Stethoscope Asepsis: Amanda S and Sam F. Final Policy Paper

Healthcare Use of Sterilized Stethoscopes
Submitted By: Samantha Fritsch and Amanda Schwingler Joint Healthcare Disease Control Committee Iowa Healthcare Association


The concern of aseptic practices in healthcare settings is crucial to prevent nosocomial infections and to assure quality of patient care. Although healthcare settings require standard precautions related to patient care, equipment used in multiple patient cares heightens the risk of spreading virulent bacteria. The use of the stethoscope is a primary example of a medical instrument that is a reservoir for bacterial growth. The direct contact of the diaphragm or bell of the stethoscope to a patient’s skin could harbor a mode of transmission of virulent bacterium from client to another.
In Kiernan’s research, (1995) stethoscope cleanliness was observed with 150 medical professionals. Results found that an estimated 75 percent did not clean stethoscopes daily; of the stethoscopes not disinfected, 89 percent were contaminated with the Staphylococcus group bacteria. Within the 89 percent, 19 percent were contaminated with Staphylococcus aureus species, a bacterium that can potentially cause serious, even fatal infections. MRSA, or Methicillin-resistant Staphylococcus aureus, is a form of staph infection. The strain of MRSA generally enters into a human through a break in the skin or a cut. The wound will tend to transform into a boil or pimple-like sore; however, people with compromised immune systems run a much higher risk of life-threatening open sores or even an infection in the bloodstream. Septicemia, or blood poisoning, occurs when bacteria enter into the bloodstream. This can have many detrimental effects on a patient, including fevers, chills, and in extreme cases death. “Healthcare- and community-associated MRSAs are on the rise. MRSA has become responsible for 20 percent of bloodstream infections and about 64 percent of staph infections in hospitals and other healthcare facilities.” (Harvard Women’s Health, 2008).
An important part of healthcare asepsis techniques is learning how to prevent the spread of nosocomial infections, especially MRSA. In a single-blinded study, 92 stethoscopes were tested in a pre-wash period and a post-wash period, where colony counts were much lower after being cleansed with an alcohol based foam wash. An additional note, three nosocomial Methicillin-resistant Staphylococcus aureus strains were found before washing the stethoscopes; however, the alcohol-based foam killed all the MRSA strains found. “Simultaneously using [alcohol-based] hand foam to clean hands and stethoscope heads reduces bacterial counts on stethoscopes” (Schroeder, et. al., 2009). The studies above show why a standard of stethoscope asepsis should be made universal. Currently, there are no stethoscope cleaning procedures for medical professionals in Iowa.

In order to decrease the amount of nosocomial infections within healthcare settings it is proposed by the Iowa Healthcare Association to mandate the use of a standard stethoscope isolation system and alcohol-based foam washing of the stethoscope; also, the program would mandate required alcohol wipe dispensing stations. By making this procedure mandatory, it will significantly reduce the transfer of virulent bacteria found on the stethoscope from one patient to another. The washing procedure will be required before and after every shift change.
The second part of implementation would include the usage of stethoscope isolation system. This system involves the use of a disposable sleeve encasing the diaphragm and the tubal body of the stethoscope. The makeup of the sleeve is a clear plastic that is resistant to the transmission of bacteria, viruses, and fluid onto the stethoscope (Gilbert, patent 5466898). The disposable covers will come in a sterile bag and be required of all healthcare professionals for use with every new patient. Training for the use of disposable covers will be a mandatory education requirement of healthcare employees every six months and upon hire.
Required alcohol wipe dispensing stations will be built onto the walls of hallways in which patient care is administered, nursing stations, and in emergency response vehicles. By providing the alcohol wipes, healthcare professionals and emergency response personal will clean stethoscopes regularly throughout the shift further decreasing bacterial transfer (Merlin, et. al. 2009).
The state of Iowa Healthcare Association will annually visit healthcare establishments and review the use of the cleaning and barrier procedures, along with having the alcohol wipe dispensing stations. The Iowa Healthcare Association will post the ratings of healthcare facilities for the use of the standardized cleaning procedures and stethoscope asepsis. The top ten best hospitals, nursing care facilities, and clinics that have adequately met the standards of stethoscope asepsis techniques will be posted on the website for public viewing (along with links to the specific facility’s website). Any hospital, nursing care facility, or clinic that has not met sufficient standards of stethoscope asepsis will be posted on a probationary list, including the reasons why the facility did not pass the annual review.

The most probable arguments relating to the policy would be that it takes up critical time or that in order to implement this strategy the hospital would have to pay extra costs to keep the covers and alcohol wipes in stock. In the case of time, the requirement for washing the stethoscopes in an alcoholic based foam will only be required before and after each shift. This should not be inconvenient because healthcare workers as a factor of standard practice should be washing their hands before coming on and leaving each shift. The alcohol based washed will be located at the same sink that people wash their hands at during a shift change. The cost to implement the procedure of the stethoscope covers and the alcohol wipe stations would seem at first like a profit loss but after being implemented would save the hospital more money than they spend on the precautionary items. By stopping the spread of MRSA and other nosocomical infections, it will in turn reduce the cost that the hospital spends to treat patients. Many patients arrive at the hospital with an unrelated condition to MRSA, but may attain the bacterial infection while receiving treatment. Since the patient now has MRSA, care will be extended and it may even be a more serious condition than the original problem. In conclusion, the stethoscope isolation system, alcohol based foam washing, and the alcohol dispensing stations, long term, will reduce costs of patient care and save time from treating nosocomical infections.

Combating MRSA: The Drug-Resistant “Superbug”. (March, 2008). Harvard Women’s Health Watch. Vol. 15, Issue 7. (pgs. 4-5). Retrieved September 30, 2009, from Biology Digest search database.
Gilbert, Edwin E. (1512 Severn Ave., Metairie, LA, 70001), Foret, Timothy J. (557 Hospital Dr., Raceland, LA, 70394) 1995, Stethoscope Isolation System, United States. Patent: 5466898. Retrieved September 18, 2009, from <>.
Shroeder, Ariel, Shrodeder, Maryellen A., & D’Amico, Frank. What’s growing on your sthethoscope? Alcohol-based foam can do double duty, cleansing hands and stethoscope heads with a single scrub. (August, 2009). Journal of Family Practice. Vol. 58, Issue 10. (pgs. 16-22). Retrieved September 18, 2009, from Biology Digest search database.
Merlin, Mark A., et. al. Prevalence of Methicillin-Resistant Staphylococcus aureus on the Stethoscopes of Emergency Medical Services Providers. (January, 2009). Prehospital Emergency Care. Vol. 13, Issue 1. (pgs. 71-74). Retrieved September 18, 2009, from <>.
Kiernan, Vincent. Dirty Doctors Spread Disease. (September 23, 1995). NewScientist. 1996 Issue. Retrieved September 18, 2009, from <>.

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