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

KATARZYNA TALAGA-ĆWIERTNIA
KATARZYNA TALAGA-ĆWIERTNIA
, 
DOROTA OCHOŃSKA
DOROTA OCHOŃSKA
, 
MATEUSZ GAJDA
MATEUSZ GAJDA
, 
MONIKA KOWALCZYK
MONIKA KOWALCZYK
, 
MAGDALENA PALCZEWSKA
MAGDALENA PALCZEWSKA
 und 
MONIKA BRZYCHCZY-WŁOCH
MONIKA BRZYCHCZY-WŁOCH
   | 24. März 2023
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Article Category: ORIGINAL PAPER
Online veröffentlicht: 24. März 2023
Seitenbereich: 79 - 91
Eingereicht: 28. Dez. 2022
Akzeptiert: 13. Feb. 2023
DOI: https://doi.org/10.33073/pjm-2023-012
Schlüsselwörter
© 2023 KATARZYNA TALAGA-ĆWIERTNIA et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Fig. 1.

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

Fig. 2.

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).
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).

Fig. 3.

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.

Fig. 4.

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.

Fig. 5.

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].
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?
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
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
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
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
3rd (n = 25) 4th (n = 28) 5th (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 3a 2.25–4 1–5 43.88 4a 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
3rd 4th 5th total
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%
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