A Routine Surgery That Wasn’t Routine

In January 2016, I underwent what was supposed to be a straightforward total hip arthroplasty.

I had reached a point where the pain in my hips was no longer manageable. Otherwise, I was healthy. My labs were normal. I had no underlying conditions that would put me at higher risk. As part of the preoperative process, I was screened for methicillin-resistant Staphylococcus aureus (MRSA). The culture was negative.

The surgery itself went as planned.

A few days later, things began to change.

There was swelling in the extremity. Then a fever. Within a short period of time, my condition deteriorated in ways that were difficult for my family to fully understand. I became confused. My speech changed. By the end of that week, I was no longer able to communicate clearly.

I was readmitted post-op day 10, the diagnosis of septic bacteremia/MRSA came on day 14.

The shift from routine recovery to a life-threatening infection happened in a matter of days.

Living With the Question

Because of my background in infection prevention, I understood what this diagnosis meant. I also understood something else that has stayed with me since.

I was not colonized with MRSA before surgery, then the infection did not originate from me.

In infection prevention terms, that distinction matters. Some infections are endogenous, meaning they come from the patient’s own flora. Others are exogenous, introduced from the environment or through contact during care.

In my case, the evidence pointed to an external source.

That leads to a difficult question.

Where did it come from?

That question has never been answered, no Root Cause Analysis was done. Even with the progress that has been made in infection prevention, there are still cases where we cannot identify the source. For patients, that uncertainty does not go away. It stays with you.

Transmission Does Not Require a Major Failure

When people think about infection risk, they often picture a breakdown in sterile technique or a missed step in a protocol.

In reality, transmission can occur in far more routine ways.

Healthcare is built on constant interaction. Patients are examined, reassessed, and monitored throughout the day. Each interaction involves contact, and each point of contact carries some level of risk.

In that environment, bacteria do not need a major lapse to move from one place to another. They only need a pathway, a vector.

Over time, I found myself returning to a simple observation.

Something was carrying bacteria.

The Clinician’s Third Hand: The Stethoscope Diaphragm Is Routinely Contaminated With MRSA and Other Resistant Pathogens

Among the many surfaces and tools used in patient care, some receive more attention than others. Hands have been the focus of decades of research and behavior change efforts, and for good reason. What about other surfaces?

One vector of concern is the “Clinician’s Third Hand”, the stethoscope diaphragm, which comes into direct contact with patients often.

Work led by Didier Pittet, the infectious disease expert who helped integrate workflow-compatible alcohol dispensers into modern care through the CDC’s 2002 hand hygiene guidelines, has shown strong evidence that the stethoscope diaphragm acts as a vector for pathogen transmission.¹

He demonstrated that after a single patient exam, the diaphragm of a stethoscope can become contaminated with bacteria, including MRSA, at levels comparable to a clinician’s hands. In some cases, contamination has been detected even before patient contact, suggesting that the device itself can serve as a reservoir.

The stethoscope diaphragm was the second most contaminated surface, with MRSA among the pathogens identified, second only to clinicians’ fingertips.¹

What is more concerning is not just the contamination, but the lack of consistent systems to address it.

In many hospitals today, there is still no standardized policy or procedure ensuring stethoscope hygiene between patients.

That is not an individual failure. It is a systemic one.

Without reliable processes, even well-intentioned clinicians are left to depend on memory and time in fast-paced environments. The result is variability, and variability creates risk.

This leaves patients in a position of exposure to pathogens that can be life threatening.

The Gap Between Intention and Practice

Most clinicians are aware that stethoscopes should be cleaned between patients. The challenge is not knowledge. It is consistency.

Clinical workflows are fast-paced and complex. Priorities compete for attention. Even well-established practices can become inconsistent when they rely on perfect execution in every moment.

Unlike hand hygiene, which is reinforced through visibility and repetition, stethoscope hygiene often happens out of sight. There is no immediate cue, no clear signal to the patient, and no easy way to verify that it has been done.

Over time, this creates variability.

Infection prevention is not only about having the right protocols in place. It is about ensuring that those protocols are reliably carried out in real-world conditions.

Seeing It From the Patient’s Perspective

Before this happened, I understood infection prevention from a professional standpoint.

Afterward, I understood it as a patient.

What changed most was my understanding of the long-term impact. We talk about treating infections, managing infections, controlling infections. What we do not always talk about is the reality that, in some cases, we cannot eliminate them.

In my situation, the colonization/infection never went away. It has required multiple surgeries, long-term antibiotic therapy, and ongoing monitoring. At this point, it is something I live with.

There are limits to what current treatments can do. Antibiotics can suppress bacterial growth, but they do not always eliminate it. Over time, options become more limited.

That is a different way of thinking about healthcare-associated infections.

This is not always a short-term complication. For some patients, it becomes a permanent condition.

Moving Toward More Reliable Protection

Healthcare involves complexity, and uncertainty is part of that reality.

At the same time, there is an opportunity to reduce reliance on perfect behavior by designing processes that are easier to follow consistently.

In the case of stethoscope hygiene, that has led to interest in approaches that make cleanliness more immediate and more visible. Solutions such as The DiskCover System are built around that idea, providing a clean surface for each patient encounter without requiring a separate cleaning step.²

Affordable, rapid, and simple technology exists to protect patients from stethoscope contamination, making continued reliance on inconsistent manual cleaning increasingly difficult to justify.

In an efficacy study, disk covers protecting contaminated stethoscope diaphragm surfaces were 100% culture negative for all tested pathogens, including MRSA

An Unanswered Question

I recovered from the sepsis event, but the question of where it came from has never been fully resolved.

That question matters, not only because of what happened to me, but because it points to something broader.

Infection prevention has made significant progress over the years. Yet there are still areas where risk is not fully addressed, often because it exists in routine, familiar parts of care.

