American Journal of Medicine Article Highlights the Promise of Aseptic Barriers for Stethoscope Hygiene in the COVID-19 Era

  • The stethoscope has come under scrutiny as a vector for infection, particularly with the emergence of COVID-19 
  • A novel, aseptic barrier system from AseptiScope™ prevents pathogen transmission 

June 29, 2020 San Diego, California – An article in the new issue of The American Journal of Medicine highlights the practical and symbolic importance of the stethoscope and its key role in assessment of COVID-19 patients.  Despite continuous advances in the diagnosis of disease, the stethoscope remains a mainstay in patient evaluation in the 200 years since its invention.  Today, given the respiratory dysfunction and cardiovascular co-morbid manifestations characteristic of COVID-19, the thorough assessment of patients with a stethoscope is critical, as is the need to maintain a pathogen-free stethoscope diaphragm surface.  An automated, clinically validated and aseptic single-use barrier system from AseptiScope holds promise to fill a significant gap in stethoscope hygiene practices.

The stethoscope is the most prominent and enduring symbol of the interaction and bond between the physician and the patient. This is even more important in the COVID-19 era,” said Alan Maisel, MD, Professor Emeritus at the University of California San Diego, co-author, and co-founder of AseptiScope, Inc.  “The stethoscope is truly the clinician’s third hand and is at the heart of all physical examinations.  Its ability to provide rapid diagnostic and prognostic information is unsurpassed.”

The authors point out that common pathogens found on clinicians’ hands are also likely present on their “third hand,” the stethoscope, and often at a significantly greater magnitude.  In the light of the COVID-19 pandemic, current guidelines and practices related to stethoscope hygiene have understandably come into the spotlight.  Current CDC guidelines call for stethoscope cleaning but fail to recommend a standard cleaning frequency, ranging from between-patients to once weekly.  Given the reported ability of pathogens like COVID-19 to linger on surfaces, this lack of specificity for hygiene frequency may no longer be adequate.  Moreover, despite CDC guidelines, the authors cite observational studies of clinicians in everyday practice that show a very low frequency of stethoscope cleaning, ranging from 13% to 24%.

With the emergence of COVID-19, and in its wake, the difficulties in stethoscope hygiene have become disturbingly clear,” said Robert Gaynes, MD of the Division of Infectious Diseases at Emory University and co-author.  “Just as clear is the persistent importance of the stethoscope and, so, the need to establish new approaches for its safe use.”   

The authors emphasize that common stethoscope cleaning practices, such as alcohol wipes, bleach, and hydrogen peroxide, even when used effectively, produce mixed results in reducing pathogen transmission risk.  Additionally, the authors cite studies finding that single-patient disposable stethoscopes offer compromised auscultation quality and present a concerning cross-contamination risk for the clinicians who share them.  

The article concludes that a promising solution for infection protection for the stethoscope is the use of aseptic disposable diaphragm barriers.  The authors cite a recent study of the AseptiScope DiskCover barriers (Mayo Clin Proc Innov Qual Outcomes. 2020. doi:10.1016 / j.mayocpiqo.2019.10.010), which concluded that barrier use provided protection against common hospital-associated pathogens including MRSA, VRE, and E. Coli

The application of single-use aseptic stethoscope barriers is emerging as the first practical solution to this long-standing challenge,” said Scott Mader, CEO and President of AseptiScope.  “The upcoming launch of the touch-free DiskCover System will allow healthcare providers to safely and confidently use their most frequently employed medical device, the stethoscope, at a time when infection control is the paramount priority.”

About AseptiScope, Inc.

AseptiScope is a privately funded San Diego, California based, clinical innovation company, formed in early 2016. The organization is founded and led by clinical innovation experts, leading medical researchers and practicing physicians. The AseptiScope mission is to design, develop, manufacture and commercialize novel solutions that ensure “Infection Protection for Clinician & Patient.” The company will introduce the first true and practical solution for the longstanding challenge of stethoscope contamination in the summer of 2020: The AseptiScope DiskCover System. Visit for more information.

AseptiScope, DiskCover, and related logos are trademarks of AseptiScope, Inc.

Irene Mulonni


OP ED #5

Achieving The TripleAim With Our Third Hand

By Dr. Alpesh N. Amin

Hand hygiene is a proven safety practice in health care. Unfortunately, hand hygiene is underperformed on a routine basis, leading to the transmission of pathogens and spread of infection from patient to patient. Similarly, stethoscopes – the clinician’s third hand – pose the risk of carrying pathogens and spreading infection from patient to patient. Like hands, stethoscopes can be effectively decolonized using alcohol. Yet, despite effective means to decolonize stethoscopes, our study in the Journal of Hospital Medicine showed only 16% of physicians or student trainees employed stethoscope hygiene prior to patient contact.1 In non-isolation rooms, the issue was exacerbated – we found only 4% of patients received care involving stethoscope hygiene.1

As patients are alarmingly exposed to unclean stethoscopes, stethoscope transmission of pathogens from patient to patient can undermine the efforts of hand hygiene programs. Effectively promoting hand and “third hand” hygiene best practices could reduce infection rates. In turn, infection control can decrease healthcare costs (including reducing antibiotic use and complications) while improving the patient experience – cornerstones of the Institute for Healthcare Improvement’s “Triple Aim”.

An easy to use and fail-safe method that improves stethoscope hygiene could help facilitate achieving the Triple Aim.

1. Jenkins IH, et al. Low Rates of Stethoscope Hygiene. J. Hosp. Med 2015;7;457-458. 

Alpesh N. Amin is Professor of Medicine at the School of Medicine, Chair of the Department of Medicine, and Executive Director for the Hospitalist Program at the University of California, Irvine.  He specializes in hospital, internal and perioperative medicine with research interests including patient care and quality improvement in the acute setting.

