That's right. Not one of the 169 opportunities was seized. And mak-
ing it even more surprising, 41 of those opportunities occurred after
the residents and physicians were shown a PowerPoint presentation
about stethoscope hygiene — a presentation that concluded with the
sentence, "We may be monitoring intermittently." The observers
emphasized to the study subjects that both alcohol swabs and hand
sanitizers, which were readily available outside patient rooms, were
acceptable and generally equivalent means of disinfecting stetho-
scopes.
The usual suspects
How big a deal is this? This was a relatively small study, but we know
from previous studies that many of the microorganisms that live on
patients' skin can adhere to inanimate objects. That's well supported in
the literature. Studies have found Staphylococcus aureus,
Pseudomonas aeruginosa, Clostridium difficile and vancomycin-
resistant enterococci, among other potential pathogens, living on
stethoscopes (osmag.net/jjec7j and osmag.net/7xqpyk). Stethoscope
contamination after one patient exam has been shown to be compara-
ble to the contamination on a physician's dominant hand.
Nurses, surgeons and anesthesia providers all use stethoscopes
routinely, but how often are they being wiped down or otherwise
disinfected? Even if facility-provided stethoscopes are confined to
single rooms or bays, and cleaned regularly, physicians may prefer
to use their own better-quality scopes.
One well-established point that the study underscores is that educa-
tion in the absence of other interventions isn't enough. To change
behavior, you need a feedback loop and reinforcement. Behavior is a
lot more likely to change when an observer says, Hey, I just noticed
that you went into that patient's room and you didn't wipe down
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