Stethoscopes are one example.

They are used constantly. They come into direct contact with patients. And we know they can carry the same organisms we work so hard to control elsewhere.

If we are serious about reducing preventable infections, we have to be willing to look closely at those everyday moments.

That is where many of the remaining gaps still exist.

References

1. Longtin Y, Schneider A, Tschopp C, et al. Contamination of stethoscopes and physicians’ hands after a physical examination. Mayo Clin Proc. 2014;89(3):291-299. doi:10.1016/j.mayocp.2013.11.016
2. Vasudevan R, Shin JH, Chopyk J, et al. Aseptic Barriers Allow a Clean Contact for Contaminated Stethoscope Diaphragms. Mayo Clin Proc Innov Qual Outcomes. 2020;4(1):21-30. Published 2020 Feb 5. doi:10.1016/j.mayocpiqo.2019.10.010

The post I Survived MRSA. We Still Don’t Know Where It Came From: A Stethoscope Hygiene Perspective appeared first on The DiskCover System.

Key Takeaways

• Patients are increasingly aware of infection prevention practices during their care.
• Stethoscopes can carry contamination levels comparable to clinicians’ hands when not disinfected between patients.
• Visible hygiene practices can reassure patients and strengthen trust in the care environment.
• Healthcare providers always want to do the right thing, but workflow may be a barrier.
• Emerging workflow solutions aim to ensure clean patient-contact surfaces during every examination.

Why Patients Pay Attention to Hospital Cleanliness and Infection Prevention

Patients today are more attentive than ever to the cleanliness of their healthcare environment. Research examining patient experience data has shown that perceptions of cleanliness strongly influence how patients evaluate the quality and safety of care they receive.

Press Ganey analysis of patient experience data has found that visible signs of hygiene, environmental cleanliness, and infection prevention practices are closely tied to patient confidence in healthcare organizations. Patients often interpret these cues as indicators of how seriously their care team takes safety and infection prevention.¹

In unfamiliar clinical environments, patients naturally look for reassurance that they are being protected from potential risks. Simple actions such as hand hygiene, the use of protective equipment, and visible cleaning practices help communicate a culture of safety.

Over the past several years, public awareness of healthcare-associated infections has also increased. Patients increasingly recognize that infection prevention involves many aspects of care, including the medical devices used during routine examinations.

One device that patients see used repeatedly throughout their care is the stethoscope.

Stethoscope Contamination and Infection Risk During Patient Examinations

Because stethoscopes are used so frequently, they also move between patients throughout the day. Research has demonstrated that stethoscope diaphragms can harbor microbial contamination similar to that found on clinicians’ hands if they are not cleaned between patient encounters.²

For patients, understanding that a device used in their examination may have contacted many other patients can raise questions about infection risk.

While clinicians are trained to follow disinfection guidelines, maintaining perfect compliance in busy clinical environments can be challenging. These realities have led infection prevention leaders to explore ways to strengthen hygiene practices around commonly used medical devices.

Cancer Patients Emphasize the Importance of Clean Stethoscopes

While patients often notice visible hygiene practices such as hand hygiene and environmental cleaning, research suggests that expectations extend to the medical devices used during examinations.

A study conducted at the Cleveland Clinic surveyed both patients and healthcare professionals regarding their perceptions of stethoscope hygiene and the use of stethoscope barriers.³ The patient cohort included immunocompromised patients receiving cancer care, where infection prevention practices are particularly critical.

During the study, patients reported that they rarely witnessed healthcare professionals cleaning stethoscopes, raising concerns about whether the device had been cleaned between patient encounters.

When asked to rate the importance of a stethoscope being clean before it touches them, patients gave the practice the highest possible importance rating, averaging 100 out of 100 on a 100-point scale.

For many patients, the stethoscope is one of the most visible medical tools used during examinations. Seeing the same device used repeatedly across multiple patient encounters can lead patients to question whether the contact surface has been disinfected.

These findings reinforce a broader trend seen in patient experience research: visible infection prevention practices help patients feel safer and more confident in their care environment. Ensuring that examination devices begin each patient encounter with a clean contact surface may therefore support both patient safety and patient trust.

How Visible Infection Prevention Practices Improve Patient Confidence

Patients often interpret visible safety practices as a reflection of the overall quality of care they are receiving.

When infection prevention steps are clearly observable, they can help reassure patients that their care team is actively protecting them from potential risks. For example, watching a clinician perform hand hygiene before an examination signals a commitment to patient safety.

The same principle applies to the tools used during care.

If patients see that a clean patient-contact surface is being used during their examination, it reinforces the perception that infection prevention is being taken seriously. These visible safeguards can be especially meaningful for individuals who are already anxious about their health or hospitalization.

In this way, infection prevention practices can contribute not only to patient safety but also to patient confidence.

Why Stethoscope Hygiene Compliance Can Be Challenging in Clinical Workflows

Guidelines recommend disinfecting stethoscopes between patient encounters. However, studies have shown that achieving consistent compliance with these recommendations can be difficult in real-world clinical settings.

Healthcare providers often work in fast-paced environments where examinations must occur quickly and efficiently. Ensuring that every stethoscope surface is disinfected thoroughly between patients can be challenging when clinicians are managing multiple responsibilities.

Because the stethoscope functions almost like a “third hand” during patient care, infection prevention teams have begun examining whether new approaches might better support consistent hygiene practices.

Emerging Workflow Solutions to Improve Stethoscope Hygiene and Patient Safety

To address these challenges, some healthcare organizations have explored workflow-based approaches that help ensure a clean patient-contact surface for every examination.

