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Contamination of medical charts: an important source of potential infection in hospitals.

Chen KH, Chen LR, Wang YK - PLoS ONE (2014)

Bottom Line: Except for obstetric-gynecologic charts, the incidence was significantly higher in each and in all ICUs than in corresponding wards.Special units had a significantly higher incidence of bacterial contamination due to Staphylococcus aureus (17.8%), Methicillin-resistant Staphylococcus aureus (9.3%), Streptococcus viridans (9.4%), Escherichia coli (11.2%), Klebsiella pneumoniae (7.5%), and Acinetobacter baumannii (7.5%).These findings highlight the importance of effective hand-washing before and after handling medical charts.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Taipei Tzu-Chi Hospital, The Buddhist Tzu-Chi Medical Foundation, Taipei, Taiwan ; School of Medicine, Tzu-Chi University, Hualien, Taiwan.

ABSTRACT

Objective: This prospective study aims to identify and compare the incidence of bacterial contamination of hospital charts and the distribution of species responsible for chart contamination in different units of a tertiary hospital.

Methods: All beds in medical, surgical, pediatric, and obstetric-gynecologic general wards (556) and those in corresponding special units (125) including medical, surgical, pediatric intensive care units (ICUs), the obstetric tocolytic unit and delivery room were surveyed for possible chart contamination. The outer surfaces of included charts were sampled by one experienced investigator with sterile cotton swabs rinsed with normal saline.

Results: For general wards and special units, the overall sampling rates were 81.8% (455/556) and 85.6% (107/125) (pā€Š=ā€Š0.316); the incidence of chart contamination was 63.5% and 83.2%, respectively (p<0.001). Except for obstetric-gynecologic charts, the incidence was significantly higher in each and in all ICUs than in corresponding wards. Coagulase-negative staphylococci was the most common contaminant in general wards (40.0%) and special units (34.6%) (p>0.05). Special units had a significantly higher incidence of bacterial contamination due to Staphylococcus aureus (17.8%), Methicillin-resistant Staphylococcus aureus (9.3%), Streptococcus viridans (9.4%), Escherichia coli (11.2%), Klebsiella pneumoniae (7.5%), and Acinetobacter baumannii (7.5%). Logistic regression analysis revealed the incidence of chart contamination was 2- to 4-fold higher in special units than in general wards [odds ratios: 1.97-4.00].

Conclusions: Noting that most hospital charts are contaminated, our study confirms that a hospital chart is not only a medical record but also an important source of potential infection. The plastic cover of the medical chart can harbor potential pathogens, thus acting as a vector of bacteria. Additionally, chart contamination is more common in ICUs. These findings highlight the importance of effective hand-washing before and after handling medical charts. However, managers and clinical staff should pay more attention to the issue and may consider some interventions.

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Related in: MedlinePlus

Flow chart for sampling of hospital medical charts.The selection and exclusion of hospital medical charts for sampling to detect possible bacterial contamination.
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pone-0078512-g001: Flow chart for sampling of hospital medical charts.The selection and exclusion of hospital medical charts for sampling to detect possible bacterial contamination.

Mentions: Considering the differences in frequencies of handling the charts, medical charts of patients who were not hospitalized were excluded in order to avoid selection bias. Furthermore, both of excessively short and long hospitalizations may be major confounders for sampling the medical charts. Since a longer hospital stay may increase the chance of contamination of medical charts, charts of patients who had been in hospital for more than two weeks were excluded. Except for patients in the delivery room with a usually rapid turnover rate, we also excluded patients hospitalized for <3 days. This is because in Taiwan, many minor surgeries or laparoscopic surgeries are performed on patients with a subsequent hospitalization for one or two days based on payment or insurance considerations. In such cases, the physicians and nursing staff often complete all their records including admission, progress and discharge notes at one time and medical charts are handled with low frequency. Otherwise, medical charts that met the inclusion criteria in the general wards and special units were totally collected by means of an ordinary survey rather than being selected according to the investigator's preference (highly selected samples) so as to avoid selection bias (Figure 1). In order to avoid inter-investigator bias and inadequate sampling of the medical charts (measuring bias), only one experienced investigator was responsible for sampling all included charts. Finally, considering the possible effect of time or seasons on organisms, charts in general wards and their corresponding special units (i.e., medical wards vs MICU; surgical wards vs SICU; pediatric wards vs PICU; Obs-Gyn wards vs special units) were sampled in the same month to avoid confounding bias.