Third Hand Vector series spotlights the clinician’s third hand and the risks that contaminated stethoscopes pose to clinicians, patients and healthcare systems. The series features leading experts in infection control, patient care and quality measures raising awareness of the importance of aseptic barriers in reducing transmission of infectious diseases.

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OP ED #4

Protect Your Patient

By Cynthia Cadwell, RN, ANP-BC, CNS

In the 1840s, Ignaz Semmelweis proved that handwashing reduced death in childbirth. Providers have since strived to prevent cross contamination, including the use of environmental sanitization between patients. The point of ‘care’ is to apply life-saving science while doing no harm. Yet, insidious infections occur and can be potentially lethal, particularly in the immunocompromised patients, even among meticulous providers.

Despite the abundance of studies showing the need for cleaning frequently touched items such as cell phones, keyboards, patient care areas and other items to prevent the cross contamination, it is difficult to ensure compliance. Providers know the importance of cleaning their stethoscope before use on a patient. However, when observing stethoscope hygiene in practice, busy providers who see multiple patients in a fast-paced environment frequently forget… because humans can and will make errors!1

Effective quality techniques are exemplified by routine, simple methods implemented in standard workflows. Best practices are those that are easily applied by multiple staff without work-arounds.2  Technologies to help eliminate human error are the most effective – ensuring providers do the right thing, each and every time. Hand sanitizer and gloves immediately visible at the entrance of patient rooms enhance routine use. Adding a touch-free stethoscope barrier dispenser in these locations will decrease stethoscope contamination. Goal: “Do No Harm.” 

1. Institute of Medicine (US) Committee on Quality of Health Care in America; Kohn LT, Corrigan JM, Donaldson MS, editors. Washington (DC): National Academies Press (US); 2000.

2. Crossing the Quality Chasm: A New Health System for the 21st Century. Institute of Medicine (US) Committee on Quality of Health Care in America. Washington (DC): National Academies Press (US); 2001.

Cynthia Cadwell, Principal Consultant at Cadwell Consulting, is a Nurse Practitioner with over 25 years of clinical and biotech experience focused on lean initiatives and quality improvement for patient care and healthcare systems.  As an RN, CNS, CPHQ, and Clinical Educator, her clinical experience spans SNF/PAC, advanced wound care, occupational health, critical care and cardiovascular disease.

Third Hand Vector series spotlights the clinician’s third hand and the risks that contaminated stethoscopes pose to clinicians, patients and healthcare systems. The series features leading experts in infection control, patient care and quality measures raising awareness of the importance of aseptic barriers in reducing transmission of infectious diseases.

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OP ED #3

Stethoscope Contamination: What We Haven’t Learned in 150 Years

By W. Frank Peacock, IV, MD, FACEP, FACC, FESC

Standard of Care?

If you ask a doctor “How often do you clean your stethoscope?” you will likely hear “Oh, in about 30-40% of patient encounters.” If you would then ask “In those 30-40% of encounters, how do you clean your stethoscope?” they will commonly respond “I rub it with an alcohol swab.”

Unfortunately, self-reporting is not very accurate. And although everyone knows that the stethoscope is a strong vector for the transmission of disease, no one wants to admit they do something wrong all day long.

We recently published an observational study in the American Journal of Infection Control. The purpose of this important study was to uncover the facts about real-life stethoscope hygiene. For this investigation, we surreptitiously watched 400 patient-practitioner interactions (the staff didn’t know they were being observed) in high-risk hospital environments like the ER, ICU, and labor and delivery. No (zero) stethoscope hygiene was performed before the patient encounter in 82% of examinations.1 A disgusting finding. And, even when stethoscope cleaning was performed, the quality almost never met the Centers for Disease Control (CDC) cleaning guidelines. In fact, stethoscopes were cleaned consistent with CDC guidance only 4% of the time.1

Unfortunately, the apparent standard of care is to rub dirty contaminated stethoscopes on our patients.  This is because there has never – not in 150 years – been a system that efficiently and reliably provides a clean stethoscope while preserving its function.  This is not a call for a large investment in stethoscope washing, as others have shown that even guideline-compliant stethoscope washing is not effective at eliminating pathogens.  Rather, a disposable, aseptic barrier system for stethoscope diaphragms, one that completely prevents pathogen transmission, presents a strong opportunity for the medical community to improve patient safety.2

1. Boulée D, Kalra S, Haddock A, et al. Contemporary stethoscope cleaning practices: What we haven’t learned in 150 years.Am J Infect Control. 2018 Nov 2 Published online 2018 Nov 2.

2. Vasudevan R, Shin JH, Chopyk J, et al. Aseptic Barriers Allow a Clean Contact for Contaminated Stethoscope Diaphragms. Mayo Clin Proc Innov Qual Outcomes. 2020;4(1):21–30. 

W. Frank Peacock IV, MD, FACEP, FACC, FESC is a Professor of Emergency Medicine and Vice Chair for Research in the department of Emergency Medicine at Baylor College of Medicine, in Houston, Texas. With >600 publications, he is a two-time winner of the Best Research Paper of the Year Award from the American College of Emergency Physicians, and he was the 2019 recipient of the Ray Bahr Award for Excellence from the American College of Cardiology.  Finally, he is the founder of Comprehensive Research Associates, LLC, and Emergencies in Medicine, LLC.

Third Hand Vector series spotlights the clinician’s third hand and the risks that contaminated stethoscopes pose to clinicians, patients and healthcare systems. The series features leading experts in infection control, patient care and quality measures raising awareness of the importance of aseptic barriers in reducing transmission of infectious diseases.

Connect with Us