Molecular analysis of bacterial contamination on stethoscopes in an intensive care unit

• Published in: Infection control and hospital epidemiology Vol. 40; no. 2; pp. 1 - 177
• Main Authors: Knecht, Vincent R, McGinniss, John E, Shankar, Hari M, Clarke, Erik L, Kelly, Brendan J, Imai, Ize, Fitzgerald, Ayannah S, Bittinger, Kyle, Bushman, Frederic D, Collman, Ronald G
• Format: Journal Article
• Language: English
• Published: United States Cambridge University Press 01.02.2019
• Subjects: Bacteria; Community composition; Contamination; Gene amplification; Hydrogen peroxide; Intensive care; Mann-Whitney U test; Microbial activity; Nosocomial infection; Nursing; Patients; Relative abundance; Taxonomy; Veganism
• ISSN: 0899-823X; 1559-6834
• DOI: 10.1017/ice.2018.319

Culture-based studies, which focus on individual organisms, have implicated stethoscopes as potential vectors of nosocomial bacterial transmission. However, the full bacterial communities that contaminate in-use stethoscopes have not been investigated. We used bacterial 16S rRNA gene deep-sequencing, analysis, and quantification to profile entire bacterial populations on stethoscopes in use in an intensive care unit (ICU), including practitioner stethoscopes, individual-use patient-room stethoscopes, and clean unused individual-use stethoscopes. Two additional sets of practitioner stethoscopes were sampled before and after cleaning using standardized or practitioner-preferred methods. Bacterial contamination levels were highest on practitioner stethoscopes, followed by patient-room stethoscopes, whereas clean stethoscopes were indistinguishable from background controls. Bacterial communities on stethoscopes were complex, and community analysis by weighted UniFrac showed that physician and patient-room stethoscopes were indistinguishable and significantly different from clean stethoscopes and background controls. Genera relevant to healthcare-associated infections (HAIs) were common on practitioner stethoscopes, among which Staphylococcus was ubiquitous and had the highest relative abundance (6.8%-14% of contaminating bacterial sequences). Other HAI-related genera were also widespread although lower in abundance. Cleaning of practitioner stethoscopes resulted in a significant reduction in bacterial contamination levels, but these levels reached those of clean stethoscopes in only a few cases with either standardized or practitioner-preferred methods, and bacterial community composition did not significantly change. Stethoscopes used in an ICU carry bacterial DNA reflecting complex microbial communities that include nosocomially important taxa. Commonly used cleaning practices reduce contamination but are only partially successful at modifying or eliminating these communities.