The culprit: a CT scanner in the hospital’s emergency department,
according to a new report in JAMA Internal Medicine online October
The study was the first to use time and location stamps on
electronic records to map patients throughout the hospital and track
the course of an infectious agent.
Lead author Dr. Sara Murray of the University of California, San
Francisco (UCSF) said the research demonstrates just a snippet of
the power of electronic health records (EHRs) to point to ways to
“I think it’s a proof-of-concept for the capabilities of EHR data
that other hospitals can use,” she said in a phone interview.
“Maybe it’s not their CT scanner. Maybe it’s their
pulmonary-function lab or their MRI machine or their operating
room,” said Murray, who is Medical Director of Clinical Informatics
at UCSF Health.
Murray and her team wanted to know whether using a room within 24
hours after it had been used by a patient infected with Clostridium
difficile was tied to an increased risk of C. diff infections in
specific areas across their hospital.
The U.S. Centers for Disease Control and Prevention describes C.
difficile as “the most common microbial cause of
healthcare-associated infections in U.S. hospitals” and “a very
important cause of infectious disease death.”
The researchers mapped patient-location changes for more than 86,000
adults in the San Francisco hospital over three years. Those who
entered the CT scanner in the emergency department within 24 hours
after patients who tested positive for C. diff were two and a half
times more likely to also become infected than patients who entered
the same scanner at other times, the study found.
A subsequent investigation revealed that standards for cleaning the
CT scanner table had not been upgraded as they had been in the
hospital’s other radiology suites.
Researchers are now conducting a study to see if the finding and
consequent changes to the cleaning regimen lowered the hospital’s
rate of C. diff infections.
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The U.S. government has touted electronic records, initially
designed for billing, as a way to dramatically improve patient care
and has used financial incentives to speed their adoption. The hope
was that the widespread use of EHRs would reduce medical errors,
inefficiencies and inappropriate care.
But many doctors see EHRs as the bane of their existence, forcing
them to keep their eyes on computer screens rather than on patients.
Murray frequently hears doctors complaining about EHRs. As studies
like hers continue to reveal answers to medical mysteries, she
believes doctors will come around and see the benefits.
“The private sector has been data mining for years,” she said. “We
are just starting in the healthcare sector to improve care for our
patients. This is an example of that kind of data mining and
something that could be replicated at other institutions.”
Dr. Stuart Johnson, a professor at Loyola University Medical Center
in Chicago who was not involved in the new study, said it points to
unexpected transmission routes of C. diff infection and the need for
careful review of cleaning practices for equipment and rooms used by
patients with diarrhea.
A prior study found that patients in hospital rooms where previous
occupants received antibiotics were at heightened risk for
developing C. diff infections themselves, he said in an email.
“Although the relative contribution of the environment to C.
difficile transmission as opposed to direct person-to-person
transmission is unknown, it is important to consider environmental
sources outside of the room of (infected) patients,” he said.
JAMA Intern Med 2017.
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