One example includes the use of aseptic stethoscope barriers that create a fresh contact surface for the stethoscope diaphragm before each patient encounter. Systems such as The DiskCover System automate the application of these touch-free, aseptic single-use barriers, allowing clinicians to maintain consistent hygiene without adding additional manual cleaning steps.

Because the barrier is visibly applied before the examination, patients can also see that a clean surface is being used during their care. For some healthcare organizations, this combination of safety and visibility has been an important component of improving the patient experience.

Strengthening Patient Trust Through Infection Prevention

Patient trust is built through consistent actions that demonstrate a commitment to safety.

Infection prevention practices such as hand hygiene, environmental cleaning, and device hygiene all contribute to creating a care environment where patients feel protected. While many of these precautions occur behind the scenes, visible safety measures can play a powerful role in reinforcing confidence in the care team.

As healthcare organizations continue working to reduce healthcare-associated infections, attention to commonly used examination devices such as the stethoscope may represent an additional opportunity to improve both patient safety and patient experience.

Ensuring that every patient examination begins with a clean contact surface helps reinforce a culture where safety, trust, and compassionate care remain central to the healthcare experience.

References

1. Press Ganey. Emerging Best Practices in Response to Evolving Patient Perceptions of Clean. Compass One Healthcare. 2022.
2. Longtin Y, Schneider A, Tschopp C, Renzi G, Gayet-Ageron A, Schrenzel J, et al. Contamination of stethoscopes and physicians’ hands after a physical examination. Mayo Clin Proc. 2014;89(3):291-299.
3. Siegmund, L.A., Peacock IV, W.F., Bena, J., Morrison, S. “Patients and Healthcare Professionals’ Perceptions of Stethoscope Barriers” OJIN: The Online Journal of Issues in Nursing Vol. 29, No. 3. 2024 Sep 17.

The post Patients Feel a Clean Stethoscope is CRITICALLY IMPORTANT. So Why Don’t Healthcare Providers Perform Hygiene? appeared first on The DiskCover System.

Key Takeaways

• Stethoscope hygiene remains an underrecognized patient safety issue in healthcare.
• The stethoscope diaphragm can carry pathogens similar to clinicians’ hands.
• Disky’s National Patient Safety Initiative raises awareness about safe and effective stethoscope hygiene
• Patients and clinicians can both participate in promoting safer care practices.

Why Stethoscope Hygiene Matters for Patient Safety

For many patients, the stethoscope is one of the most recognizable symbols of healthcare.

It is also one of the most frequently used diagnostic tools in medicine.

Clinicians use it during routine exams to listen to heart sounds, lung sounds, and other important findings. Because it is used so often, the stethoscope also comes into direct contact with patients throughout the day.

Research has shown that the stethoscope diaphragm can accumulate microbes in a way similar to clinicians’ hands, which led researchers to describe it as a clinician’s “third hand.”¹

Hospitals devote extensive attention to hand hygiene because of its role in preventing the spread of infection.

However, stethoscope hygiene has historically received far less attention, even though the device follows the same pattern of patient contact. Improving awareness of this issue is an important step toward strengthening infection prevention and protecting patients during everyday clinical care.

The Hidden Gap in Stethoscope Hygiene

Hospitals have long recommended cleaning the stethoscope diaphragm between patient exams.

While the concept is simple, decades of research have shown that manual cleaning alone has not produced consistent hygiene in real clinical environments.²

Cleaning practices may be shortened or skipped during busy shifts.
Even when cleaning occurs, it does not always return the device to a fully clean state.³

Studies have found that observed stethoscope cleaning compliance can be extremely low (less than 4%) in routine care settings.²

These challenges are not caused by a lack of concern for patient safety.
They reflect the reality of clinical workflow, where clinicians must move quickly between patients while managing many competing priorities.

Recognizing this gap has led infection prevention leaders to call for greater attention to stethoscope hygiene as part of patient safety efforts.

Disky’s National Patient Safety Initiative for Stethoscope Hygiene

Disky’s National Patient Safety Initiative was created to help raise awareness about stethoscope hygiene and its role in patient safety.

Disky, the curator for safe and effective stethoscope hygiene, represents a simple idea:

The stethoscope should be treated with the same level of hygiene awareness as the clinician’s hands.

The initiative focuses on three goals:

1. Raising awareness of stethoscope contamination
Helping clinicians, healthcare leaders, and patients better understand how stethoscope contamination can occur during routine care.

2. Encouraging conversations about stethoscope hygiene
Creating opportunities for clinicians and patient safety advocates to discuss practical approaches to improving hygiene.

3. Promoting safer stethoscope hygiene habits in everyday care
Highlighting solutions that help ensure a clean patient contact surface during each exam.

By bringing visibility to the issue, the initiative helps make stethoscope hygiene part of the broader patient safety conversation.

How Clinicians and Patients Can Participate in Promoting Safer Care

For clinicians passionate about improving patient safety and experience in their clinical setting, the first step is easy: just request your free Disky figure.

Following the request, healthcare professionals are shipped a small Disky figure that can travel with them back to their clinical units or departments.

Patients and families can also participate by sharing photos with Disky during healthcare visits or by supporting the message of safe stethoscope hygiene.

After taking their photo(s) with Disky in their healthcare settings, clinicians and patients are encouraged to send their photos in via email to disky@aseptiscope.com, or directly by going to (https://diskcover.com/disky-submission/), where we can feature them as the weekly Stethoscope Hygiene Champion on AseptiScope social media platforms.

These shared stories help highlight a simple but powerful message:

Patient safety is a shared responsibility between healthcare teams and the patients they care for.

When patients feel comfortable asking questions about infection prevention practices, it strengthens the culture of safety throughout the healthcare system.

Why Patient Experience Is Part of Infection Prevention

Infection prevention is not only about reducing clinical risk.
It also shapes how patients experience care.

