Open Access

Bacteriological assessment of stethoscopes used by healthcare workers in a tertiary care centre of Nepal

BMC Research Notes201710:353

https://doi.org/10.1186/s13104-017-2677-7

Received: 4 April 2017

Accepted: 22 July 2017

Published: 28 July 2017

Abstract

Objective

Stethoscope is a medical device universally used by health care workers. Stethoscope may transmit pathogens among patients and health care workers if it is not disinfected. The objective of this study was to, determine the level of stethoscope contamination used by health care workers, survey the practices of disinfecting the stethoscope, identify various microorganisms and assess their role as potential pathogens and determine the effectiveness of 70% ethanol as a disinfecting agent.

Results

This was a cross-sectional study conducted in the department of Microbiology, Chitwan Medical College, Bharatpur, Nepal. Stethoscopes of 122 health care workers from different departments were included in this study. Out of a total 122 diaphragms, 88 (72.1%) were colonized. Only 71 (58.1%) bells and 152 earpieces (66.2%) were contaminated. Micrococcus and coagulase negative staphylococci were predominantly isolated species. The contamination was lowest among stethoscopes cleaned after touching every patient (11.5%) and the difference is statistically significant (P < 0.0001). Significantly lower level of contamination (13.6%) were found on stethoscopes cleaned everyday (P < 0.0001). Only 8.5% stethoscope showed growth with decreased number of colonies after disinfecting the stethoscopes with 70% ethanol. Thus, demonstrating the effectiveness of disinfection.

Keywords

Contamination Health care workers Health care associated infections Stethoscope

Introduction

The development of nosocomial infection is a significant problem in each hospital. Such infections can result due to multiple causes like development and persistence of multidrug resistant (MDR) bacteria, immunocompromised states of patients, and mechanical transmission of microorganisms [1]. Some non-critical medical devices routinely used by Health care workers (HCWs) such as stethoscopes, blood pressure cuffs electronic thermometers, latex gloves, masks, pens, and white coats play significant role in the transmission of health care associated infections (HCAIs) [2]. Among these devices, stethoscopes routinely used by HCWs pose a potential threat for the transmission of HCAIs in the hospital settings [3]. Stethoscopes frequently come in contact with many patients. During such contacts, microorganisms can colonize on the stethoscopes which could further spread to other patients if proper disinfection practices are not followed by HCWs [4, 5]. Since, routine disinfection practice of stethoscopes are not followed by HCWs, there is high risk of transmission of multidrug antibiotic resistant microorganisms in the hospital settings [6, 7]. These include methicillin-resistant staphylococci, ceftazidime-resistant Klebsiella pneumoniae, vancomycin-resistant enterococci, ciprofloxin-resistant Pseudomonas aeruginosa, gentamicin-resistant Pseudomonas aeruginosa, and penicillin-resistant pneumococci [8].

Despite stethoscopes being a potential vector for the transmission of HCAIs, disinfection of stethoscopes is neglected by HCWs [9]. Stethoscope swiping using alcohol pads is the current gold standard method for the disinfection of stethoscopes [10]. Medical device like stethoscopes should be evaluated for microbial colonization frequently and HCWs should be sensitized about the regular disinfection practices to control nosocomial infections [11].

Main text

This cross-sectional study was conducted in the Department of Microbiology, Chitwan Medical College, Bharatpur, Nepal, between August 2015 and February 2016. Stethoscopes of 122 healthcare workers from different departments were included in this study.

Methodology

Specimens were collected from the diaphragms, bells and both earpieces. Direct inoculation onto blood agar plates was done for the earpieces while swab moistened in sterile normal saline was used for the diaphragms and bells. The diaphragms, bell and both earpieces of the stethoscopes were pressed firmly and rubbed 1 cm on both sides on blood agar and MacConkey agar. The plates were incubated aerobically at 37 °C for 48 h. Microorganisms were identified by conventional phenotypic methods [12]. Antibiotic sensitivity test (ABST) of the microorganisms was performed by Kirby-Bauer disk diffusion method. In addition, randomly 35 stethoscopes were swabbed once with 70% ethanol, allowed to dry, and then sampled.

Before sample collection all the participants were given a preformed questionnaire regarding HCWs routine stethoscope disinfection practices (Additional file 1). Survey was done on frequency and methods practiced for cleaning of stethoscopes, frequency of hand washing and barriers to cleaning of stethoscopes by HCWs.

