The Cost of Stethoscope Hygiene vs. the Cost of Hygiene Failure

Background Stethoscopes, well established as vectors, are recommended to be cleaned by alcohol swab scrubbing for 60 seconds. The new 2024 CDC guidelines mandate stethoscope cleaning between every patient. Unfortunately, guideline failure is poorly described, especially in immunocompromised cancer patients. We thus performed a model examining the expense of stethoscope hygiene using the probabilities and costs of stethoscope infection transmission from 2 well described pathogens; Methicillin Resistant Staphylococcus Aureus (MRSA) and Clostridioides difficile infection (CDI), in both immunocompromised and immunocompetent patients. Methods We performed an economic analysis of pathogen transmission costs and consequences in immunocompromised and immunocompetent ED patients. Variables were defined as auscultations/day in a medium sized ED =90 (30/physician, 3 physicians/24 hours), stethoscope cleaning time =60 seconds, annual ED physician salary =$352,000.00, published stethoscope contamination rates of MRSA and CDI =7.4% and 5%, respectively, and published hospital acquired infection costs for MRSA and CDI =$38,561.00 and $24,205, respectively. The immunocompromised rate was defined as 2.7%, and the estimated probability of infection occurring after exposure in immunocompetent and immunocompromised patients is analyzed by ranges of 1-3% and 10-30%, respectively. Results Using the above definitions provides an estimation of 32,850 auscultations/year/ED, which equates to 547 annual hours of emergency physician stethoscope cleaning; prorated by salary, results in an annual ED cost of $115,940.00/yr. Conclusions Cleaning personal stethoscope costs $115,940.00/yr, but its failure may cost up to $4.98 million/yr/hospital.