Patients often notice the actions clinicians take to protect them.
Hand hygiene, protective equipment, and visible infection prevention practices can reassure patients that their safety is a priority.

Stethoscope hygiene can play a similar role.

When patients see that clinicians are using clean equipment for each exam, it reinforces trust and confidence in the care they receive.

Visible hygiene practices help demonstrate a commitment to patient safety, which can improve patient experience and strengthen the relationship between clinicians and the people they care for.

A Growing Movement for Stethoscope Hygiene and Patient Safety

Disky’s National Patient Safety Initiative is part of a broader effort to bring attention to stethoscope hygiene as an important component of infection prevention.

The stethoscope has been a trusted diagnostic tool for more than two centuries.

Ensuring that this trusted instrument remains both clinically effective and hygienically safe is an important step toward improving patient safety.

Through awareness, education, and collaboration between clinicians and patients, the healthcare community can continue advancing toward safer care for every patient encounter.

References

1. Longtin Y, Schneider A, Tschopp C, Renzi G, Gayet-Ageron A, Schrenzel J, et al. Contamination of stethoscopes and physicians’ hands after a physical examination. Mayo Clin Proc. 2014;89(3):291-299.
2. Boulée D, Kalra S, Haddock A, Johnson TD, Peacock WF. Contemporary stethoscope cleaning practices: What we haven’t learned in 150 years. Am J Infect Control. 2019 Mar;47(3):238-242. doi: 10.1016/j.ajic.2018.08.005. Epub 2018 Nov 2.
3. Knecht VR, McGinniss JE, Shankar HM, et al. Molecular analysis of bacterial contamination on stethoscopes in an intensive care unit. Infect Control Hosp Epidemiol. 2019;40(2):171-177. doi:10.1017/ice.2018.319

The post Why Stethoscope Hygiene Matters for Patient Safety: Disky’s National Patient Safety Initiative appeared first on The DiskCover System.

Key Takeaways

• Stethoscope hygiene is an overlooked part of infection prevention. Research shows the stethoscope diaphragm can carry bacterial contamination levels similar to clinicians’ hands, making it a potential vector for healthcare-associated infections (HAIs).

• Manual cleaning between patients is difficult to sustain in real clinical workflow. Time pressure, low compliance, and inconsistent cleaning effectiveness make traditional wipe-based stethoscope disinfection unreliable in busy healthcare environments.

• Workflow-based hygiene solutions improve compliance and patient safety. Technologies such as touch-free aseptic stethoscope barriers help ensure a clean diaphragm surface for each exam without disrupting clinical care.

The Stethoscope as the Clinician’s “Third Hand”

For patients, the consequences of healthcare-associated infections (HAIs) can be serious. HAIs can lead to longer hospital stays, additional treatments, and in some cases life-threatening complications. Patients who are already vulnerable, such as those in intensive care, oncology units, or post-surgical recovery, face even greater risk.

Because of these risks, infection prevention is an important, constant focus in healthcare. When people think about infection prevention in healthcare, they usually think about hand hygiene.

For good reason. Hands are the primary way pathogens move from one surface to another in clinical care.

But there is another surface that touches patients just as often.

The stethoscope, particularly the diaphragm which intentionally comes into direct contact with patients.

It is used constantly during patient care. It comes into direct contact with skin. And it often moves from patient to patient throughout the day.

For these reasons, experts have referred to the stethoscope as the clinician’s third hand.

Yet it rarely receives the same attention as hand hygiene.

Research Shows Stethoscopes Frequently Carry Patient Pathogens

The idea of the stethoscope as a “third hand” is not just a metaphor. It is supported by research.

Didier Pittet, MD, MS, is an infectious disease expert, global leader in infection prevention, and key contributor to the 2002 CDC Guideline for Hand Hygiene in Health‑Care Settings which brought alcohol-based hand rub dispensers into standard of care.¹ Pittet also helped advance research into how pathogens move during patient care through the stethoscope.

In his widely cited study, investigators measured bacteria on physicians’ hands and on their stethoscopes immediately after examining patients.²

They found that the stethoscope diaphragm had substantial contamination, second only to the fingertips. The contamination levels also correlated closely with contamination of the clinician’s hands.

In simple terms, the stethoscope behaves much like another hand during patient care.

It touches patients.
It picks up pathogens.
And it can carry them to the next patient.

Preventing infections requires attention to every point of patient contact, including the stethoscope diaphragm.

This is why infection prevention leaders increasingly emphasize that stethoscope hygiene deserves attention alongside hand hygiene. If the stethoscope functions as the clinician’s third hand, it should be treated with the same level of care.

Experts Are Bringing the Issue Back Into Focus

In recent months, the topic has resurfaced in professional discussions across infection prevention communities.

Experts speaking in Infection Control Today have highlighted the persistent gap in stethoscope hygiene and the need for practical solutions that fit into clinical workflow.

The conversation reflects something many clinicians already recognize.

The challenge is not awareness.

The challenge is making the right action easy to perform every time.

Why Stethoscope Cleaning Between Patients Is Difficult in Clinical Practice

We have already discussed why disposable stethoscopes are not a great solution to this longstanding issue in a previous article.

So let us address the elephant in the room: Why don’t we just have everyone clean their stethoscope between every patient?

On paper, the solution may appear simple. In reality, this approach faces several challenges.

Time pressure. Clinicians move quickly between patients, often in high‑acuity environments. Even short cleaning steps can be difficult to perform consistently during a busy shift. When guidance requires up to a minute of cleaning for maximum (yet still incomplete) efficacy, and at least two minutes of dwell time for the disinfectant to do its job, it raises a practical question: where does that time come from during routine patient care?

Workflow interruptions. Many cleaning methods require locating wipes or disinfectants, applying them correctly, and waiting for proper contact time. These extra steps can interrupt the flow of patient care.