Statistical analysis

All the data were entered in the Microsoft Excel and analyzed by SPSS version 20. Differences between the proportions were assessed by means of Chi square analysis. P < 0.05 was said to be statistically significant. Point estimates for the primary outcome are reported with 95% confidence interval.

Results

Stethoscopes of 122 HCWs were sampled in the study from wards 41.8%, outpatient department (OPD) 35.2% and intensive care unit (ICU) 23% which included 70 (57.3%) males and 52 (42.6%) females. The bacterial load varied, with a minimum number of 9 colonies from a stethoscope sampled from the anesthesia department and a maximum 60 colonies from surgery ward and ICU. The results of the study was based on questionnaires which were filled by HCWs reported that 96.7% were aware that stethoscopes could transfer microorganisms, while all HCWs 100% were aware that disinfection of stethoscopes is needed. Majority of the HCWs 108 (88.5%) used stethoscope after removing the clothes of patients, while 14 (11.4%) used stethoscope without removing the clothes. Among, 122 diaphragms, 88 (72.1%) were colonized. Only 71 (58.1%) bells and 152 (66.2%) earpieces out of total 244 earpieces (122 left and 122 right) were contaminated. There were altogether 178 isolates from 88 contaminated diaphragms. Micrococcus and CONS were most commonly isolated (Table 1).
Table 1

Organisms isolated from bell, diaphragm and earpieces of stethoscope

Organisms

Number of isolates

Bell

Diaphragm

Earpiece (left)

Earpiece (right)

Micrococcus species

56

64

18

20

Coagulase negative staphylococci

16

45

11

14

Bacillus species

18

22

24

21

Diptheroids

4

6

Staphylococcus aureus (MSSA)

6

15

4

Staphylococcus aureus (MRSA)

10

11

Pseudomonas species

6

Enterobacter species

4

Escherichia coli

3

Candida species

2

Total no of isolates

110

178

53

59

 No growth on stethoscopes

51

34

48

44

 Growth on stethoscopes

71 (58.1%)

88 (72.1%)

74 (60.6%)

78 (63.9%)

– not isolated

Table 2 depicts that overall, 88 (72.1%) HCWs reported cleaning of stethoscopes by one method or the other, but 34 (27.8%) had never cleaned their stethoscopes. Out of 122 stethoscope, 22 (18%) HCWs reported regular disinfection of stethoscope after use. On comparing frequency of stethoscope disinfection practices among HCWs highest colonization was found among stethoscopes which was never cleaned 32 (94.1%) and lowest colonization among stethoscopes cleaned everyday 3 (13.6%). This was statistically significant (P < 0.0001). Highest contamination was found among stethoscopes which was not cleaned after contact with every patient 85 (88.5%) and lowest among the stethoscopes cleaned after contact with every patient 3 (11.5%) using 70% ethanol. This was statistically significant (P < 0.0001).
Table 2

Health care workers stethoscope disinfection practices

Methods

Number (%) of stethoscopes examined

Number (%) of stethoscopes contaminated

95% confidence interval

Frequency of disinfection of stethoscopes

 Every day

22 (18)

3 (13.6)

0.72–27.92

 Alternate day

14 (11.4)

9 (64.2)

39.09–89.31

 Once a week

27 (22.1)

22 (81.4)

66.72–96.08

 Once a month

16 (13.1)

14 (87.5)

71.3–103.7

 >Once yearly

9 (7.3)

8 (88.8)

68.2–109.4

 Never cleaned

34 (27.8)

32 (94.1)

86.18–102.02

 Total

122

88 (72.1)

64.14–80.06

Methods

Numbers (%)

Methods practiced by HCW for cleaning of stethoscopes

 Methylated spirit swab

42 (34.4)

18 (42.8)

27.84–57.76

 Hand sanitizer

21 (17.2)

16 (76.1)

57.86–94.34

 Cloth

11 (9)

10 (90.9)

73.9–107.9

 Soapy water

14 (11.4)

12 (85.7)

67.36–104.04

 No agent/never cleaned

34 (27.8)

32 (94.1)

86.18–102.02

 Total

122

88 (72.1)

64.14–80.06

Hand washing after each patient

 Yes

21 (17.2)

6 (28.5)

9.19–47.81

 No

101 (82.7)

82 (81.1)

73.46–88.74

 Total

122

88 (72.1)

64.14–80.06

Stethoscope cleaning after every patient

 Yes

26 (21.3)

3 (11.5)

0.76–23.76

 No

96 (78.6)

85 (88.5)

82.12–94.88

 Total

122

88 (72.1)

