Improving Stethoscope Disinfection at a Children's Hospital

Justin Zaghi, BS; Jing Zhou, MS; Dionne A. Graham, PhD; Gail Potter-Bynoe, BS, CIC; and Thomas J. Sandora, MD, MPH

Disclosures

Infect Control Hosp Epidemiol. 2013;34(11):1189-1193. 

In This Article

Abstract and Introduction

Abstract

Objective. Stethoscopes are contaminated with pathogenic bacteria and pose a risk for transmission of infections, but few clinicians disinfect their stethoscope after every use. We sought to improve stethoscope disinfection rates among pediatric healthcare providers by providing access to disinfection materials and visual reminders to disinfect stethoscopes.

Design. Prospective intervention study.

Setting. Inpatient units and emergency department of a major pediatric hospital.

Participants. Physicians and nurses with high anticipated stethoscope use.

Methods. Baskets filled with alcohol prep pads and a sticker reminding providers to regularly disinfect stethoscopes were installed outside of patient rooms. Healthcare providers' stethoscope disinfection behaviors were directly observed before and after the intervention. Multivariable logistic regression models were created to identify independent predictors of stethoscope disinfection.

Results. Two hundred twenty-six observations were made in the preintervention… period and 261 in the postintervention period (83% were of physicians). Stethoscope disinfection compliance increased significantly from a baseline of 34% to 59% postintervention (P <. 001). In adjusted analyses, the postintervention period was associated with improved disinfection among both physicians (odds ratio [OR], 2.3 [95% confidence interval (CI), 1.4–3.5]) and nurses (OR, 14.3 [95% CI, 4.6–44.6]). Additional factors independently associated with disinfection included subspecialty unit (vs general pediatrics; OR, 0.5 [95% CI, 0.3–0.8]) and contact precautions (OR, 2.3 [95% CI, 1.2–4.1]).

Conclusions. Providing stethoscope disinfection supplies and visible reminders outside of patient rooms significantly increased stethoscope disinfection rates among physicians and nurses at a children's hospital. This simple intervention could be replicated at other healthcare facilities. Future research should assess the impact on patient infections.

Introduction

Several studies have demonstrated that stethoscope membranes harbor pathogenic bacteria, including methicillin-resistant Staphylococcus aureus,[1–4] vancomycin-resistant enterococci,[5–7] and Clostridium difficile.[8] While direct evidence linking contaminated stethoscopes with patient infections remains sparse outside of outbreak settings, stethoscopes inoculated with C. difficile and methicillin-resistant Staphylococcus aureus were recently shown to transmit these bacteria to skin,[9] highlighting the potential role of contaminated stethoscopes in transmission of organisms between patients.

Despite the availability of disinfectants that can reduce the burden of bacterial contamination on stethoscope diaphragms, only a minority of healthcare providers regularly disinfect their stethoscopes.[10,11] In a survey we conducted at Boston Children's Hospital in 2010, only 24% of physicians and nurses reported routinely disinfecting their stethoscope after every use, even though 76% believed that infection transmission occurs via stethoscopes.[12] In multivariate analyses, barriers to stethoscope disinfection after every use included lack of time, lack of access to disinfection material, and lack of visual reminders to disinfect. On the basis of these findings, we hypothesized that installing baskets filled with alcohol prep pads outside of patient rooms, with a visual reminder to disinfect, could significantly improve stethoscope disinfection practices. We therefore undertook a project to provide these materials at the point of patient care and sought to assess the impact of this intervention on providers' stethoscope disinfection rates.

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