Limited effectiveness. Studies have also shown that common cleaning practices do not always fully remove contamination from the diaphragm surface. In one study, observations on CDC-recommended cleaning (60 seconds of wiping) revealed only a 50% return to clean rate. This was reduced to 10% when “clinician-preferred” cleaning methods were observed.³

For this reason, simply telling clinicians to clean it more has not solved the problem.

Lessons from Hand Hygiene and IV Connector Infection Prevention

For hand and IV connector hygiene, compliance improved because the workflow improved. In healthcare, safety practices work best when they are built directly into the care process.

It required identifying what was not working, understanding why it failed in real clinical workflows, and putting a solution in place that clinicians would actually use.

In other words, a break from the status quo. Just as hand hygiene and IV connector hygiene improved through evidence-based innovation, stethoscope hygiene should follow the same path. The data is clear. Cleaning alone is not enough. What is needed is a standardized solution that fits naturally into clinical workflow.

A New Approach to Stethoscope Hygiene: Touch-Free Aseptic Stethoscope Barriers

The DiskCover® System is evidence-based and addresses both compliance and efficacy challenges, by providing a touch-free, aseptic barrier for the stethoscope diaphragm before each exam.⁴

Instead of requiring clinicians to stop and manually clean the device, the system automatically applies a new aseptic disk cover at the point of care. This allows clinicians to use their own high-quality stethoscope while ensuring a clean patient contact surface during every exam.

Because the process takes only a moment and fits naturally into clinical workflow, it helps reduce the reliance on manual cleaning and supports more consistent stethoscope hygiene.

Improving Patient Safety by Addressing Stethoscope Hygiene

The stethoscope will remain a central tool in medicine. It is trusted by clinicians and recognized by patients around the world.

But as research continues to show, it should also be recognized for what it is during patient care.

A third hand.

And just like the other two hands clinicians use every day, it deserves a hygiene approach that fits naturally into clinical workflow.

Because in infection prevention, the safest systems are the ones that make the right action easy to perform every time.

References

1. Boyce JM, Pittet D; Healthcare Infection Control Practices Advisory Committee; HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Guideline for Hand Hygiene in Health-Care Settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America/Association for Professionals in Infection Control/Infectious Diseases Society of America. MMWR Recomm Rep. 2002;51(RR-16):1-CE4.
2. Longtin Y, Schneider A, Tschopp C, et al. Contamination of stethoscopes and physicians’ hands after a physical examination. Mayo Clin Proc. 2014;89(3):291-299. doi:10.1016/j.mayocp.2013.11.016
3. Knecht VR, McGinniss JE, Shankar HM, et al. Molecular analysis of bacterial contamination on stethoscopes in an intensive care unit. Infect Control Hosp Epidemiol. 2019;40(2):171-177. doi:10.1017/ice.2018.319
4. Vasudevan R, Shin JH, Chopyk J, et al. Aseptic Barriers Allow a Clean Contact for Contaminated Stethoscope Diaphragms. Mayo Clin Proc Innov Qual Outcomes. 2020;4(1):21-30. Published 2020 Feb 5. doi:10.1016/j.mayocpiqo.2019.10.010

The post Stethoscope Hygiene: The Clinician’s Third Hand In Infection Prevention appeared first on The DiskCover System.

Key Takeaways

• Disposable stethoscopes reduce diagnostic accuracy
• Patient-room devices still become contaminated during routine use
• Clinicians often revert to personal stethoscopes for careful exams
• Workflow-based hygiene solutions improve compliance

“Useless. Cheaply made, but not cheap to procure. Can’t hear a thing out of them. ‘Fisher-Price’ toys!”

These are the common reactions we get from clinicians when we ask them just how much they like using their single-patient disposable stethoscopes.

Hospitals adopted disposable stethoscopes with a clear goal: Reduce the risk of infection between patients.

At first glance, the idea seems practical. Place a stethoscope in each patient room. Limit cross contact between patients. Replace it when the patient leaves.

But over time, clinicians and infection prevention leaders have noticed a pattern. Disposable stethoscopes do not solve the stethoscope hygiene problem as well as many expected.

The reasons come down to three issues: diagnostic quality, contamination during use, and clinical workflow.

Disposable Stethoscopes Often Reduce Diagnostic Accuracy

The stethoscope remains one of the most widely used diagnostic tools in healthcare. Clinicians rely on it to detect heart murmurs, lung sounds, and other subtle clinical findings during routine exams.

Disposable stethoscopes often use lighter materials and simpler construction than clinical grade devices. This design can reduce sound clarity.

In testing environments, clinicians using disposable stethoscopes have shown higher rates of misidentifying cardiac murmurs compared with those using high quality clinical stethoscopes, with one peer-reviewed publication revealing a 10.9% misdiagnosis rate. Missing a murmur can delay recognition of serious cardiovascular conditions, potentially causing harm to a patient.

Because of this limitation, many clinicians still rely on their own stethoscope when they need a careful exam.

When this happens, the intended infection control benefit of the disposable device disappears.

Though this behavior is understandable. Clinicians trust the sound quality of the instrument they use every day.

It is a pity they’re being forced to choose between adhering to protocols (albeit for an implementation that is not evidence-based), or missing vital diagnostic sounds when they examine their patients!

Disposable Stethoscopes Still Become Contaminated

Disposable stethoscopes do not remain sterile once they enter a patient care environment.

During routine use, the diaphragm touches skin, bedding, clothing, and medical equipment. These surfaces can carry bacteria and other pathogens. As a result, microbes can accumulate on the stethoscope during the course of patient care.

Studies have shown that patient room stethoscopes can become colonized with hospital organisms after routine use. Bacteria such as MRSA have been found on both personal and shared stethoscopes in clinical settings.

