Another vote for EHR? Paper records are 'germ hotspot'

Study: Bacteria fester on paper for up to one week

Paper medical records can be hotspots for hospital germs, according to a study in the American Journal of Nursing (AJN), which found that bacteria on paper may survive for up to one week.

According to the authors, "paper may still be one of the most common materials on any hospital unit." For example, hospitals use paper for medical and nursing charts, patient files, notes, and reports; facilities also provide books, newspapers, and magazines for visitors.

Methodology: Most bacteria linger on paper for at least three days 
For the study, German researchers contaminated swatches of office paper with Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, and Enterococcus hirae. Although the length of survival of the four organisms depended on environmental room conditions, they found that most of them remained viable on the paper for at least 72 hours and could still be cultivated one week later. Moreover, they found that the organisms could be transferred from hands to paper and back to hands in sufficient quantities to cause infection.

Although the finding that "paper can carry bacteria is not a surprise," the Los Angeles Times notes that the study underscores the need for hospitals to "treat paper-transmitted bacteria seriously." According to the authors, paper contamination may be especially problematic for hospitals because it cannot be eliminated with chemical disinfectant like bacteria on other inanimate surfaces.

The study authors conclude that "the best way to minimize the spread of pathogens is proper hand hygiene, because the transiently contaminated hands of health care workers are known to be the most important route of transmission." Although electronic health record adoption can help avoid pathogen transmission through paper, the authors note that keyboards and screens still require regular cleaning. 

Editorial offers simple advice: 'Wash your hands'
In an accompanying editorial, AJN Editor-in-Chief Maureen Shawn Kennedy writes that "[t]he need for infection control is clearer than ever," but warns against policies that place the burden of infection control on patients.

For example, she notes that some hospitals ask patients to ask every person who enters their hospital room whether they have washed their hands. "[W]e shouldn't be touting it as a solution to the problem; it's just another work-around in a dysfunctional system," Kennedy writes.

According to Kennedy, "[t]his is where we can reinforce the case for adequate nurse staffing, improve patient outcomes, lower costs and readmissions rates, and help facilities avoid financial penalties," and "[i]t starts with simply washing our hands" (Hubner et al., AJN, December 2011; Kennedy, AJN, December 2011; Roan, "Booster Shots," Los Angeles Times, 11/29).


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