Stethoscopes or Maybe “Bacterioscopes” – Is hand Hygiene Solely Capable of Preventing Hospital-Associated Infections?

TALAGA-ĆWIERTNIA, KATARZYNA; OCHOŃSKA, DOROTA; GAJDA, MATEUSZ; KOWALCZYK, MONIKA; PALCZEWSKA, MAGDALENA; BRZYCHCZY-WŁOCH, MONIKA

doi:10.33073/pjm-2023-012

Figures & Tables

Fig. 1.

Bacteriological profile of microorganisms isolated from personal medical students’ stethoscopes with particular emphasis on Staphylococcus species.

Bacteria strains isolated from membranes and bells of personal stethoscopes used by medical students from Jagiellonian University Medical College (JUMC). Bacteria are presented as general taxa (A) and listed as species (B).

Macrorestriction analysis of the chromosomal DNA of methicillin-resistant S. aureus strains (MRSA) with concomitant macrolide, lincosamide, and streptogramin B (MLSB) resistance phenotype isolated from the surface of stethoscopes after digestion with the restriction enzyme SmaI, plotted using the Gel Compar® II program (Applied Maths).
Legend: The frames indicate three students’ stethoscopes on which surfaces both MRSA and MRSE (presented in the Fig. 4) strains were identified. The declared frequency of stethoscope disinfection were as follow: 1 – after each examination, 2 – several times a day, 3 – once a day, 4 – once a week, 5 – once a year. — Macrorestriction analysis of the chromosomal DNA of methicillin-resistant S. aureus strains (MRSA) with concomitant macrolide, lincosamide, and streptogramin B (MLSB) resistance phenotype isolated from the surface of stethoscopes after digestion with the restriction enzyme SmaI, plotted using the Gel Compar® II program (Applied Maths). Legend: The frames indicate three students’ stethoscopes on which surfaces both MRSA and MRSE (presented in the Fig. 4) strains were identified. The declared frequency of stethoscope disinfection were as follow: 1 – after each examination, 2 – several times a day, 3 – once a day, 4 – once a week, 5 – once a year.

Macrorestriction analysis of the chromosomal DNA of methicillin-resistant S. epidermidis strains (MRSE) with concomitant macrolide, lincosamide, and streptogramin B (MLSB) resistance phenotype isolated from the surface of stethoscopes after digestion with the restriction enzyme SmaI, plotted using the Gel Compar® II program (Applied Maths).
Legend: The frames indicate three students’ stethoscopes on which surfaces both MRSA (presented in Fig. 3) and MRSE strains were identified. Declared frequency of stethoscope disinfection were as follow: 1 – after each examination, 2 – several times a day, 3 – once a day, 4 – once a week, 5 – once a year. — Macrorestriction analysis of the chromosomal DNA of methicillin-resistant S. epidermidis strains (MRSE) with concomitant macrolide, lincosamide, and streptogramin B (MLSB) resistance phenotype isolated from the surface of stethoscopes after digestion with the restriction enzyme SmaI, plotted using the Gel Compar® II program (Applied Maths). Legend: The frames indicate three students’ stethoscopes on which surfaces both MRSA (presented in Fig. 3) and MRSE strains were identified. Declared frequency of stethoscope disinfection were as follow: 1 – after each examination, 2 – several times a day, 3 – once a day, 4 – once a week, 5 – once a year.

The importance of stethoscope hygiene as an essential factor in preventing hospital-associated infections (HAIs) [The infographic prepared according to the author’s own idea].

Correlations between answers given in the Likert scale (Likert 1932) and declared frequency of stethoscopes’ disinfection declared by medical students of the 3rd, 4th, and 5th year of study at Jagiellonian University Medical College (JUMC)_