This means a disposable stethoscope may still carry pathogens during repeated exams of the same patient or during contact with staff and nearby surfaces.

The device may start clean, but it does not stay clean.

The Real Challenge Is Consistent Stethoscope Hygiene

Disposable stethoscopes were implemented with good intention to protect patients, and attempt to reduce contamination.

However, they are not evidence-based, do not fully solve the core problem, and even present dangerous trade-offs related to contamination between clinicians and misdiagnosis of patients.

The real challenge is consistent stethoscope hygiene between patient exams.

Hand hygiene has clear standards and strong compliance programs in hospitals. Stethoscope hygiene has historically lacked the same level of attention.

Cleaning the diaphragm between patients takes time and often disrupts clinical workflow. As a result, compliance can be inconsistent in busy care environments.

A solution that truly improves stethoscope hygiene must meet several conditions. It must preserve sound quality so clinicians can diagnose patients accurately. It must fit naturally into clinical workflow so it can be used consistently. And it must provide a clean patient contact surface during every exam.

Disposable stethoscopes addressed only part of the problem. As healthcare systems continue to focus on infection prevention and patient safety, attention is shifting toward solutions that allow clinicians to maintain both diagnostic performance and reliable hygiene practices.

References

1. Knecht VR, McGinniss JE, Shankar HM, et al. Molecular analysis of bacterial contamination on stethoscopes in an intensive care unit. Infect Control Hosp Epidemiol. 2019;40(2):171-177. doi:10.1017/ice.2018.319
2. Kalra S, Garri RF, Shewale JB. Aseptic Disposable Stethoscope Barrier: Acoustically Invisible and Superior to Disposable Stethoscopes. Mayo Clin Proc. 2021;96(1):263-264. doi:10.1016/j.mayocp.2020.10.029

The post Disposable Stethoscopes and Infection Control: Why They Fall Short of Solving the Hygiene Problem appeared first on The DiskCover System.

By Dr. Sarathi Kalra

Stethoscopes are an integral part of acute and clinic patient care settings. In addition to routine physical exams, various medical conditions require thorough auscultation of the chest and abdomen for a comprehensive evaluation.

While some may argue that advancements in ultrasound and CT imaging provide superior clinical information, it is inappropriate to over-test patients, even when adequate healthcare resources are available. Additionally, due to financial feasibility and potential health risks from radiation exposure, it is not practical for the majority of hospitals to unnecessarily image all patients as radiation poses health risks. As such, the stethoscope has been, and will continue to be, an essential tool in patient care decision-making.

In acute care settings, the stethoscope is the “gateway” to choosing the appropriate imaging or procedure for a patient who is having difficulty breathing. Similarly, a child presenting with a detected heart murmur may prompt additional imaging, such as an echocardiograph. Without a stethoscope, there is the potential for significant delay in the identification of medical conditions. Over the last several decades, it has become evident that stethoscopes are vectors of infection. Several studies have shown that bacteria with the potential to cause fatal infections can be grown from different parts of the stethoscope.^1-3

Assuring an aseptic barrier is available to protect every patient is long overdue development – the AseptiScope DiskCover System provides an evidence-based “ray of hope.” Studies show the DiskCover aseptic barriers are effective in preventing patient exposure to harmful pathogens and contaminants while preserving sound quality for an optimal clinical experience.^4,5 Furthermore, it is easy to apply and remove new barriers, in seconds, between every patient exam.

As an Emergency Medicine physician who was recently diagnosed with COVID-19, I know any available barrier that may prevent infection transmission from clinician to patient is of utmost importance. SARS-CoV-2 has been detected on various hospital surfaces, including the stethoscope.⁶

For stethoscope infection barriers, the system must be easy to apply, aseptic and not impede the quality of auscultation. With the supportive evidence from clinical studies, the AseptiScope DiskCover System demonstrates these critical attributes and provides valuable protection to benefit patients and health care providers alike. Prevention is always better than cure, and the DiskCover System is a fast and simple solution that helps keep patients safe without impacting provider care.

1. Longtin Y, et al. Contamination of stethoscopes and physicians’ hands after a physical examination. Mayo Clin Proc. 2014;89(3):291-299. 

2. O’Flaherty, N.; Fenelon, L. The stethoscope and healthcare-associated infection: A snake in the grass or innocent bystander? J. Hosp. Infect. 2015, 91, 1–7.

3. Raghubanshi, BR, et al. Use of 90% ethanol to decontaminate stethoscopes in resource limited settings. Antimicrob. Resist. Infect. Control 2017, 6, 68.

4. Vasudevan R, et al. Aseptic Barriers Allow a Clean Contact for Contaminated Stethoscope Diaphragms. Mayo Clin Proc Innov Qual Outcomes. 2020;4(1):21-30. Published 2020 Feb 5. 

5. Data on file, AseptiScope. 

6. Pasquarella C, et al. Detection of SARS-CoV-2 on hospital surfaces. Acta Biomed 2020; Vol. 91, Supplement 9: 76-78.

Dr. Sarathi Kalra is an Assistant Professor and Research Director for the Department of Emergency Medicine at University of South Alabama in Mobile, AL. He has been closely involved with the department leadership in building the residency program and research curriculum for emergency medicine residents. 

Third Hand Vector series spotlights the clinician’s third hand and the risks that contaminated stethoscopes pose to clinicians, patients and healthcare systems. The series features leading experts in infection control, patient care and quality measures raising awareness of the importance of aseptic barriers in reducing transmission of infectious diseases.

The post OP ED #7: A Ray of Hope appeared first on The DiskCover System.