64.14–80.06

Barriers to cleaning of stethoscopes

 Lack of time

43 (35.2)

31 (72)

58.58–85.42

 Forgetfulness/laziness

26 (21.3)

17 (65.3)

47–83.6

 Lack of knowledge regarding best disinfectant

16 (13.1)

12 (75)

53.78–96.22

 Lack of access to disinfectants

11 (9)

8 (72.7)

46.37–99.03

 Concern for damaging one’s stethoscope

4 (3.2)

3 (75)

32.57–117.43

 Sharing of stethoscopes

13 (10.6)

9 (69.2)

44.1–94.3

 Unspecified

9 (7.3)

8 (88.8)

68.2–109.4

 Total

122

88 (72.1)

64.14–80.06

Methylated spirit swab (63.9%) was most commonly used cleaning agent. When the methods practiced by HCWs for cleaning of stethoscopes was related to the stethoscope contamination results showed highest colonization among stethoscope which was never cleaned 32 (94.1%); lowest colonization among stethoscope which was cleaned using methylated spirit swab 18 (42.8%) and the difference is statistically significant (P < 0.0001).

The most common barrier to cleaning of stethoscope among HCWs were lack of time (35.2%), forgetfulness (21.3%), lack of knowledge regarding best disinfectant (13.1%), lack of access to disinfectants (9%), concern for damaging one’s stethoscope (3.2%), sharing of stethoscopes (10.6%) and unspecified (7.3%). Out of a total 122 HCWs, 21 (17.2%) wash their hand after touching every patient and 101 (82.7%) do not wash their hand after touching every patient. Lower bacterial contamination was found on stethoscopes of HCWs who practice hand washing after touching every patient compared to those who did not wash hands after touching every patients (28.5% vs. 81.1%; P < 0.0001). Out of 35 randomly cleaned stethoscopes, 35 (100%) showed colonization before disinfection and after disinfection only 3 (8.5%) showed colonization with decreased number of colonies (3–5), thus demonstrating the effectiveness of disinfection with 70% ethanol. This was statistically significant (P < 0.0001).

Antibiotic susceptibility testing (AST) of Gram positive bacteria showed resistance to erythromycin, cefoxitin, clindamycin, ampicillin/sulbactum and piperacillin-Tozabactum. Out of 46 S. aureus isolated, 21 were MRSA. Most of the isolated Gram negative bacteria showed 100% resistance to ceftriaxone, cotrimoxazole and ampicillin (Table 3).
Table 3

Antibiotic resistance pattern of gram positive and gram negative isolates

 

E

CIP

CTR

CX

G

COT

CD

AMP

A/s

PIT

IPM

AK

VA

CONS

53.4

15.1

19.7

24.4

13.9

37.2

27.9

25.5

18.6

13.9

6.9

S. aureus

47.8

13

17.3

30.4

19.5

26

34.7

39.13

15.2

17.3

4.3

P. aeruginosa

33.3

16.6

50

100

100

00

Enterobacter species

50

00

25

100

100

00

E. coli

33.3

100

66.6

100

100

33.3

Figures depict %, – not tested, P penicillin, E erythromycin, CIP ciprofloxacin, CTR ceftriaxone, C chloramphenicol, OX oxacillin, CZ cefazolin, G gentamicin, CN cephalexin, COT cotrimoxazole, AMP ampicillin, AZM azithromycin, AMC amoxy-clavulanic acid, AK amikacin

Discussion

This study showed that 72.1% stethoscopes were contaminated by different microorganisms which is similar to the contamination rates observed in previous studies by various investigators [1315]. Health care staffs and their contaminated medical devices have been attributed as potential carriers of pathogenic microorganisms [16].

A majority 88.5% of the HCWs used stethoscopes after removing the clothes of the patients, clothes are source of a variety of microorganisms and also interferes with the conduction of sound waves. In this study, contamination of the diaphragms 72.1% was higher compared to ear piece 66.2% and bells 58.1%. This finding is comparable to the result of previous study, which reported 71–100% stethoscopes were colonized by different bacteria [17]. The diaphragm with a relatively larger flat surface area directly comes in contact with the patient. Therefore, it has higher chances of bacterial colonization and contamination. The bell due to its smaller surface area, has less chances of bacterial colonization [18]. Total 66.2% of the earpieces were contaminated. These earpieces do not play significant role in the transmission of bacteria as they lack direct contact with the patient’s skin. Bacterial colonization in the ear from the earpieces may transfer bacteria to the nose and skin leading to HCAIs.

