Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Bacteriology Laboratory and Genomic Research Laboratory, University of Geneva Hospitals, Geneva, Switzerland.
Mayo Clin Proc. 2014 Mar;89(3):291-9. doi: 10.1016/j.mayocp.2013.11.016.
To compare the contamination level of physicians' hands and stethoscopes and to explore the risk of cross-transmission of microorganisms through the use of stethoscopes.
We conducted a structured prospective study between January 1, 2009, and May 31, 2009, involving 83 inpatients at a Swiss university teaching hospital. After a standardized physical examination, 4 regions of the physician's gloved or ungloved dominant hand and 2 sections of the stethoscopes were pressed onto selective and nonselective media; 489 surfaces were sampled. Total aerobic colony counts (ACCs) and total methicillin-resistant Staphylococcus aureus (MRSA) colony-forming unit (CFU) counts were assessed.
Median total ACCs (interquartile range) for fingertips, thenar eminence, hypothenar eminence, hand dorsum, stethoscope diaphragm, and tube were 467, 37, 34, 8, 89, and 18, respectively. The contamination level of the diaphragm was lower than the contamination level of the fingertips (P<.001) but higher than the contamination level of the thenar eminence (P=.004). The MRSA contamination level of the diaphragm was higher than the MRSA contamination level of the thenar eminence (7 CFUs/25 cm(2) vs 4 CFUs/25 cm(2); P=.004). The correlation analysis for both total ACCs and MRSA CFU counts revealed that the contamination level of the diaphragm was associated with the contamination level of the fingertips (Spearman's rank correlation coefficient, ρ=0.80; P<.001 and ρ=0.76; P<.001, respectively). Similarly, the contamination level of the stethoscope tube increased with the increase in the contamination level of the fingertips for both total ACCs and MRSA CFU counts (ρ=0.56; P<.001 and ρ=.59; P<.001, respectively).
These results suggest that the contamination level of the stethoscope is substantial after a single physical examination and comparable to the contamination of parts of the physician's dominant hand.
比较医生手部和听诊器的污染程度，并探讨通过使用听诊器传播微生物的风险。
我们在 2009 年 1 月 1 日至 5 月 31 日进行了一项结构前瞻性研究，涉及瑞士一所大学教学医院的 83 名住院患者。在标准化体检后，将医生戴手套或未戴手套的优势手的 4 个区域和听诊器的 2 个部分按在选择性和非选择性培养基上；共采样 489 个表面。评估总需氧菌菌落计数（ACC）和耐甲氧西林金黄色葡萄球菌（MRSA）总菌落形成单位（CFU）计数。
指尖、大鱼际、小鱼际、手掌背、听诊器膜和管的 ACC 中位数（四分位距）分别为 467、37、34、8、89 和 18。膜的污染程度低于指尖（P<.001），但高于大鱼际（P=.004）。膜的 MRSA 污染程度高于大鱼际（7 CFUs/25 cm²与 4 CFUs/25 cm²；P=.004）。对于总 ACC 和 MRSA CFU 计数的相关性分析表明，膜的污染程度与指尖的污染程度相关（Spearman 等级相关系数，ρ=0.80；P<.001 和 ρ=0.76；P<.001）。同样，对于总 ACC 和 MRSA CFU 计数，听诊器管的污染程度随着指尖的污染程度增加而增加（ρ=0.56；P<.001 和 ρ=0.59；P<.001）。
这些结果表明，单次体检后听诊器的污染程度相当高，与医生优势手某些部位的污染程度相当。
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