Predictors of Stethoscope Disinfection Among Pediatric Healthcare Providers

Background: Stethoscopes can be contaminated with important bacteria including methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci and could serve as potential vectors for transmission. Studies have shown that a low proportion of healthcare workers regularly disinfect their stethoscopes, but predictors of good practice are unknown.

Objective: To describe attitudes and stethoscope disinfection practices of healthcare providers and to determine predictors of frequent disinfection.

Methods: We conducted an anonymous web-based survey about stethoscope disinfection perceptions and practices at Children’s Hospital Boston in October 2010. Eligible participants included all nurses, nurse practitioners, and trainee and attending physicians; providers in specialties with anticipated low stethoscope usage were excluded. We assessed frequency and methods of disinfection, perceptions of contamination, barriers to disinfection, and potential predictors of practice (age, gender, role [e.g. physician, nurse], and specialty). Multivariate logistic regression models were created to identify independent predictors of disinfecting after every use.

Results: Of 3,194 eligible recipients, 1,261 (39.5%) completed the survey; 57% of respondents were physicians. The median age was 38 years (interquartile range 31-48). Physicians practiced in a pediatric medical subspecialty (45%), general pediatrics (30%), emergency medicine (7%), surgical fields (5%), critical care (4%), or other (9%). 76% of respondents believed that infection transmission occurs via stethoscopes, but only 24% reported disinfecting their stethoscope after every use. In multivariate analyses, belief that infection transmission occurs via stethoscopes significantly increased the odds of disinfection after every use (OR 2.51 [95% CI 1.62-3.90]), whereas the odds of disinfection after every use were significantly decreased in those who perceived the following barriers: lack of time (OR 0.31 [95% CI 0.17-0.58]), lack of access to disinfection material (OR 0.34 [95% CI 0.23-0.48]), or lack of visual reminders to disinfect (OR 0.18 [95% CI 0.11-0.30]). Among physicians, the odds of disinfection after every use were significantly higher in critical care (OR 6.09 [95% CI 1.96-18.94]) and medical subspecialties (OR 1.94 [95% CI 1.18-3.20]) compared with all other fields.

Conclusions: Most pediatric healthcare providers believed that infections can be transmitted by stethoscopes, but only a minority reported disinfecting their stethoscopes after every use. Limited access to disinfection material, perceived lack of time, and lack of visual reminders were significantly associated with less frequent disinfection. Directly addressing these factors in healthcare facilities may improve stethoscope disinfection practices.