By Dr. Alan Maisel

For years, hospital infection control committees have endorsed the integration of single-use or “patient dedicated” stethoscopes as a means to mitigate stethoscope contamination. Support for these stethoscopes arose because disinfecting diaphragms between every patient as a standard of care was simply viewed as untenable in high workflow environments. While, conceptually, single-use stethoscopes seemed a reasonable alternative in high acuity care, in practice their use has been costly in three important ways:

1. Single-use stethoscopes cross-contaminate and remain a vector for infection. More aptly named “single-patient” stethoscopes, they remain in the patient’s room and are used by every clinician who examines that patient. Whittington et al. demonstrated that these stethoscopes are unprotected from pathogens, exposed to contaminants in the patient’s room, and handled by many clinicians. The diaphragms become and remain contaminated,¹ thus defeating their value in infection prevention.

2. Single-use stethoscopes cross-contaminate at both ends of the stethoscope. The earbuds of single-use stethoscopes become contaminated as they move in and out of the ears of multiple clinicians, essentially sharing the contents of one clinician’s ears with the next examining clinician’s ears¹ – and so on.

3. Single-use stethoscopes compromise our examination of the patient. Stethoscopes are incredibly fundamental tools; literally functioning as our third hand in evaluating patients. In high acuity care we rely on the ability to leverage heart, lung, and abdominal sounds to identify and manage clinical pathologies. The sound dampening of these inferior products is obvious to anyone who has used them; they confound accurate diagnosis and compromise patient management².

As infection prevention efforts intensify, and as effective auscultation remains essential for clinical care, it is time to reduce reliance on “single-patient” stethoscopes. Instead, stethoscope cross-contamination should be prevented with an aseptic and high-fidelity barrier that is applied in a touch-free fashion to our personal stethoscope diaphragms – to protect our patients, ourselves and the effectivity of our most valued clinical tool.

1. Whittington AM. Bacterial contamination of stethoscopes on the intensive care unit. Anaesthesia, 2009, 64: 620–624.

2.  Mehmood M.  Comparing the auscultatory accuracy of health care professionals using three different brands of stethoscopes on a simulator.  Medical Devices: Evidence and Research 2014:7 273–281.

Dr. Maisel is Professor of Medicine Emiritus, University of California, San Diego. He was director of the Coronary Care Unit and Heart Failure Program at the VA San Diego Healthcare System for 35 years. As a cardiologist, Dr. Maisel is considered a global expert in the application of cardiovascular biomarkers and has led multinational clinical trials that have paved the way for new care standards in diagnosis and management of acute cardiovascular conditions. He has published over 500 peer reviewed articles and original investigations. In 2001, the New England Journal of Medicine published his “Breathing Not Properly (BNP) Multinational Study” that signaled a clinical breakthrough that improved the diagnosis and risk stratification of heart failure. Dr. Maisel continues to advocate for the implementation of novel products that assist acute patient care.

Third Hand Vector series spotlights the clinician’s third hand and the risks that contaminated stethoscopes pose to clinicians, patients and healthcare systems. The series features leading experts in infection control, patient care and quality measures raising awareness of the importance of aseptic barriers in reducing transmission of infectious diseases.

The post OP ED #6: Hearing is Believing appeared first on The DiskCover System.

A novel, aseptic barrier system from AseptiScope prevents pathogen transmission 

June 29, 2020 San Diego, California – An article in the new issue of The American Journal of Medicine highlights the practical and symbolic importance of the stethoscope and its key role in assessment of COVID-19 patients.  Despite continuous advances in the diagnosis of disease, the stethoscope remains a mainstay in patient evaluation in the 200 years since its invention.  Today, given the respiratory dysfunction and cardiovascular co-morbid manifestations characteristic of COVID-19, the thorough assessment of patients with a stethoscope is critical, as is the need to maintain a pathogen-free stethoscope diaphragm surface.  An automated, clinically validated and aseptic single-use barrier system from AseptiScope holds promise to fill a significant gap in stethoscope hygiene practices.

“The stethoscope is the most prominent and enduring symbol of the interaction and bond between the physician and the patient. This is even more important in the COVID-19 era,” said Alan Maisel, MD, Professor Emeritus at the University of California San Diego, co-author, and co-founder of AseptiScope, Inc.  “The stethoscope is truly the clinician’s third hand and is at the heart of all physical examinations.  Its ability to provide rapid diagnostic and prognostic information is unsurpassed.”

The authors point out that common pathogens found on clinicians’ hands are also likely present on their “third hand,” the stethoscope, and often at a significantly greater magnitude.  In the light of the COVID-19 pandemic, current guidelines and practices related to stethoscope hygiene have understandably come into the spotlight.  Current CDC guidelines call for stethoscope cleaning but fail to recommend a standard cleaning frequency, ranging from between-patients to once weekly.  Given the reported ability of pathogens like COVID-19 to linger on surfaces, this lack of specificity for hygiene frequency may no longer be adequate.  Moreover, despite CDC guidelines, the authors cite observational studies of clinicians in everyday practice that show a very low frequency of stethoscope cleaning, ranging from 13% to 24%.

“With the emergence of COVID-19, and in its wake, the difficulties in stethoscope hygiene have become disturbingly clear,” said Robert Gaynes, MD of the Division of Infectious Diseases at Emory University and co-author.  “Just as clear is the persistent importance of the stethoscope and, so, the need to establish new approaches for its safe use.”   

The authors emphasize that common stethoscope cleaning practices, such as alcohol wipes, bleach, and hydrogen peroxide, even when used effectively, produce mixed results in reducing pathogen transmission risk.  Additionally, the authors cite studies finding that single-patient disposable stethoscopes offer compromised auscultation quality and present a concerning cross-contamination risk for the clinicians who share them.  

