A quasi-experimental study on stethoscopes contamination with multidrug-resistant bacteria: Its role as a vehicle of transmission

PLoS One. 2021 Apr 22;16(4):e0250455. doi: 10.1371/journal.pone.0250455. eCollection 2021.

Abstract

Stethoscopes have been suggested to be a possible vector of contact transmission. However, only a few studies have focused on the prevalence of contamination by multidrug-resistant (MDR) bacteria and effectiveness of disinfection training to reduce. This study is to investigate the burden of stethoscope contamination with nosocomial pathogens and multidrug-resistant (MDR) bacteria and to analyze habit changes in disinfection of stethoscopes among healthcare workers (HCWs) before and after education and training. We performed a prospective pre and post quasi-experimental study. A total of 100 HCWs (55 doctors and 45 nurses) were recruited. HCWs were surveyed on their disinfection behavior and stethoscopes were cultured by pressing the diaphragm directly onto a blood agar plate before and after education on disinfection. Pulsed-field gel electrophoresis was performed to determine the relatedness of carbapenem-resistant Enterobacteriaceae. Most of the stethoscopes were contaminated with microorganisms before and after the intervention (97.9% and 91.5%, respectively). The contamination rate of stethoscopes with nosocomial pathogens before and after education was 20.8% and 19.2%, respectively. Stethoscope disinfection habits improved (55.1% vs 31.0%; p<0.001), and the overall bacterial loads of contamination were reduced (median colony-forming units, 15 vs 10; p = 0.019) after the intervention. However, the contamination rate by nosocomial pathogens and MDR bacteria did not decrease significantly. A carbapenemase-producing Klebsiella pneumoniae isolates from a stethoscope was closely related to isolates from the patients admitted at the same ward where the stethoscope was used. Stethoscopes were contaminated with various nosocomial pathogens including MDR bacteria and might act as a vehicle of MDR bacteria. Continuous, consistent education and training should be provided to HCWs using multifaceted approach to reduce the nosocomial transmission via stethoscopes.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Carbapenems / pharmacology
  • Cross Infection / epidemiology
  • Cross Infection / microbiology*
  • Cross Infection / prevention & control
  • Disinfection / standards
  • Drug Contamination
  • Drug Resistance, Multiple, Bacterial / genetics
  • Enterobacteriaceae / drug effects*
  • Enterobacteriaceae / pathogenicity
  • Equipment Contamination / prevention & control
  • Female
  • Health Personnel
  • Humans
  • Klebsiella pneumoniae / drug effects*
  • Klebsiella pneumoniae / pathogenicity
  • Male
  • Middle Aged
  • Physicians
  • Prospective Studies
  • Stethoscopes / microbiology*

Substances

  • Carbapenems

Grants and funding

This study was supported by grant of the Institute of Clinical Medical Research in the Yeouido St. Mary’s Hospital, Catholic University of Korea (cooperative agreement no. YSI 2019-07) (to RL). The funding agencies had no role in the study design, the data collection or analysis, the decision to publish, or the preparation of the manuscript. URL: https://www.cmcsungmo.or.kr/en.common.main.main.sp.