# How Clean Is Your Stethoscope?



## AJ Hidell (Mar 10, 2009)

This ties well into the current discussion here about cleaning our equipment.*The Prevalence of MRSA Transmission by Stethoscope*
Keith Wesley, MD, FACEP
Street Science
2009 Mar 9

The authors of this study swabbed 50 stethoscopes of EMS providers presenting to their emergency department (ED) with patients. The swabs were then cultured to detect the presence of methicillin-resistant staph aureus (MRSA). They found 16 (32%) colonized with MRSA. When asked, none of the 16 (32%) could recall the last time their stethoscope had been cleaned.​Read the full article at:  http://www.jems.com/news_and_articles/columns/Wesley/is_mrsa_on_your_stethoscope.html


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## reaper (Mar 10, 2009)

I wipe mine down with Cavi-wipes, after every pt. Plus I use a DRG, which uses the Safeseal covers. They are antimicrobe and get changed every two weeks.

It may still have something on it, but I try to keep it to a minimum.


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## AJ Hidell (Mar 10, 2009)

I am appalled by the response of one hundred percent of those whose stethoscopes cultured positive for MRSA!



> *When asked, none of the 16 (32%) could recall the last time their stethoscope had been cleaned.*


That's insane!  Not only is it a danger to their patients, but they are hanging those things around their necks and sticking them in their ears too!


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## medic417 (Mar 10, 2009)

AJ Hidell said:


> I am appalled by the response of one hundred percent of those whose stethoscopes cultured positive for MRSA!
> 
> 
> That's insane!  Not only is it a danger to their patients, but they are hanging those things around their necks and sticking them in their ears too!



Those type of providers need to be removed from EMS.  Anything that is in that environment needs cleaned after every patient.


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## LucidResq (Mar 10, 2009)

I have been made fun of for my OCD equipment cleaning, hand-washing and BSI precautions but when the stakes are so high for my life and the lives of others I find it shocking that so many people out there don't feel the same way. I hope these people now realize the implications of their failure to clean. This article makes me want to go clean my 'scope, even though it doesn't really need it.


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## vquintessence (Mar 10, 2009)

Just had a conversation with my mum (RN in Boston) who's employer is participating in an internal CQI regarding MRSA and cell phones that the RN's and MD's are given during shift.  Similar results, along with "I thought xyz cleaned it before and after I got them"


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## JPINFV (Mar 10, 2009)

I posted it over there, but it needs to be repeated, "Meh. What should we expect from a health care field where the majority of don't have, nor care to take, a microbiology course?"


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## Aidey (Mar 10, 2009)

All of our hospitals and ambulances carry the super-crazy-eat-your-skin-if-you're-not-wearing-gloves wipes and I use one every time we drop a patient off. Or if it's a no transport I use the wipes in the ambulance. 

I wouldn't be shocked if my stethoscope had MRSA coming into the ED. If the pt had MRSA, my stethoscope will have MRSA, and just walking in the door I haven't had a chance to wipe it off yet.


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## medic417 (Mar 11, 2009)

How many have a cover on their stethoscope?  No way to wash those every call.


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## VentMedic (Mar 11, 2009)

This is why I don't hang my stethoscope around my neck regardless of how well I clean my scope after each patient. I have seen providers get some nasty wounds in this area.

I also replace the rings and diaphragms frequently. After a few wipings with the heavy chemicals, they can get more porous or develop tiny cracks which makes cleaning thoroughly more difficult. It is also very  difficult to clean under the ring when stuff starts to accumulate.  The diaphragm covers which can be easily cleaned and disposed of frequently can be beneficial.


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## firecoins (Mar 11, 2009)

good idea vent.


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## silver (Mar 11, 2009)

Im wondering if they could make autoclavable scopes, which can be sterilized at the end of a shift.

I use wipes on mine after every patient, and then use a full decon of rubbing alcohol at the end of a shift. Occasionally if I feel in more of a "green" mood, I'll rub down the whole thing with hydrogen peroxide which kills bacteria but is generally safe with humans. However the scope is not close to being sterile, just cleaner.


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## Sasha (Mar 11, 2009)

Honestly, I'm a little more lax. I wipe down the bell and diaphram after every patient with alcohol wipes, and at the end of each shift cancer wipe the whole thing down.

However, after that article and the points some have made, I think I'll start to wipe it down after every patient!


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## VentMedic (Mar 11, 2009)

Here is an overview of some disinfectants including hydrogen peroxide which can damage some surfaces on the stethoscope or even make them more difficult to clean.:

http://www.engenderhealth.org/ip/instrum/in15c.html



> Hydrogen peroxide (6%)
> Although the commonly available 3% solution should not be used for HLD, it is suitable for disinfecting surfaces. The use of stronger solutions for HLD has not been well studied. Hydrogen peroxide rapidly loses effectiveness when exposed to heat and light and requires careful storage. For this reason, the World Health Organization recommends that hydrogen peroxide not be used in tropical areas or warm climates. In addition, this solution may cause corrosion, which may damage laparoscopes and metal, rubber, and plastic items.


