Abstract
ObjectiveThis 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.MethodsAll 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.ResultsFor general wards and special units, the overall sampling rates were 81.8% (455/556) and 85.6% (107/125) (p = 0.316); 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].ConclusionsNoting 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.
Highlights
Reducing healthcare-associated infection (HAI) remains a critical issue for clinicians and managers in hospitals and healthcare institutions all over the world
We evaluated a total of 681 charts comprising 556 charts of patients in the general wards and 125 charts of patients in the special units,.The 681 beds included 313 medical, 179 surgical, 30 pediatric, and 34 obstetric and gynecologic (Obs-Gyn) beds in the general wards, as well as 62 medical, 30 surgical, 22 pediatric intensive care units (ICUs) beds, and 11 Obs-Gyn delivery or tocolytic beds
We showed that the odds ratios of bacterial contamination in special units ranged from 1.97 [95% confidence intervals (CI): 1.10– 3.53] for S. aureus contamination to 4.00 [95% Confidence Intervals (95% CI): 1.51–10.64] for K. pneumoniae contamination, and the odds ratio of bacterial contamination by methicillinresistant Staphylococcus aureus (MRSA) was 2.50 [95% CI: 1.12–5.59] in special units when compared with general wards
Summary
Reducing healthcare-associated infection (HAI) remains a critical issue for clinicians and managers in hospitals and healthcare institutions all over the world. Based on the WHO guidelines, good hand hygiene can lower the risk of hand transmission of microorganisms [1,5]. Previous studies have showed that the compliance with hand hygiene guidelines is low and unsatisfactory among healthcare workers [6,7,8,9]. Most healthcare personnel do not wash their hands between handling medical charts and touching patients [9]. Detecting possible vectors of pathologic microorganisms in healthcare institutions is another important step in blocking the transmission or eradicating these pathogens. A number of methods, including hand washing, have been used to minimize the occurrence of related infections, there has not been much focus on the source of potential infection in the environment, the role of hospital medical charts as a possible vector of pathogens
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