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CHAPTER 2

REVIEW OF RELATED LITERATURE

Over the year bacterial organisms find residence in equipments used by

medical professionals has been known for a long period of time but this has been

investigated only recently. Stethoscope is an extension of the hand in clinical settings and

should be cleaned with the same frequency like the hands that is, after and before contact

with each patient. The stethoscope is one of the medical equipments which are

universally used by Health Care Workers. As nursing students, basic infection control

protocols including hand washing techniques, glove use and sharps safety have been

taught, but not once has stethoscope disinfection been mentioned. On placement, Health

care workers are majorly observed to be placing stethoscopes on visibly unclean skins,

near wounds, and on patients with communicable diseases, without cleaning the

stethoscopes in between patients. Following assessment, the stethoscope is typically

placed in a laboratory coat pocket, draped around the neck, or suspended from a

medication cart. Thus in a single day, the stethoscope may come in direct contact with

multiple patients, clothing, and the environment.

Cleaning a stethoscope takes little time and effort, requires no special equipment,

and it could avoid a deadly infection. Thermometers, tongue depressors, otoscopes , BP

cuffs and particularly, stethoscope it is already implemented and a common knowledge

that it carries microorganisms which changes it into a vector itself of infection which can

harm the one who uses them.

Studies have been conducted in different countries to detect presence of

microorganism located in the stethoscopes. In some of the studies individual parts of the


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stethoscopes like diaphragm, bell the tube and etc. Have been studied but the most

neglected part was the earpiece which is directly in contact with our auricular canal. The

sharing of stethoscopes over the year is already one of the most common practices

amongst the nursing staffs and other Healthcare Workers not to say including the student

nurses and medical interns, this may have led to the transmission of microorganisms to

them. The colonization in the ear may spread to the nose and skin and can lead to

Hospital acquired infection if they already have impaired skin integrity secondary to

broken skin in the ear or lets just say a wound in the ear which may become a port of

entry for opportunistic microorganisms which will then result to infection. The

stethoscope is a tool that every healthcare provider uses daily in the assessment of

patients. Thus, in a single day, the stethoscope earpiece may come in direct contact with

multiple patients, clothing and exposed to an open environment. It is already a common

knowledge that there are already a lot of microorganism residing on the earpiece of the

stethoscope but the thing is, microorganism in this part of the stethoscope are still

unknown ,are they aerobic or non aerobic? Can these microorganisms harmful or not?

Several studies have been conducted in different countries to detect presence of

organisms located in the stethoscope. It was found out that majority of health care

professionals stethoscopes are colonized with bacteria.

Just like a normal headphones, an earpiece of a stethoscope can be a breeding

ground for microorganisms and could lead to ear infections. Study shows that frequency

of using the stethoscope may increase bacterial growth in the ear, the more frequent, the

more the bacteria will multiply from 6o to 650 microorganisms. (Daily Express, 2009).


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(21%) including one case ofAcinetobacterbaumanniiin the neonatal intensive care unit.

(Berkovitch M. et al. 2008).

In contrast to other studies, Coronnel et al.study showed that all the three agents

(soap and water, 70% alcohol and hypochlorous acid) used to clean the stethoscopes were

equally effective in disinfecting the stethoscope, while other authors showed that though

it is not statistically significant, there is a trend that alcohol was more effective in

reducing the bacterial count. The disadvantage of this is that there would be a possibility

that alcohol may dry out the rubber seals. Cleaning with soap and water would be the

simplest and most convenient method of disinfecting the stethoscope, while the use of

hospital disinfectants in the form of hypochlorous acid is less convenient because the

solution is more tedious to prepare. (Coronnel et al. 2010).


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