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## silver (Mar 11, 2009)

VentMedic said:


> Here is an overview of some disinfectants including hydrogen peroxide which can damage some surfaces on the stethoscope or even make them more difficult to clean.:
> 
> http://www.engenderhealth.org/ip/instrum/in15c.html



so what is your recommendation to use then?


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## medic417 (Mar 11, 2009)

silver said:


> so what is your recommendation to use then?



http://www.nextag.com/disposable-stethoscope/search-html


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## VentMedic (Mar 11, 2009)

I use these products which come in the large canisters and easy to carry packets. 

http://www.pdipdi.com/healthcare/surface_disinfect.aspx 

I use what will work on whatever virus or bacteria I am aware of. If you are transporting a patient at a hospital or NH where there are known Clostridium difficile (C-diff) precautions, see what they are using since this particular bacteria is resistant to many regular disinfectants.


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## AJ Hidell (Mar 11, 2009)

VentMedic said:


> I use these products which come in the large canisters and easy to carry packets.
> 
> http://www.pdipdi.com/healthcare/surface_disinfect.aspx


I've had those in every ambulance I've worked in for the last fifteen years. Even the gym I go to has those canisters all over the place.  It's hard to believe there is any professional EMS service that is not providing similar resources for their personnel.


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## VentMedic (Mar 11, 2009)

BTW, my previous post was not an endorsement of that product. However, it is a good product and it clearly lists what it is effective against. 

When choosing a product, make sure it lists what it will be effective against.  One bottle may not be the solution to all.


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## PapaBear434 (Mar 11, 2009)

reaper said:


> I wipe mine down with Cavi-wipes, after every pt. Plus I use a DRG, which uses the Safeseal covers. They are antimicrobe and get changed every two weeks.
> 
> It may still have something on it, but I try to keep it to a minimum.



I use the cavi-wipes too, and I use a bottle of bleach water to spray down my scope, pens, boots after every shift before I get in my POV.  I don't want to take any of that crap home to my daughters.


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## AJ Hidell (Mar 11, 2009)

silver said:


> Im wondering if they could make autoclavable scopes, which can be sterilized at the end of a shift.


In the hospital environment, I have mine sterilized every week or so by ethylene oxide sterilization.  You might check with your local facilitiy to see if they have EtO.  If so, they'd probably be happy to run your stethoscope through every now and then.


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## silver (Mar 11, 2009)

VentMedic said:


> I use these products which come in the large canisters and easy to carry packets.
> 
> http://www.pdipdi.com/healthcare/surface_disinfect.aspx
> 
> I use what will work on whatever virus or bacteria I am aware of. If you are transporting a patient at a hospital or NH where there are known Clostridium difficile (C-diff) precautions, see what they are using since this particular bacteria is resistant to many regular disinfectants.



Hopefully I dont look like an idiot, but low alcohol or high alcohol? 5 minutes seems a bit long, since the solutions are fairly volatile and evaporate really fast. And 55% isopropyl compared to 70% isopropyl would do relatively the same damage to the scope.

Now we use the purple ones (high alcohol), but I havent been in the business long enough to ruin something like a scope to know if the purple wipes cause damage.


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## Scout (Mar 11, 2009)

Is disposable scopes an option?


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## BossyCow (Mar 11, 2009)

Scout said:


> Is disposable scopes an option?



I have seen those cots for the end of a scope advertised but I dont' know how well they work. They always look to me like they would interfere with the sound. 

I just virex mine. When the membrane tanks.. I put another one on it. That's why they give you extras.


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## medic417 (Mar 11, 2009)

Scout said:


> Is disposable scopes an option?



Yes I posted a link somewhere in this discussion.  You can buy them for about $5 each.


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## silver (Mar 11, 2009)

medic417 said:


> Yes I posted a link somewhere in this discussion.  You can buy them for about $5 each.



do you consider that economically logical? Even if you threw away the scope every two weeks it would be cheaper to properly maintain a $40-70 scope until it was shot


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## medic417 (Mar 11, 2009)

silver said:


> do you consider that economically logical? Even if you threw away the scope every two weeks it would be cheaper to properly maintain a $40-70 scope until it was shot



Patient would pay for it so not a problem.  All disposables are billed to each patient.


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## PapaBear434 (Mar 12, 2009)

medic417 said:


> Patient would pay for it so not a problem.  All disposables are billed to each patient.



Let's forget the economic issues, and think ecological.  We throw away enough non-biodegradable things as it is.


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## medic417 (Mar 12, 2009)

PapaBear434 said:


> Let's forget the economic issues, and think ecological.  We throw away enough non-biodegradable things as it is.



But if we cause an epidemic with our filthy stethescope would be better?

Also what about all the toxic waste we are harming the environment with with the cleaning products?  

So we lose whichever way we go.  Mankind is doomed.


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## TransportJockey (Mar 12, 2009)

My Ultrascope is wiped with cavi-wipes after every pt... Most of hte time. When I worked an MCI in the next county it was wiped after about every 3 pts, when I could.


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