This study shows that stethoscopes are contaminated with potentially pathogenic microorganisms. Previous study also reported that these bacteria were isolated from contaminated stethoscopes of HCWs [19]. Similarly, study conducted in this hospital revealed that these pathogenic microorganisms are most common cause of nosocomial infection [20]. Therefore, contaminated stethoscope can act as a source of nosocomial pathogens. Coagulase negative staphylococci (CONS) have the ability to acquire MDR and can be extremely virulent for population at risk. Gram negative bacilli and methicillin resistant Staphylococcus aureus (MRSA) were isolated from stethoscope which was a matter of concern. In this study 17.2% MRSA were isolated, which was cleaned only once a month/yearly. Other investigators reported 15.8–89% S. aureus on stethoscopes used by HCWs. Stethoscopes which was cleaned once a week/month gram negative bacilli were isolated. This emphasizes that there is need for regular disinfection of the stethoscopes. Other studies which isolated gram-negative bacilli reported that few of them are pathogenic [21, 22]. Similarly, most of the bacteria isolated were resistant to commonly used antibiotics. The emergence of antibiotic resistance by bacterial pathogens is a serious public health concern [23].

The contamination was lowest (11.5%) among stethoscopes cleaned after touching every patient. Previous study proved that regular disinfection of stethoscope substantially reduces transmission of bacterial pathogens [24]. The least contamination (13.6%) was found among stethoscopes cleaned everyday and highest level of contamination (94.1%) among stethoscopes which were never cleaned (P < 0.0001).

Stethoscopes disinfected using methylated spirit swab showed lower contamination (42.8%). Similarly, other study reported significant reduction in colony counts after disinfection using methylated spirit swab [25]. Lack of time (35.2%) and forgetfulness/laziness (21.3%) were common reasons for not cleaning stethoscopes, which might consequently increase HCAIs. Common habit among HCWs is hanging stethoscope around neck or carrying it outside non-patient related places such as canteen, lecture hall, meeting rooms and office etc. These practices should be avoided to prevent spread of nosocomial pathogens.

Lower contamination 28.5% was found on stethoscope of HCWs who practiced hand washing after touching each patient demonstrating importance of hand hygiene. Recently, the WHO reported that hand hygiene should be performed regularly in a effective manner which is fundamental in ensuring patient and HCWs safety [26].

This study demonstrated the effectiveness of disinfecting the stethoscopes with 70% ethanol, only (8.5%) stethoscope showed colonization with decreased number of colonies. Other study reported that regular cleaning of stethoscopes with alcohol 70% ethanol results in significant decline in the number of colony-forming units (CFUs) [27]. Mehta et al. demonstrated the efficacy of alcohol-based hand rubs in the disinfection of stethoscopes [28]. Therefore, hand rubs can be used for disinfection of stethoscopes and maintainence of hand hygiene. Educational and promotional campaigns for HCWs are required to achieve better compliance regarding stethoscope disinfection practices which can minimize HAIs [29].

Implications for policy and practice

Based on the findings of this study, stethoscopes used by HCWs are contaminated with microorganisms. Hence, identification of microorganisms and to access their role as potential pathogens is mandatory as nosocomial pathogens may spread among patient’s and HCWs. Survey of stethoscope disinfection practices among HCWs is necessary because contamination and further spread of microorganisms is greatly reduced by regular cleaning stethoscope with suitable disinfectant. Performing AST is required to identify antibiotic resistant strains from as stethoscope used by HCWs as these can transfer among patients and HCWs. Motivating and training the HCWs regarding routine simple disinfection of stethoscope and regular maintainence of hand hygiene into practice can be an important step to reduce burden of nosocomial infections.

Conclusions

Stethoscopes used by HCWs are contaminated with pathogenic microorganisms and therefore are potential vectors for the transmission of hospital pathogens. This contamination and spread of organisms can be greatly reduced by regular disinfection of stethoscope with 70% ethanol. There is a definite need for strict adherence to disinfection practices by HCWs to minimize cross-contamination and ensure patient safety in the hospital. Therefore, we need to train and motivate the HCWs in understanding different aspects of stethoscope disinfection practices. It could be an important step of intervention to minimize transmission of nosocomial pathogens among patients and HCWs.

