The emerging Coronavirus disease 2019 (COVID-19) poses a serious risk for medical personnel infection, which may in turn cause nosocomial spread and endanger staff ability to provide patient care [1]. SARS-CoV-2, the causative agent of COVID-19, is transmitted mainly through droplets and contact [2]. The World Health Organization (WHO) recommends that medical staff use appropriate precautions, including personal protective equipment (PPE) and use of disposable or dedicated medical equipment; PPE used in high-risk settings include face mask or respirator, disposable gloves, face shield, and in many medical centers including our own, waterproof coveralls [3].
Physical examination is a cornerstone of medical assessment, and heart and lung auscultation is one of its inherent core skills [4]. A full physical examination is required when assessing newly admitted patients and is also required for ongoing assessment of the respiratory and cardiac condition of hospitalized patients in COVID-19 wards, for example to rapidly identify life threatening complications such as pneumothorax or non-endotracheal intubation.
However, stethoscope use causes breaches of PPE since placement of earbuds requires breaking coverall protection, and stethoscope removal and placing in COVID-19 wards while not in use can lead to contamination of staff. Recently, a commentary suggested that stethoscopes should be abandoned favoring ultrasound due to those infection/contamination risks [5].
When faced with this conundrum, we found that physicians in our hospital were routinely breaking infection control guidelines to provide the best care for their patients. Here, we describe our risk-minimizing approach in examining suspected and confirmed COVID-19 patients combining adequate infection control and proper stethoscope use.