The Clinician's Third Hand
The Stethoscope
Just like a clinician’s hands, stethoscope diaphragms can, and DO, harbor dangerous contaminants and organisms. Coming into direct contact with patients often, it is for these reasons it is called “The Clinician’s Third Hand.”
The Stethoscope Diaphragm carries the same volume and diversity of pathogens as the Hand1
Both Stethoscopes & Physicians’ Hands Are Significantly Contaminated After A Physical Examination1
Study: 489 sample surfaces
Conclusion: Stethoscope contamination is “substantial after a single physical examination and comparable to contamination” of the physician’s hand.
“Transmission of pathogens… by stethoscopes could undermine the benefits of hand hygiene programs” 2
The Clinician’s Third Hand:
Contaminated Stethoscopes Are Common And Pose A Significant Safety Risk
Stethoscope Cleaning
Standard Of Care
- • 1-minute with alcohol wipe
- • Seldom performed
- • Ineffective against resistant pathogens
- • Surfaces often remain contaminated
Imagine doing this for 60s between every patient...
CLINICANS RARELY CLEAN THEIR STETHOSCOPES
Less than 4% of stethoscopes are cleaned between patients per CDC guidelines 3
STETHOSCOPE COMPLIANCE
WITH CDC GUIDELINES
PATHOGENS FREQUENTLY PERSIST AFTER CLEANING
Stethoscope contamination is reduced but not eliminated after cleaning 4
BACTERIAL CONTAMINATION
PRE-AND POST-PRACTITIONER CLEANING
Shared (Disposable) Stethoscopes Reduce Sound Quality and May Contaminate Staff and Patients 5
“Practitioner and patient room stethoscopes are colonized with nosocomial pathogens, and cleaning reduces but doesn’t always eliminate contamination.” 6
NEJM Journal Watch, January 7, 2019
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. Dressler RL, Cruser B, Dressler DD. Hospital Physicians’ Stethoscopes: Bacterial Contamination After a Simple Cleaning Protocol. Cureus. 2023;15(4):e37061. Published 2023 Apr 3. doi:10.7759/cureus.37061
3. 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;47(3):238-242. doi:10.1016/j.ajic.2018.08.005
4. 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
5. Marinella MA. COVID-19 pandemic and the stethoscope: Do not forget to sanitize. Heart Lung. 2020;49(4):350. doi:10.1016/j.hrtlng.2020.03.017
6. Ellison RT III. NEJM Journal Watch. Jan 7, 2019. https://www.jwatch.org/na48156/2019/01/07/stethoscope-contamination. Accessed June 23, 2020.