Limits...
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.

Show MeSH

Related in: MedlinePlus

Sampling of a hospital medical chart.The sample was collected from the entire outer surface (plastic cover) of a hospital medical chart with a sterile cotton swab rinsed by normal saline after the experienced investigator had worn sterile gloves.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3928153&req=5

pone-0078512-g002: Sampling of a hospital medical chart.The sample was collected from the entire outer surface (plastic cover) of a hospital medical chart with a sterile cotton swab rinsed by normal saline after the experienced investigator had worn sterile gloves.

Mentions: Samples were collected from the entire outer surfaces (plastic covers) of the hospital medical charts with sterile cotton swabs rinsed with normal saline by an experienced investigator wearing sterile gloves (Figure 2). Prior to transportation, each sampled swab was immediately placed into a special sterile container without spillage or contamination of the sample so as to ensure the accuracy and safety of this study. The swabs along with their containers were then rapidly transferred to the department of laboratory medicine to check the incidence of chart contamination and the bacterial species responsible for said contamination. Cultures were performed according to standard methods used in the hospital [25]. After transportation, each swab was immediately inoculated into a tripticase soy broth and incubated aerobically for 48 hours, then subcultured in a biplate medium composed of sheep blood agar and eosin-methylene blue agar. The identification was carried out using standard microbiological and biochemical laboratory techniques. Cultured organisms were identified using automated methods. If the culture yielded S. aureus, the presentation of MRSA was further confirmed by antibiotic susceptibility testing using the disk diffusion technique.


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

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

Sampling of a hospital medical chart.The sample was collected from the entire outer surface (plastic cover) of a hospital medical chart with a sterile cotton swab rinsed by normal saline after the experienced investigator had worn sterile gloves.
© Copyright Policy
Related In: Results  -  Collection

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

pone-0078512-g002: Sampling of a hospital medical chart.The sample was collected from the entire outer surface (plastic cover) of a hospital medical chart with a sterile cotton swab rinsed by normal saline after the experienced investigator had worn sterile gloves.
Mentions: Samples were collected from the entire outer surfaces (plastic covers) of the hospital medical charts with sterile cotton swabs rinsed with normal saline by an experienced investigator wearing sterile gloves (Figure 2). Prior to transportation, each sampled swab was immediately placed into a special sterile container without spillage or contamination of the sample so as to ensure the accuracy and safety of this study. The swabs along with their containers were then rapidly transferred to the department of laboratory medicine to check the incidence of chart contamination and the bacterial species responsible for said contamination. Cultures were performed according to standard methods used in the hospital [25]. After transportation, each swab was immediately inoculated into a tripticase soy broth and incubated aerobically for 48 hours, then subcultured in a biplate medium composed of sheep blood agar and eosin-methylene blue agar. The identification was carried out using standard microbiological and biochemical laboratory techniques. Cultured organisms were identified using automated methods. If the culture yielded S. aureus, the presentation of MRSA was further confirmed by antibiotic susceptibility testing using the disk diffusion technique.

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