This division of the stethoscope into two parts was done to obviate the effect of physical removal of microbes by the first swab, thereby affecting the assessment of reduction in microbial load after cleaning, if any. After cleaning and allowing the stethoscope to dry for 30 s, two samples were further collected using sterile swabs (labelled S 1D and S 1B) from the other half of the stethoscopeвЂ™s diaphragm and bell. The stethoscope was then cleaned by alcohol-based disinfectant (Sterillium), commonly used as hand disinfectant in the hospitals. The stethoscope diaphragm (D) and bell (B) were divided into two equal parts and the initial samples (labelled S 0D and S 0B, respectively) were collected using sterile swabs moistened with sterile saline from one half of the stethoscope to document the baseline microbial load on the diaphragm. In order to assess the knowledge and cleaning practices regarding the disinfection of stethoscopes, the healthcare personnel were administered a questionnaire at the same visit while collecting samples from their stethoscopes.

A total of 62 participants were included. These students also collected the swabs from the stethoscopes. The students distributed the questionnaire and collected it from the participants. None of the approached staff denied consent and 100% response rate was achieved. The eligible candidates were approached by two final-year medical students and were explained about the study in detail.

Sample size: All the doctors (faculty members and residents), nurses and medical students engaged in active patient care who use their individual stethoscopes in the various areas of the hospital were eligible to participate in the study. Since the study was conducted in a new institutional set-up where the staff strength was lower, universal sampling was carried out and all the doctors/staff nurses engaged in clinical care were approached. The medical personnel who use stethoscopes regularly in their clinical practice and those who consented were recruited in the study. Study participants: Faculty members, resident doctors, medical students and paramedical personnel who were working in clinical care settings at a tertiary care setting. Study setting: Outpatient department (OPD)/inpatient department (IPD)/intensive care unit (ICU)/nursing stations/operating theatres (OTs) at a tertiary care hospital in Central India where stethoscopes were being used They are a potential vector for nosocomial infections ( Jones et al., 1995) with an increased risk of transmitting antibiotic resistant microorganisms because following contact with the skin, pathogens can attach and establish themselves on the diaphragms/bells of stethoscopes and subsequently be transferred to other patients if the stethoscope is not disinfected regularly. Stethoscopes are an integral part of the physical examination of patients. HCAIs are caused by bacteria, fungi or viruses through various sources including person-to-person contact via the hands of healthcare providers and visitors, personal equipment, airborne transmission, environmental contamination and colonised hospital staff ( Gastmeier et al., 2005). The impact of HCAI implies prolonged hospital stay, long-term disability, increased resistance of microorganisms to antimicrobials, a massive additional financial burden for health systems, high costs for patientsвЂ™ families and increased mortality. The risk of HCAI in developing countries is 2вЂ“20 times higher than in developed countries ( WHO, 2010). A survey conducted by the WHO in 55 hospitals across 14 countries revealed an average of 8.7% hospitalised patients suffering from HCAIs. The World Health Organization (WHO) defines a healthcare-associated infection (HCAI) as an infection occurring in a patient in a hospital or other healthcare facility, in whom the infection was not present or incubating at the time of admission ( WHO, 2002).

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