Paper Charts and Cross-Contamination

Paper Charts and Cross-contamination

Kaplan University

NU420

The purpose of this paper is to describe how changing old fashioned ways of handling medical charts will help reduce the incidence of nosocomial infections in the hospital setting by utilizing electronic technology available that would greatly reduce or eliminate the use of paper charts.

While working in the Labor and Delivery unit at a hospital, I observed how staff were careless with transporting unsanitary charts throughout the hospital. These unsanitary charts would also be taken into the Operating Rooms. After delivery and recovery, the patients were transported to Maternity with the chart either tucked under a corner of the mattress or on the patient's lap. Once on the Maternity Unit, the nurse would handle the chart, place it on the rack and would hand the L&D nurse an empty chart in exchange. All this is so automatic, that no attention is paid to the potential spreading of bacteria and fungi.

Charts are potential vectors for bacterium and fungi and may be the cause of many types of potentially fatal infections.

There are various studies to support the statement that hospital surfaces and medical equipment used during clinical and surgical procedures become contaminated by various pathogenic organisms. These surfaces may include medical devices such as blood pressure cuffs, pulse oximeters, portable thermometers, other items and surfaces, and one of the biggest culprits, hospital paper charts.

Where surgical and clinical tools undergo frequent cleaning and sterilization, patients' charts are the most neglected objects which are more prone to contamination.

To show the connection between bacterial cross-contamination and patient's charts, a study was conducted in 2009 by Wang Fang hospital in Taiwan by local surgical residents (Teng, et al., 2009). For this study, a random sample of 180 medical charts was taken with 50 percent representation from surgical ICU and surgical wards. Moistened sterile swabs were used for the take samples from these charts using sterile normal saline. These samples were transferred to trypticase soy broth and were kept in aerobic incubation for the time period of 48 hours. The sample was later sub-cultured into separated sheep blood and eosin-methylene blue agars. Standards methods were used for the identification of microorganisms present in these subcultures using normal microbiological laboratory.

It was found that samples taken from surgical ICU as well as surgical wards showed contamination respective of their place of origin. The presence of pathogenic and potentially pathogenic bacterium was found on 90 percent of surgical ICU samples and 72 percent of surgical wards samples respectively. Coagulase-negative staphylococci (CoNS) were the most commonly isolated bacteria, both in the surgical ICU and in the surgical ward. Several bacteria isolated from the charts, including multidrug-resistant Acinetobacter baumannii, Stenotrophomonas maltophilia, and Klebsiella pneumoniae, had the same antibiogram as the same bacteria isolated from patients (Teng, et al., 2009).

This study clearly helped the establishment of the evidence that patients' charts are susceptible to contamination with pathogenic and potential pathogenic bacteria leading to potential nosocomial infections.

A related study was conducted by Nils-Olaf Hubner, Claudia Hubner, Axel Kramer, and Ojan Assadian in 2011. The objective was to evaluate the chances of survival of bacterial pathogens on paper and bacterial transfer from paper to hands. Samples of four bacterial pathogens (Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, and Enterococcus hirae) were prepared according to standard laboratory procedures. Sterile swatches of office paper were inoculated with the pathogens and in seven days they were tested for survival. To test the transmission of bacteria from one person's hands to paper and back to another person's hands, the fingertips of volunteers were inoculated with a nonpathogenic strain of E. coli; these volunteers then pressed their fingers onto sterile paper swatches. Another group of volunteers, whose hands had been moistened, pressed their fingertips onto the contaminated paper swatches. Bacteria transferred to the moistened fingertips were cultivated. Results showed that all the bacteria from the four samples showed a different rate of survival depending on environmental conditions; test organisms showed positive transfer via touch from paper medium back to human. All test strains survived on the inoculated paper (Hubner, Hubner, Kramer,