Contamination of medical charts: an important source of potential infection in hospitals.

Chen KH, Chen LR, Wang YK - PLoS ONE (2014)

Flow chart for sampling of hospital medical charts.The selection and exclusion of hospital medical charts for sampling to detect possible bacterial contamination.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3928153&req=5

pone-0078512-g001: Flow chart for sampling of hospital medical charts.The selection and exclusion of hospital medical charts for sampling to detect possible bacterial contamination.
Mentions: Considering the differences in frequencies of handling the charts, medical charts of patients who were not hospitalized were excluded in order to avoid selection bias. Furthermore, both of excessively short and long hospitalizations may be major confounders for sampling the medical charts. Since a longer hospital stay may increase the chance of contamination of medical charts, charts of patients who had been in hospital for more than two weeks were excluded. Except for patients in the delivery room with a usually rapid turnover rate, we also excluded patients hospitalized for <3 days. This is because in Taiwan, many minor surgeries or laparoscopic surgeries are performed on patients with a subsequent hospitalization for one or two days based on payment or insurance considerations. In such cases, the physicians and nursing staff often complete all their records including admission, progress and discharge notes at one time and medical charts are handled with low frequency. Otherwise, medical charts that met the inclusion criteria in the general wards and special units were totally collected by means of an ordinary survey rather than being selected according to the investigator's preference (highly selected samples) so as to avoid selection bias (Figure 1). In order to avoid inter-investigator bias and inadequate sampling of the medical charts (measuring bias), only one experienced investigator was responsible for sampling all included charts. Finally, considering the possible effect of time or seasons on organisms, charts in general wards and their corresponding special units (i.e., medical wards vs MICU; surgical wards vs SICU; pediatric wards vs PICU; Obs-Gyn wards vs special units) were sampled in the same month to avoid confounding bias.

Bottom Line: Except for obstetric-gynecologic charts, the incidence was significantly higher in each and in all ICUs than in corresponding wards.Special units had a significantly higher incidence of bacterial contamination due to Staphylococcus aureus (17.8%), Methicillin-resistant Staphylococcus aureus (9.3%), Streptococcus viridans (9.4%), Escherichia coli (11.2%), Klebsiella pneumoniae (7.5%), and Acinetobacter baumannii (7.5%).These findings highlight the importance of effective hand-washing before and after handling medical charts.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Taipei Tzu-Chi Hospital, The Buddhist Tzu-Chi Medical Foundation, Taipei, Taiwan ; School of Medicine, Tzu-Chi University, Hualien, Taiwan.

ABSTRACT

Objective: This prospective study aims to identify and compare the incidence of bacterial contamination of hospital charts and the distribution of species responsible for chart contamination in different units of a tertiary hospital.

Methods: All beds in medical, surgical, pediatric, and obstetric-gynecologic general wards (556) and those in corresponding special units (125) including medical, surgical, pediatric intensive care units (ICUs), the obstetric tocolytic unit and delivery room were surveyed for possible chart contamination. The outer surfaces of included charts were sampled by one experienced investigator with sterile cotton swabs rinsed with normal saline.

Results: For general wards and special units, the overall sampling rates were 81.8% (455/556) and 85.6% (107/125) (pā€Š=ā€Š0.316); the incidence of chart contamination was 63.5% and 83.2%, respectively (p<0.001). Except for obstetric-gynecologic charts, the incidence was significantly higher in each and in all ICUs than in corresponding wards. Coagulase-negative staphylococci was the most common contaminant in general wards (40.0%) and special units (34.6%) (p>0.05). Special units had a significantly higher incidence of bacterial contamination due to Staphylococcus aureus (17.8%), Methicillin-resistant Staphylococcus aureus (9.3%), Streptococcus viridans (9.4%), Escherichia coli (11.2%), Klebsiella pneumoniae (7.5%), and Acinetobacter baumannii (7.5%). Logistic regression analysis revealed the incidence of chart contamination was 2- to 4-fold higher in special units than in general wards [odds ratios: 1.97-4.00].

Conclusions: Noting that most hospital charts are contaminated, our study confirms that a hospital chart is not only a medical record but also an important source of potential infection. The plastic cover of the medical chart can harbor potential pathogens, thus acting as a vector of bacteria. Additionally, chart contamination is more common in ICUs. These findings highlight the importance of effective hand-washing before and after handling medical charts. However, managers and clinical staff should pay more attention to the issue and may consider some interventions.

Show MeSH
Related in: MedlinePlus