Stethoscope Hygiene Gaps Persist: Infection Prevention Leaders Call for Workflow-Based Solutions to Reduce HAIs

Stethoscopes have long been considered a routine part of bedside care, but a panel hosted by Infection Control Today argued that they remain a quietly persistent vector for health care–associated infections (HAIs). The discussion brought together infection prevention leaders and clinicians from acute care, perioperative settings, emergency medicine, and outpatient oncology to examine why stethoscope hygiene continues to “fall through the cracks” and what it takes to move from policy to measurable practice change.

Peter Graves, BSN, RN, CNOR, CEO and independent consultant with Clinical Solutions, opened by noting that stethoscope hygiene is frequently neglected across settings. Surveys conducted with his colleague, Maureen Spencer, MEd, BSN, RN, CIC, FAPIC, indicate that the problem is widespread and not limited to a single hospital type or region. “One thing I see is frequently missed or completely missed is stethoscope hygiene,” Graves said, adding that data from observational studies consistently show high rates of missed opportunities. The panel quickly converged on a core theme: Inconsistent cleaning is not simply a knowledge deficit. It is a workflow problem, a culture problem, and in high-risk populations, a patient safety problem.

W. Frank Peacock, MD, FACEP, FACC, FESC, professor of emergency medicine and research director and vice chair for research at Baylor College of Medicine, challenged the assumption that routine wiping reliably decontaminates stethoscopes. Drawing on his research findings, Peacock emphasized that cleaning reduces bioburden but does not make an instrument truly clean. “There’s never been a publication that shows you can wash your way out of this,” he said. “It gets cleaner, but it never gets clean.” In his view, partial cleaning is insufficient when caring for patients with highly transmissible pathogens. “Sort of clean isn’t good enough,” Peacock said. “It’s got to be completely clean.”

He also criticized classifying stethoscopes as noncritical surfaces. “The CDC called the stethoscope a noncritical surface years ago, which was a bonehead move,” he said. “There [are] very few things other than your hands that you rub on every patient.” He compared stethoscope hygiene to hand hygiene accountability in emergency medicine. “The hands and the stethoscope have the identical bugs,” Peacock said. “If you get one clean and not the other, it’s just absolutely pointless.”

Natalia G. Nunez, DNP, MPH, RN, CIC, CSPDT, LSSYB, manager of infection prevention and control at Baptist Health in Coral Gables, Florida, added some perspective from ambulatory oncology. She oversees the Cancer Institute, which sees “anywhere between 1000 [and] 1400 patients…daily.” That pace pressures clinicians to turn [patients] over quickly, leading to inconsistent stethoscope cleaning. “For our immunocompromised patients, even low-level contamination can become clinically significant for them,” Nunez said. “These everyday gaps, brief as they may be, create the opportunity for stethoscopes to act as a subtle but real vector of transmission for these folks.”

Wendy Simpson, MSN, RN, CCRN, infection preventionist at Lt. Col. Luke J. Weathers, Jr. Veterans Administration (VA) Medical Center in Memphis, Tennessee, described the day-to-day realities of staffing and workload. “The patient load and short staffing, that’s a constant problem,” Simpson said. She noted that many clinicians still underestimate the harm potential. “Staff don’t necessarily realize the harm, the role this stethoscope can play,” she said. She also acknowledged that embedding evidence into practice takes time. “It’s not been something people are talking about, even though it’s something we’ve known for a long time.”

When the conversation shifted to implementation, panelists emphasized employee agreement and workflow alignment. Simpson argued that change must connect directly to patient outcomes. “You have to bring everything back to the patient,” she said. She recalled convincing a skeptical nurse during an early mobility initiative. “She said, ‘I just want to tell you that you convinced me this is something that has to be done.’” Trust and relevance drive adoption. “If they trust you and believe in you and you can get their buy-in, then that’s going to seal the deal for you,” Simpson said.

Nunez stressed the need for leadership engagement. “You also need the buy-in of your senior leadership,” she said. For nonclinical leaders, infection prevention must be translated into financial terms. “An infection is going to cost you x amount of money more than if you were to adopt these infection prevention practices,” she said. At the unit level, she meets staff where they are. “I understand your workflow. I’ve been there. I was one of you,” she said, reinforcing that “patient safety should always be at the forefront.”

Workflow ease repeatedly emerged as critical. “If you make their workflow worse, it’s really hard to get people on board,” Peacock said. Simpson cautioned against overwhelming staff. “If we have an avalanche of change sent at staff, they are going to rebel,” she said, advocating for small, measurable steps that become lasting habits.

Naomi Ragsdale, BSBA, BSN, RN, an infection control nurse at the same VA facility, described how her team revisited stethoscope hygiene after a rise in central line infections. “Our journey started within our intensive care unit on stethoscope hygiene,” she said. It was initially “an afterthought,” but observations revealed serious gaps. “It was obviously terrible,” Ragsdale said. “It was not being performed, and when it was being performed, it was not done properly.”

An early attempt using sleeve-style covers failed. “They are horrible, cumbersome,…and staff hated them,” she said. Later, the team implemented diaphragm covers through a touch-free dispenser as part of a broader central line prevention bundle. “It was part of a bundled approach for our central line prevention,” Ragsdale said. “We had a significant decrease [in HAIs],” she added, noting the cover was “the last piece” of a multilayer strategy.

The panel debated disposable stethoscopes. Peacock was direct. “The disposable stethoscope is a toy,” he said, citing research findings in which residents “missed 1 out of every 11 patients” when using disposables. “It should not be in a hospital. It is a dangerous tool.” Ragsdale’s survey data supported that position. “One hundred percent of them preferred using the barrier vs the disposable stethoscopes,” she said, because “we can’t hear anything with those.”

Placement and infrastructure also matter. Peacock noted practical failure points, such as poor placement that disrupts workflow. “Placement is key,” Simpson agreed, recalling that “the sensor was a little too sensitive” early on. Nunez described adjusting equipment placement in outpatient exam rooms to prevent unintended activation and discourage “playing with it.” Graves emphasized perioperative needs. “It has to be convenient,” he said. “It needs to be available in preop, [postanesthesia care unit],” and [operating room] adjacent areas.

Policies alone are not enough. “Why things fail is because they’re hard,” Peacock said. “Most people will do the right thing. You just have to make it easy for them.” Nunez described 1-page guides, modules, reminders, and repeated messaging. “Sometimes it requires repetition…until they understand,” she said. Graves underscored ownership. “Getting end-user feedback as part of the entire process” increases adoption because it gives people a sense of agency.

In closing, Peacock summarized bluntly. “We aren’t going to wash our way out of this.” He argued that touch-free barriers reduce the risk of recontamination. Graves urged colleagues to treat stethoscope hygiene with the same vigilance as sterile technique. Ragsdale said, “Now that we know about that…we have to do something about it.” Nunez centered on vulnerable patients. Reducing contamination risk removes “one more thing for them to worry about.”

The panel agreed that stethoscope contamination is solvable. Success depends on aligning interventions with workflows, securing buy-in from frontline staff and leadership, and supporting adoption through infrastructure and accountability. The stethoscope, they concluded, is not a benign accessory. It is a patient-contact device whose cleaning requires the same rigor as hand hygiene to prevent avoidable harm.

REFERENCES

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