The article concludes that a promising solution for infection protection for the stethoscope is the use of aseptic disposable diaphragm barriers.  The authors cite a recent study of the AseptiScope DiskCover barriers (Mayo Clin Proc Innov Qual Outcomes. 2020. doi:10.1016 / j.mayocpiqo.2019.10.010), which concluded that barrier use provided protection against common hospital-associated pathogens including MRSA, VRE, and E. Coli. 

“The application of single-use aseptic stethoscope barriers is emerging as the first practical solution to this long-standing challenge,” said Scott Mader, CEO and President of AseptiScope.  “The upcoming launch of the touch-free DiskCover System will allow healthcare providers to safely and confidently use their most frequently employed medical device, the stethoscope, at a time when infection control is the paramount priority.”

About AseptiScope, Inc.

AseptiScope is a privately funded San Diego, California based, clinical innovation company, formed in early 2016. The organization is founded and led by clinical innovation experts, leading medical researchers and practicing physicians. The AseptiScope mission is to design, develop, manufacture and commercialize novel solutions that ensure “Infection Protection for Clinician & Patient.” The company will introduce the first true and practical solution for the longstanding challenge of stethoscope contamination in the summer of 2020: The AseptiScope DiskCover System. Visit www.aseptiscope.com for more information.

AseptiScope, DiskCover, and related logos are trademarks of AseptiScope, Inc.

MEDIA CONTACT
Irene Mulonni
irene@mulonni.com
858-859-7001

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The post American Journal of Medicine Article Highlights the Promise of Aseptic Barriers for Stethoscope Hygiene in the COVID-19 Era appeared first on The DiskCover System.

By Dr. Alpesh N. Amin

Hand hygiene is a proven safety practice in health care. Unfortunately, hand hygiene is underperformed on a routine basis, leading to the transmission of pathogens and spread of infection from patient to patient. Similarly, stethoscopes – the clinician’s third hand – pose the risk of carrying pathogens and spreading infection from patient to patient. Like hands, stethoscopes can be effectively decolonized using alcohol. Yet, despite effective means to decolonize stethoscopes, our study in the Journal of Hospital Medicine showed only 16% of physicians or student trainees employed stethoscope hygiene prior to patient contact.¹ In non-isolation rooms, the issue was exacerbated – we found only 4% of patients received care involving stethoscope hygiene.¹

As patients are alarmingly exposed to unclean stethoscopes, stethoscope transmission of pathogens from patient to patient can undermine the efforts of hand hygiene programs. Effectively promoting hand and “third hand” hygiene best practices could reduce infection rates. In turn, infection control can decrease healthcare costs (including reducing antibiotic use and complications) while improving the patient experience – cornerstones of the Institute for Healthcare Improvement’s “Triple Aim.”

An easy to use and reliably effective method that improves stethoscope hygiene could help facilitate achieving the Triple Aim.

1. Jenkins IH, et al. Low Rates of Stethoscope Hygiene. J. Hosp. Med 2015;7;457-458. 

Alpesh N. Amin is Professor of Medicine at the School of Medicine, Chair of the Department of Medicine, and Executive Director for the Hospitalist Program at the University of California, Irvine.  He specializes in hospital, internal and perioperative medicine with research interests including patient care and quality improvement in the acute setting.

Third Hand Vector series spotlights the clinician’s third hand and the risks that contaminated stethoscopes pose to clinicians, patients and healthcare systems. The series features leading experts in infection control, patient care and quality measures raising awareness of the importance of aseptic barriers in reducing transmission of infectious diseases.

The post OP ED #5: Achieving The Triple Aim With Our Third Hand appeared first on The DiskCover System.

By Cynthia Cadwell, RN, ANP-BC, CNS

In the 1840s, Ignaz Semmelweis proved that handwashing reduced death in childbirth. Providers have since strived to prevent cross contamination, including the use of environmental sanitization between patients. The point of “care” is to apply life-saving science while doing no harm. Yet, insidious infections occur and can be potentially lethal, particularly in the immunocompromised patients, even among meticulous providers.

Despite the abundance of studies showing the need for cleaning frequently touched items such as cell phones, keyboards, patient care areas and other items to prevent the cross contamination, it is difficult to ensure compliance. Providers know the importance of cleaning their stethoscope before use on a patient. However, when observing stethoscope hygiene in practice, busy providers who see multiple patients in a fast-paced environment frequently forget… because humans can and will make errors!¹

Effective quality techniques are exemplified by routine, simple methods implemented in standard workflows. Best practices are those that are easily applied by multiple staff without work-arounds.²  Technologies to help eliminate human error are the most effective – ensuring providers do the right thing, each and every time. Hand sanitizer and gloves immediately visible at the entrance of patient rooms enhance routine use. Adding a touch-free stethoscope barrier dispenser in these locations will decrease stethoscope contamination. Goal: “Do No Harm.” 

1. Institute of Medicine (US) Committee on Quality of Health Care in America; Kohn LT, Corrigan JM, Donaldson MS, editors. Washington (DC): National Academies Press (US); 2000.

2. Crossing the Quality Chasm: A New Health System for the 21st Century. Institute of Medicine (US) Committee on Quality of Health Care in America. Washington (DC): National Academies Press (US); 2001.

Cynthia Cadwell, Principal Consultant at Cadwell Consulting, is a Nurse Practitioner with over 25 years of clinical and biotech experience focused on lean initiatives and quality improvement for patient care and healthcare systems.  As an RN, CNS, CPHQ, and Clinical Educator, her clinical experience spans SNF/PAC, advanced wound care, occupational health, critical care and cardiovascular disease.

Third Hand Vector series spotlights the clinician’s third hand and the risks that contaminated stethoscopes pose to clinicians, patients and healthcare systems. The series features leading experts in infection control, patient care and quality measures raising awareness of the importance of aseptic barriers in reducing transmission of infectious diseases.

The post OP ED #4: Protect Your Patient appeared first on The DiskCover System.