Every day in our nation’s hospitals, clinicians use stethoscopes on patients roughly 13.7 million times. This totals roughly 5 billion auscultations annually and each encounter carries an infection risk. Health care-associated infections (HAIs) affect 1 in 31 hospitalized patients in the U.S. each year, causing over 72,000 deaths and $147 billion in total costs. Stethoscopes are among the most contaminated objects in clinics and hospitals. A review in the Journal of Hospital Infection found bacterial contamination on 85% of stethoscopes, with dangerous pathogens like methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci, and Clostridium difficile present at rates comparable to unwashed hands. Despite this, clinicians properly disinfect stethoscopes per protocol in less than 4% of patient encounters.
The solution is simple. Habits form early, so medical schools should teach stethoscope hygiene as a core clinical skill in the same way they teach hand hygiene.
This is especially urgent now. As respiratory viruses rise in the fall and winter, the tools that touch many patients in quick succession need to be clean every time. We already know how to do this. Keep an EPA-registered hospital disinfectant suitable for stethoscopes at the point of care and use it according to label instructions. Before the diaphragm touches skin, clean it, let it dry, then listen. Tell the patient what you are doing. The time cost is measured in seconds. The benefit is measured across millions of patient contacts.
If stethoscope hygiene is so straightforward, why is it so rare? The answer is culture and training. We have spent decades teaching, auditing, and enforcing hand hygiene. We post signs over sinks. We build prompts into electronic records. We make it visible and expected. For stethoscopes, we have normalized the omission.
Simulation labs and bedside teaching offer the fastest path to change. During standardized patient encounters, schools should stock every bay with disinfectant and require students to perform and narrate the cleaning step. Faculty can grade it alongside auscultation technique. On the wards, attending physicians and residents can model the same sequence on rounds. Clean, then listen. Say it out loud. Make it part of the checklist.
When a clinician says, “I’ve cleaned your stethoscope before I listen,” it signals care and competence. It reassures patients at a vulnerable moment. It also teaches the next student in the room that this is normal.
Some wonder whether this step is worth precious curricular time. Yes, and here is why:
First, the risk is real. Stethoscopes pick up and transfer bacteria from patient to patient. Even if a single transfer rarely causes a catastrophic infection, the cumulative risk across millions of touches is how outbreaks start. A single HAI costs $20,000 to $40,000 or more, depending on infection type and severity. Preventing even a small fraction of infections through stethoscope hygiene yields substantial value for minimum investment.
Second, early training endures. When students learn a practice at the start of clinical work, they carry it into residency and beyond. The same was true for gloving protocols, sharps safety, and hand hygiene. Recent implementation research demonstrates that systemic education combined with point of care availability improves stethoscope hygiene practices in both trainees and clinical staff, with sustained effects over time.
Third, this isn’t logistically hard. You do not need to overhaul the curriculum. Stock every exam space with appropriate disinfectant at the point of care, choose products with coverage for the organisms that matter, including spores and certain viruses, and teach students to use them as labeled including contact time. Pair it with hand hygiene so “clean, then listen” becomes one seamless routine. You can add a single line to Objective Structured Clinical Examinations and bedside checklists. That’s all it takes.
If we want lasting change, a few concrete steps can help.
1) Integrate stethoscope hygiene into core clinical competencies and training milestones for all health professionals in training. This can parallel established teaching and assessment for other infection control practices, reinforcing a unified safety culture from day one.
2) Incorporate routine stethoscope cleaning into standardized skills assessments and bedside teaching, with visible supplies in every exam space. When education and environment align, behavior change persists.
3) Ensure hospital leaders support this habit by keeping disinfectant accessible wherever stethoscopes are used and modeling the expected behavior during clinical rounds. Just as accessible supplies drove hand hygiene adoption, ready access and visible leadership can normalize stethoscope hygiene.
We have been here before. In 1848, Ignaz Semmelweis showed that hand hygiene could reduce maternal mortality from 18% to below 2% in his hospital. This insight took decades to become standard practice. We built a safety culture around clean hands. Now it is time to include the tool those hands most often carry.
Dr. Biswas Shrestha, MBBS, MD, PhD, MS is a physician and global health expert with clinical and research experience across Asia-Pacific and the U.S. He currently works as a clinical researcher at Skope, Inc.
Dr. Daniel Stromberg, MD is a pediatric cardiologist, director of cardiac critical care at Dell children’s hospital, professor at UT Dell Medical school, and a co-founder and chief medical officer at Skope, Inc.
Drs. Shrestha and Stromberg are employed by Skope, Inc., a company that manufactures stethoscope disinfection devices. This article discusses stethoscope hygiene and disinfection practice in general terms and does not constitute endorsement of any specific commercial product. The analysis is based on peer-reviewed literature and clinical evidence to address a recognized gap in infection control practice.
This article is part of the Medical Insights vertical on Op-Med, which features study breakdowns, resources, and insights from Doximity members on popular topics in medicine. Want to submit to Medical Insights? See our submission guidelines here; note that we are especially interested in articles covering oncology, dermatology, or rheumatology.
Image by Roman Samborskyi / Shutterstock