Answers given on a Likert Scale	Correlation’ indicators	How often you clean your stethoscope?
Answers given on a Likert Scale	year	₃rd	₄th	₅rd	Total
Cleaning agents for stethoscopes are widely accessible during clinical classes	rho Spearman’s	0.21	0.07	0.08	0.16
	p-value	0.321	0.724	0.786	0.197
I would disinfect my stethoscope more often if the cleaning agents more accessible	rho Spearman’s	0.34	0.06	−0.23	0.12
	p-value	0.095	0.778	0.454	0.33
I would disinfect my stethoscope more often if the supervisors put more emphasis on that issue	rho Spearman’s	0.01	−0.18	0.24	0.01
	p-value	0.953	0.355	0.430	0.986
It is important for me to be sure that my stethoscope is clean	rho Spearman’s	0.41	0.49	0.26	0.36
	p-value	0.041	0.008	0.390	0.003
It is important for me to keep my hands clean	rho Spearman’s	a	0.24	−0.24	0.06
It is important for me to keep my hands clean	p-value		0.210	0.436	0.637
A stethoscope may be a vector for microorganisms	rho Spearman’s	0.35	0.05	−0.09	0.18
A stethoscope may be a vector for microorganisms	p-value	0.084	0.814	0.776	0.159
Disinfectants can cause damage to the stethoscope	rho Spearman’s	0.03	0.24	−0.06	0.04
Disinfectants can cause damage to the stethoscope	p-value	0.878	0.226	0.846	0.733
I see my colleagues disinfecting their stethoscopes regularly	rho Spearman’s	0.50	0.38	−0.06	0.40
	p-value	0.012	0.046	0.854	< 0.001

The survey results on self-reported stethoscopes hygiene habits given by medical students from 3th, 4th, and 5th years of study at Jagiellonian University Medical College (JUMC) were given on a Likert scale_

Questions	Year of study													p
	3^rd (n = 25)					4^th (n = 28)				5^th (n = 13)
	Average rank	Me	Q1-Q3	Min-Max	Average rank	Me	Q1-Q3	Min-Max	Average rank	Me	Q1-Q3	Min-Max	H(2)
Cleaning agents for stethoscopes are widely accessible during clinical classes	35.50	2	1–4	1–5	34.30	2.5	1–3	1–5	27.92	2	1–2.5	1–4	1.53	0.466
I would disinfect my stethoscope more often if the cleaning agents were more accessible	33.98	4	3–5	1–5	31.34	4	3–5	1–5	37.23	4	4–5	3–5	0.95	0.622
I would disinfect my stethoscope more often if the supervisors put more emphasis on that issue	31.04	4	3–5	1–5	34.79	4.5	3.25–5	1–5	35.46	4	4–5	2–5	0.77	0.682
It is important for me to be sure that my stethoscope is clean	38.00	5	4–5	1–5	29.54	4	3–5	1–5	33.38	4	3.5–5	1–5	2.97	0.227
It is important for me to keep my hands clean	35.00	5	5–5	5–5	32.66	5	5–5	1–5	32.42	5	5–5	1–5	1.9	0.387
Stethoscope may be a vector for microorganisms	31.70	5	4.5–5	4–5	34.64	5	5–5	1–5	34.50	5	5–5	4–5	0.79	0.673
Disinfectants can cause damage to the stethoscope	27.66	3	2–4	1–5	33.89	3^a	2.25–4	1–5	43.88	4^a	3–5	3–5	6.58	0.037
I see my colleagues disinfecting their stethoscopes regularly	34.50	2	1–3	1–4	37.00	2	1.25–4	1–5	24.04	2	1–2	1–3	4.48	0.107

The results of a survey on self-reported stethoscopes hygiene habits given by medical students from 3rd, 4th and 5th years of study at Jagiellonian University Medical College (JUMC) (authors’ elaboration based on Uneke et al_ 2008)_

