simple rule. Studies have shown that 47% to 86% of health care workers do not disinfect their stethoscope regularly
      • Sengupta S.
      • Sirkar A.
      • Shivananda P.G.
      Stethoscopes and nosocomial infection.
      • Cohen S.R.
      • McCormack D.J.
      • Youkhana A.
      • Wall R.
      Bacterial colonization of stethoscopes and the effect of cleaning.
      and that only 6% to 15% disinfect their stethoscope after every use.
      • Marinella M.A.
      • Pierson C.
      • Chenoweth C.
      The stethoscope: a potential source of nosocomial infection?.
      • Wood M.W.
      • Lund R.C.
      • Stevenson K.B.
      Bacterial contamination of stethoscopes with antimicrobial diaphragm covers.
      As a solution, Dr Lecat suggests advancement of proper behavior through education and promotion strategies. However, there are reasons to believe that such strategies would be of limited efficacy. For example, despite numerous campaigns stressing the importance of hand hygiene, physicians’ compliance with this simple gesture remains distressingly low.
      • Pittet D.
      • Simon A.
      • Hugonnet S.
      • Pessoa-Silva C.L.
      • Sauvan V.
      • Perneger T.V.
      Hand hygiene among physicians: performance, beliefs, and perceptions.
      World Health Organization
      WHO Guidelines on Hand Hygiene in Health Care (Advanced Draft).
      There are few reasons to believe that physicians could be any better at disinfecting their stethoscope than they are at disinfecting their own hands.
      Confronted with this situation, a more appealing, feasible, and scientifically sound solution should be to ban the use of personal stethoscopes and replace them with dedicated stethoscopes available at every patient’s bedside. This strategy would have the immediate benefit of greatly reducing the risk of transmitting potential pathogens between patients through this instrument.
      Regardless, we appreciate Dr Lecat’s comments and suggestions. Clearly, future research is warranted to identify methods to decrease the infectious risks associated with the use of stethoscopes.

      References

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        • Valvi C.C.
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        • Kamat J.R.
        A prospective, randomised, double-blind study of comparative efficacy of immediate versus daily cleaning of stethoscope using 66% ethyl alcohol.
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        • Sanders S.
        The stethoscope and cross-infection.
        Br J Gen Pract. 2003; 53 ([letter]): 971-972
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        Ethanol-based cleanser versus isopropyl alcohol to decontaminate stethoscopes.
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        • Lund R.C.
        • Stevenson K.B.
        Bacterial contamination of stethoscopes with antimicrobial diaphragm covers.
        Am J Infect Control. 2007; 35: 263-266
        • Pittet D.
        • Simon A.
        • Hugonnet S.
        • Pessoa-Silva C.L.
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        • Perneger T.V.
        Hand hygiene among physicians: performance, beliefs, and perceptions.
        Ann Intern Med. 2004; 141: 1-8
        • World Health Organization
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        World Health Organization, Geneva, Switzerland2006

      Linked Article

      • A “Solution” for Infectious Stethoscopes?
        Mayo Clinic ProceedingsVol. 89Issue 9
        • In Brief
          Although the article by Longtin et al1 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,2 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.
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