Limitations

Other contaminating organisms like anaerobic bacteria, fungi and viruses were not studied. The time period of contact of the stethoscope with the patient’s skin/clothes was not known. This study utilized only 70% ethanol we did not compare other alcohol and non-alcohol based products as a disinfecting agent. It is not known whether cleaning with alcohol will damage stethoscope diaphragms. Future research should focus on identification of other contaminating organisms and their role as nosocomial pathogens. More effective ways and practicable means of stethoscope disinfection.

Abbreviations

ABST: 

antibiotic sensitivity test

CFUs: 

colony-forming units

CMC: 

Chitwan medical college

CONS: 

coagulase negative staphylococci

HCAIs: 

health care associated infections

HCWS

health care workers

ICU: 

intensive care unit

MDR: 

multidrug resistant

MRSA: 

methicillin resistant Staphylococcus aureus

WHO: 

World Health Organization

Declarations

Authors’ contributions

ST conceived and designed the study. ST prepared the questionnaire. LS facilitated the study of stethoscopes in different departments. ST collected the samples processed the samples. LS and ST analyzed the results. ST prepared the initial draft of the manuscript. ST searched the scientific literature. ST prepared and refined the manuscript. Both authors read and approved the final manuscript.

Acknowledgements

Authors express their sincere gratitude to the Department of Microbiology, CMC, Bharatpur. We extend our sincere thanks to all faculty members and staff of CMC. Our special thanks to all the HCWs who participated in this study and cooperated during data collection. It was a pleasure to be associated with them through this work.

Competing interests

The authors declare that they have no competing interests.

Availability of data and materials

All relevant data supporting the conclusions of this article are contained within the article.

Consent for publication

Not applicable.

Ethical approval and consent to participate

Ethical approval was obtained from the Chitwan Medical College Institutional Review Committee (CMC-IRC) before starting the study. Informed consent was obtained from the HCWs of respective departments.

Funding

No specific funding for this study was received.

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Authors’ Affiliations

(1)
Department of Clinical Microbiology & Immunology, Chitwan Medical College & Teaching Hospital (CMCTH)
(2)
Department of Biochemistry, Chitwan Medical College

