Beware of Filthy Stethoscopes

A stethoscope cannot hear the bacteria being transferred.

By Kevin RR Williams

HEALTH Is your doctor carrying around a deadly weapon? Despite disposal of needles and diligent sanitation of most hospital surfaces, within the past year both my father-in-law and a close friend contracted pneumonia in a hospital while receiving care for another illness. Recounting further back, my mother died the night she left a hospital. A friend admitted to the hospital with a diabetic foot developed a staph infection resulting in a leg amputation that brought about more complications. Another friend admitted for unexplained rectal bleeding was removed from life support after a couple of weeks due to multi-system failure.

Each of these people either died in the hospital or within a week of being discharged due to unforeseen complications occurring while being treated for a primary illness. Such situations led a physician caring for my father-in-law to make the oft-quoted paradoxical statement: "A hospital is the worst place to be when you're sick. The only worst place to be when you're sick is not a hospital." More than 8,000 people a year die from surgical site infections (SSIs) picked up in hospitals. The Centers for Disease Control and Prevention (CDC) estimates roughly 1.7 million hospital-associated infections, from all types of bacteria combined, cause or contribute to 99,000 deaths each year. Primary defensive measures continue to be thoroughly scrubbing both sides of hands and fingernails, sterilizing the skin before puncturing or cutting, and using sterilized equipment. But infection continues to pervade medical centers.

Despite defensive measures, the grim statistics seem to encourage outpatient care over prolonged hospital stays. But why does what arguably should be one of the most sanitary environments lead to so many life-threatening infections? If you start playing the blame game, there could be any number of third-parties at fault: Antibiotic-resistant bacteria may have its source in the food chain. Germs may be transported from visitors or even flowers delivered to the patient room. Doctors, nurses, or staff who interact with multiple patients run the risk of transferring illness; in this case, hospitalization is not required. A routine medical examination can be the genesis of a bacterial infection if proper hygiene is not practiced by a doctor or nurse.

Watch Your Back

Watching a doctor care for you can seem like an attempt to discover the secret behind a sleight-of-hand trick. The physician enters the examination room, immediately squirts his hands with sanitizer or scrubs them in the nearby sink before touching your body. (If you missed that, politely ask for a redo.) He or she then listens to your heartbeat or asks you to breathe deeply while applying a stethoscope to your chest or back. Did you miss something again? Is that the same stethoscope used on the prior who-knows-how-many patients with who-knows-what illnesses?

If such a legerdemain was exposed in a casino, the doctor might be ejected from the table and thrown out of the hotel. By washing his hands and then applying a contaminated medical instrument to our skin, you are given the mere illusion of cleanliness. Germs can be immediately transferred back to the doctor's washed hands from the stethoscope or the instrument can become the conduit of infection passed from patient to patient. You could theoretically leave the exam room to pick up a prescription for one ailment, develop a rash, and assume it is a side effect of the medication. In other cases, what is transferred may be more serious.

Identifying and Minimizing Infection Sites

A research study of 71 patients by three doctors at a Swiss hospital over a period of five months has suggested that stethoscopes may spread bacteria, including MRSA, inside hospitals. After a patient examination with sterile hands and stethoscope, the part of a doctor's hands most highly contaminated with bacteria was the fingertips, followed by the diaphragm of the stethoscope. This study serves as an important reminder for doctors and other health professionals about the potential risks of cross-contamination if hospital equipment (not limited to stethoscopes) and hands are not disinfected between one patient and the next.

Beware of Stethoscopes

Bare Below the Elbows (BBE) is a physician dress code defined as wearing short sleeves, no wristwatch, and no jewelry during clinical practice. In 2007, the United Kingdom began requiring physicians to practice BBE, effectively banning the wearing of long sleeves (including scrub jackets and white coats) and watches, wristbands, bracelets, and rings on the hand, wrist, or lower arms. The aim of this mandate was to enable better hand and wrist hygiene, and to minimize the transfer of bacteria that might be contaminating the cuffs or sleeves of healthcare practitioners’ attire. Furthermore, coat hooks should be readily available to encourage wearers to remove and hang up their lab coats or long-sleeved jackets before entering a patient's immediate environment. In its place, a disposable protective gown or apron may be used with each patient, much as one would wear when performing surgery. Neckties, if worn, should be secured so as not to drape over contaminated patients and surfaces.

A research study at a children's hospital sought to determine if easily-accessible visual reminders to sanitize stethoscopes improved compliance. By having a basket of individually packaged 70% isopropyl alcohol prep pads with an encouraging sticker outside each patient room, disinfection compliance increased significantly from a baseline of 34% to 59% post intervention. The study did not record patient outcomes.

So what can you do as a patient to minimize infection? Request visual confirmation of sanitation compliance. (Politely ask those caring for you to wash their hands.) Take note of whether a new needle is used and properly disposed of. Ask that instruments like stethoscopes, blood pressure cuffs or other communal equipment be wiped down with an alcohol pad before coming in contact with you. Ask those who come into the room, whether family or medical staff, to wash their hands, then avoid shaking hands.

When going to the hospital to encourage patients, adhere to rules regarding a limited number of visitors in hospital rooms, wash thoroughly before visiting . Clean hands again after patient visits. Refrain from visiting if you have a known infection, even if minor, so everyone can remain A Bit More Healthy.

Tags: attire, contaminated, filthy, germs, hygienic, sanitary, unclean, visitation

References
  1. Why Are Hospitals the Worst Place to Be When You Are Sick? huffingtonpost.com
  2. 5 Infectious Diseases You Might Get in the ER. howstuffworks.com
  3. Stethoscopes could spread hospital infections. nhs.uk
  4. Stethoscopes could spread hospital infections. nih.gov
  5. Department of Health: Uniforms andn Workwear (PDF). nationalarchives.gov.uk
  6. Improving Stethoscope Disinfection at a Children's Hospital. medscape.com
  7. Photo by Dirima licensed from iStockPhoto.