Tuesday, November 24, 2020

A Spotlight on Stethoscopes as a Transmitter of COVID-19 and Other Pathogens

 All eyes are on healthcare providers in light of the COVID-19 pandemic and an increase in reported cases. More specifically, this added attention has highlighted the shortcomings of facilities’ infection control programs and the lack of education and enforcement for personnel. Some dangerous, but common employee habits include poor handwashing compliance, wearing scrubs out of the hospital, and not cleaning shared equipment. One of the dirtiest pieces of equipment is one that comes into contact with patients regularly, and that instrument is the stethoscope. 

Despite being  used for nearly every patient examination, the stethoscope is rarely, if ever, cleaned before being placed on a patient’s body (yes, yours included). A recent article published in Infection Control Today featured an interview with W. Frank Peacock, MD, FACEP, FACC, FESC that discussed the lack of stethoscope disinfection.  Dr. Peacock explained, “Only about 4% of healthcare providers clean stethoscopes according to guidelines set down by the US Centers for Disease Control and Prevention, and the CDC’s guidelines don’t go nearly far enough, saying that stethoscopes should be cleaned once a week.” While four percent compliance is unacceptable, the CDC’s guideline of only disinfecting stethoscopes once a week is also unacceptable.  In one week’s time, hundreds of patients can come into contact with the device, easily cross-contaminating pathogens between the sick and the healthy.  As Dr. Peacock details, “To do it [disinfect a stethoscope] right, you are supposed to take an alcohol swab and rub it for a minute. And even when you do that, 20% to 30% of the stethoscope will still be dirty.” That low rate of success is not only true for stethoscopes, but other devices and common touchpoints as well.  One example being MIT’s study of smartphone disinfection methods which showed sprays or wipes are ineffective in comparison to ultraviolet light, which was capable of eliminating all organisms on the tested devices without the use of chemicals. 

Ultraviolet light, specifically UV-C, is able to kill bacteria, viruses, and spores quickly.  UV-C’s drawback is that it essentially needs direct contact with all surfaces in order to guarantee high-level disinfection on all sides of an item.  If the light is blocked or shadowed, disinfection of those surfaces is reduced or non-existent.   To overcome those challenges, ClorDiSys Solutions, Inc utilizes quartz glass shelving in the Flashbox and Flashbox-mini UV-C disinfection chambers for items to sit upon. Quartz glass is one of the few materials capable of allowing UV-C light to penetrate through completely, allowing for the full disinfection of the surfaces resting on the shelving.  High level disinfection of a stethoscope or similar item can be as short as 30 seconds depending on the UV-C system being used.  Since no chemicals are used with UV-C light, this allows for a wide variety of items to be disinfected including clipboards, cellphones, keyboards, remotes, badges, blood pressure cuffs, even N95 masks.  

Disinfecting shared devices and supplies like a stethoscope is simple, quick, and truly a necessity when reducing possible transmission of pathogens. As quoted in ACP Hospitalist, Michael B. Edmond, MD, FACP, MPH, MPA states, “Like anything that we're asking health care workers to do, you have to make it easy for them to actually do it, or your compliance rates will be low.” Just as washing hands was once seen as new and optional but now an obvious requirement, hopefully healthcare providers will disinfect stethoscopes just as regularly and thoroughly.