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Paper medical records unlikely to be contaminated by serious pathogens
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The medical charts of patients isolated for colonization or infection with special organisms were not contaminated with those bacteria, according to German researchers, who found only normal environmental bacteria in moderate or low levels.
“Despite those multiple opportunities for contamination of medical charts in patients with special organisms placed under long-term isolation, we could not demonstrate transfer of these organisms onto their paper records,” Sebastian Schulz-Stübner, MD, and colleagues wrote in a letter to the editor in Infection Control and Hospital Epidemiology.
From October 2014 to March, the researchers tested the medical charts of clinical ward patients who were placed in single-room isolation for more than 2 weeks at a 696-bed tertiary care center. The charts, maintained outside the patient room, consisted of a plastic cover and paper inserts. The researchers sampled 15 charts upon patient discharge from isolation.
Hospital policy dictates that health care workers remove their personal protective equipment and disinfect their hands before writing their notes, but Schulz-Stübner and colleagues did not monitor adherence to this policy.
The researchers found a mean of 10 colony-forming units (CFU) of coagulase-negative staphylococci on the plastic cover of the patients’ medical charts, as well as 8 CFU of micrococci and 1 CFU of anaerobic bacillus.
The paper inserts were less contaminated than the plastic cover, according to the researchers. On the paper inserts they sampled, they found a mean of 5 CFU of coagulase-negative staphylococci, 3 CFU of micrococci and 0.3 CFU of anaerobic bacillus (P < .001).
The researchers — who noted that the study was limited by the small number of participants — did not identify any organisms specific to the patients kept in isolation. Samples from the two patients in the study with tuberculosis who were under airborne precautions demonstrated no growth of coagulase-negative staphylococci and only 1 CFU of Micrococcus on the plastic cover, they wrote.
“This result suggests that existing adherence to isolation precautions in our cases, although not formally observed and recorded, was sufficient to limit contamination,” Schulz-Stübner and colleagues wrote.
Hand hygiene after patient care but before entering case notes on the paper chart for patients in isolation for special organisms is sound practice, the researchers noted. The records of these patients, however, require no special handling precautions. – by Colleen Owens
Disclosure: Schulz-Stübner reports being an employee and shareholder of the Deutches Beratungszentrum für Hygiene. All other authors report no relevant financial disclosures.
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