Electronic health records point to CT scanner as infection source

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[November 02, 2017] By Ronnie Cohen

(Reuters Health) - Researchers used electronic health records to hunt down the source of a potentially deadly hospital-acquired infection at the University of California, San Francisco.

The culprit: a CT scanner in the hospital’s emergency department, according to a new report in JAMA Internal Medicine online October 23.

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 improve healthcare.

“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.

SOURCE: http://bit.ly/2y1dllz

JAMA Intern Med 2017.

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