References

  1. Gupta N, Gandham N, Misra NR, Jadhav S, Ujgare M, Vyawahare C. The potential role of stethoscopes as a source of nosocomial infection. Med J DY Patil Uni. 2014;7(2):156–9.View ArticleGoogle Scholar
  2. Uneke CJ, Ijeoma PA. The potential for transmission of hospital-acquired infections by non-critical medical devices: the role of thermometers and blood pressure cuffs. World Health Popul. 2011;12:5–12.View ArticlePubMedGoogle Scholar
  3. Uneke CJ, Ogbonna A, Oyibo PG, Onu CM. Bacterial contamination of stethoscopes used by health workers: public health implications. J Infect Dev Countr. 2010;4:436–41.Google Scholar
  4. Sanders S. The stethoscope and cross-infection. Br J Gen Pract. 2003;53:971–2.PubMedPubMed CentralGoogle Scholar
  5. Madar R, Novakova E, Baska T. The role of non-critical health-care tools in the transmission of nosocomial infections. Bratisl Lek Listy. 2005;106:348–50.PubMedGoogle Scholar
  6. Merlin MA, Wong ML, Pryor PW, Rynn K, Marques BA, Perritt R, et al. Prevalence of methicillin-resistant Staphylococcus aureus on the stethoscopes of emergency medical services providers. Prehosp Emerg Care. 2009;13:71–4.View ArticlePubMedGoogle Scholar
  7. Gupta A, Della LP, Todd B, San GP, Haas J, Wu F, et al. Outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in a neonatal intensive care unit linked to artificial nails. Infect Contr Hosp Epidemiol. 2004;25:210–5.View ArticleGoogle Scholar
  8. Gastmeier P, Groneberg K, Weist K, Rüden H. A cluster of nosocomial Klebsiella pneumoniae bloodstream infections in a neonatal intensive care department: identification of transmission and intervention. Am J Infect Contr. 2003;3:424–30.View ArticleGoogle Scholar
  9. Uneke CJ, Ogbonna A, Oyibo PG, Ekuma U. Bacteriological assessment of stethoscopes used by medical students in Nigeria: implications for nosocomial infection control. World Health Popul. 2008;10:53–61.PubMedGoogle Scholar
  10. Schroeder Maryellen A, D’Amico Frank. Alcohol-based foam can do double duty, cleansing hands and stethoscope heads with a single scrub. J Fam Pract. 2009;58(8):404–9.PubMedGoogle Scholar
  11. Chigozie JU, Chinwendu DN, Kingsley ON, Richard CN, Cletus DU, Nittita PP. Stethoscope disinfection campaign in a Nigerian teaching hospital: results of a before-and-after study. J Infect Dev Ctries. 2014;8(1):86–93.Google Scholar
  12. Koneman EW, Allen SD, Janda WM, Schreckenberger PC, Win WC, editors. The enterobacteriaceae. In: Color atlas and textbook of diagnostic microbiology. 5th ed. JB Lippincott Co: Philladelphia; 2006. p. 211–302.Google Scholar
  13. Jain A, Shah H, Jain A, Sharma M. Disinfection of stethoscopes: gap between knowledge and practice in an Indian tertiary care hospital. Ann Trop Med Public Health. 2013;6:236–9.View ArticleGoogle Scholar
  14. O’Flaherty N, Fenelon L. The stethoscope and healthcare-associated infection: a snake in the grass or innocent bystander? J Hosp Infect. 2015;91(1):1–7.View ArticlePubMedGoogle Scholar
  15. Ian J, Bruce Y. Patient safety and stethoscopes. J of Patient Safety & Inf Control. 2014;2(2):47–50.View ArticleGoogle Scholar
  16. Treakle AM, Thom KA, Furuno JP, Strauss SM, Harris AD, Perencevich EN, et al. Bacterial contamination of the white coats of the health care workers. Am J Infect Contr. 2009;37:101–5.View ArticleGoogle Scholar
  17. Lecat P, Cropp E, McCord G, Haller NA. Ethanol-based cleanser versus isopropyl alcohol to decontaminate stethoscopes. Am J Infect Control. 2009;37:241–3.View ArticlePubMedGoogle Scholar
  18. Bhatta DR, Gokhale S, Ansari MT, Tiwari HK, Gaur A, Mathuria JM, Ghosh AN. Stethoscopes: a possible mode for transmission of nosocomial pathogens. J Clin Diag Res. 2011;5(6):1173–6.Google Scholar
  19. Lavanya J, Jais M, Kumar V, Dutta R. Accessories of health care workers: a boon or a curse to patients in pediatric ICU and nursery? Int J Curr Microbiol App Sci. 2013;2(10):441–7.Google Scholar
  20. Gautam R, Acharya A. Antibiotic susceptibility pattern of bacterial isolates from wound infection in Chitwan Medical College Teaching Hospital, Chitwan, Nepal. Int J of Biomed Adv Res. 2013;4(4):248–52.View ArticleGoogle Scholar
  21. Fenelon L, Holcroft L, Waters N. Contamination of stethoscopes with MRSA and current disinfection practices. J Hosp Infect. 2009;71:376–8.View ArticlePubMedGoogle Scholar
  22. Nunez S, Moreno A, Green K, Villar J. The stethoscope in the emergency department: a vector of infection? Epidemiol Infect. 2000;124:233–7.View ArticlePubMedPubMed CentralGoogle Scholar
  23. World Health Organization. Overcoming antimicrobial resistance. www.who.int/infectious-disease-report/2000/. Accessed 10 Apr 2011.
  24. Saxena AK, Panhotra BR, Al-Mulhim AS. Contaminated physician’s stethoscope—a potential source of transmission of infection in the hospital. Need of frequent disinfection after use. Saudi Med J. 2005;26:348–50.PubMedGoogle Scholar
  25. Marinella MA, Pierson C, Chenoweth C. The stethoscope—a potential source of nosocomial infection? Arch Intern Med. 1997;157:786–90.View ArticlePubMedGoogle Scholar
  26. World Health Organization. Save lives clean your hands-guide to implementation. A guide to the implementation of the WHO multimodal hand hygiene improvement strategy WHO/IER/PSP/2009.02. Geneva: WHO 48p.Google Scholar
  27. Bandi S, Uddin L, Milward K, Aliyu S, Makwana N. How clean are our stethoscopes and do we need to clean them? J Infect. 2008;57:355–6.View ArticlePubMedGoogle Scholar
  28. Mehta AK, Halvosa JS, Gould CV, Steinberg JP. Efficacy of alcohol-based hand rubs in the disinfection of stethoscopes. Infect Control Hosp Epidemiol. 2010;31:870–2.View ArticlePubMedGoogle Scholar
  29. Whittington AM, Whitlow G, Hewson D, Thomas C, Brett SJ. Bacterial contamination of stethoscopes on the intensive care unit. Anaesthesia. 2009;64:620–4.View ArticlePubMedGoogle Scholar

Copyright

© The Author(s) 2017

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