Physicians as plague carriers – but, rather than rats, as in the Middle Ages, suppose it may be our stethoscopes.
In this observational study out of Ethiopia, 176 stethoscopes belonging to healthcare workers and students in a hospital were swabbed and cultured. Naturally, the authors were able to grow bacteria off 86% of these, half of which were pathologic strains such as S. aureus, Klebsiella, Citrobacter, Proteus, and P. aeruginosa. The swabs taken from the ICU harbored the greatest percentage of isolates for pathogenic strains. Most strains demonstrated some level of antibiotic resistance, such as 27% of S. aureus which proved methicillin-resistant.
Colonization, which has previously been demonstrated on the white coats of physicians, is not proof of transmission – but it is not unreasonable to suspect this may yet occur. However, only 3% of respondents in this study regularly disinfected their stethoscope after each patient. Even the mildest improvement in hygiene would likely go a long way towards reducing the theoretical risks.
“Bacterial contamination, bacterial profile and antimicrobial susceptibility pattern of isolates from stethoscopes at Jimma University Specialized Hospital”
http://www.ann-clinmicrob.com/content/12/1/39
Excellent post!!!! I have been told that British hospitals forbid physicians/registrars from wearing ties, as they are GROSS, and also promote a bare from the elbows down clothing approach. So two questions: will your hospital provide you with testing for your stethoscope to see what nasties it grows out? Who would you approach for that? And then how do we correctly disinfect an entire stethoscope? To me there is the issue of two types of needed disinfectant: between patients and then a deeper sort of cleaning. Rubbing it down with little alcohol wipes seems ridiculous, and it won't kill C dif. I have tried using the larger bleach/ H2O2 disinfectant wipes that litter our ED to wipe down a scope, and for that was rewarded by a horrific contact dermatitis on my neck where I hung the scope that took WEEKS to clear up and had many patients asking me, "Um, that thing, on your neck…. is it contagious?" Many medical professionals are already facing an epidemic of dermatitis on their hands from hand sanitizers, hand washing, and gloves….. and now this one has it on her neck…..I have tried using disposable stethoscope covers but they are just a pain to get on and off and anything that delays me from seeing the next patient on our 85,000 a year ED is not going to happen!!