Question	Answers	Year of study								Statistical parameters
		3^rd		4^th		5^th		total		Statistical parameters
		n	%	n	%	n	%	n	%	χ²	df	p
How often do you clean your stethoscope?	Never	1	4.0%	0	0.0%	0	0.0%	1	1.5%	14.97	12	0.317
	Once a year	3	12.0%	0	0.0%	0	0.0%	3	4.5%
	Once a month	2	8.0%	2	7.1%	4	30.8%	8	12.1%
	Once a week	3	12.0%	3	10.7%	2	15.4%	8	12.1%
	Once a day	4	16.0%	3	10.7%	2	15.4%	9	13.6%
	Several times a day	4	16.0%	10	35.7%	3	23.1%	17	25.8%
	After each examination	8	32.0%	10	35.7%	2	15.4%	20	30.3%
	Total	25	100.0%	28	100.0%	13	100.0%	66	100.0%
Which part of the stethoscope has been cleaned?	Membrane	15	62.5%	20	71.4%	8	61.5%	43	66.2%	0.62	2	0.744
	Bell	15	62.5%	19	67.9%	6	46.2%	40	61.5%	1.78	2	0.432
	Flexible tubing	4	16.7%	8	28.6%	3	23.1%	15	23.1%	1.03	2	0.554
	Metal tubing	3	12.5%	1	3.6%	1	7.7%	5	7.7%	1.45	2	0.510
	Olives	3	12.5%	2	7.1%	1	7.7%	6	9.2%	0.49	2	0.858
Which chemical disinfectant do you use to clean the stethoscope?	Alcohol swabs	0	0.0%	0	0.0%	2	15.4%	2	3.1%	11.66	4	0.022
	Hand disinfectant	22	91.7%	28	100.0%	11	84.6%	61	93.8%
	Special agent dedicated for medical appliances	2	8.3%	0	0.0%	0	0.0%	2	3.1%
	Total	24	100.0%	28	100.0%	13	100.0%	65	100.0%
Who does use your stethoscope?	Only me	7	30.4%	15	55.6%	5	41.7%	27	43.5%	6.51	8	0.538
	A colleague at every class	1	4.3%	0	0.0%	0	0.0%	1	1.6%
	Often a colleague	1	4.3%	2	7.4%	1	8.3%	4	6.5%
	Rarely a colleague	13	56.5%	10	37.0%	6	50.0%	29	46.8%
	Other	1	4.3%	0	0.0%	0	0.0%	1	1.6%
	Total	23	100.0%	27	100.0%	12	100.0%	62	100.0%
Did someone show you the proper stethoscope cleaning technique?	Yes	5	20.0%	6	21.4%	3	25.0%	14	21.5%	2.11	4	0.704
	No, but I was looking for such information on my own	5	20.0%	2	7.1%	2	16.7%	9	13.8%
	No, and I was not interested	15	60.0%	20	71.4%	7	58.3%	42	64.6%
	Total	25	100.0%	28	100.0%	12	100.0%	65	100.0%
Which source did you use to learn about correct technique of stethoscope cleaning?	During clinical classes	8	57.1%	6	50.0%	1	16.7%	15	46.9%	8.56	8	0.403
	Internet	2	14.3%	1	8.3%	1	16.7%	4	12.5%
	Colleagues’	0	0.0%	1	8.3%	2	33.3%	3	9.4%
	Clinical practicesOutside the university	4	28.6%	3	25.0%	2	33.3%	9	28.1%
	Other	0	0.0%	1	8.3%	0	0.0%	1	3.1%
	Total	14	100.0%	12	100.0%	6	100.0%	32	100.0%
Would you like to know more about stethoscope hygiene?	Yes	14	56.0%	14	50.0%	9	69.2%	37	56.1%	2.18	4	0.644
	No	1	4.0%	1	3.6%	1	7.7%	3	4.5%
	I didn’t think about it	10	40.0%	13	46.4%	3	23.1%	26	39.4%
	Total	25	100.0%	28	100.0%	13	100.0%	66	100.0%
Did someone show you the proper hand hygiene?	Yes, during clinical classes	23	92.0%	25	89.3%	12	100.0%	60	92.3%	1.53	4	1.000
	Yes, outside the university	1	4.0%	1	3.6%	0	0.0%	2	3.1%
	No, but I was looking for such information myself	1	4.0%	2	7.1%	0	0.0%	3	4.6%
	Total	25	100.0%	28	100.0%	12	100.0%	65	100.0%
How often do you disinfect your hands?	After each patient	23	92.0%	27	96.4%	13	100.0%	63	95.5%	4.70	4	0.329
	Several times a day	2	8.0%	0	0.0%	0	0.0%	2	3.0%
	Once a day	0	0.0%	1	3.6%	0	0.0%	1	1.5%
	Total	25	100.0%	28	100.0%	13	100.0%	66	100.0%

Stethoscopes or Maybe “Bacterioscopes” – Is hand Hygiene Solely Capable of Preventing Hospital-Associated Infections?

Figures & Tables

Fig. 1.

Fig. 2.

Fig. 3.

Fig. 4.

Fig. 5.

Correlations between answers given in the Likert scale (Likert 1932) and declared frequency of stethoscopes’ disinfection declared by medical students of the 3rd, 4th, and 5th year of study at Jagiellonian University Medical College (JUMC)_

The survey results on self-reported stethoscopes hygiene habits given by medical students from 3th, 4th, and 5th years of study at Jagiellonian University Medical College (JUMC) were given on a Likert scale_

The results of a survey on self-reported stethoscopes hygiene habits given by medical students from 3rd, 4th and 5th years of study at Jagiellonian University Medical College (JUMC) (authors’ elaboration based on Uneke et al_ 2008)_

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