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October 27, 2017

The novel way one hospital solved a C. diff mystery

Daily Briefing

    In a novel strategy, University of California-San Francisco (UCSF) Medical Center used EHR data to map out patient movements and identify the location of a source of Clostridium difficile (C. diff), according to a study published in JAMA Internal Medicine.

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    According to UCSF, C. diff is a leading cause of infections acquired in a health care setting, but it is often difficult to track the source of such infections in a hospital because of the complexity of interactions and location changes occurring.

    To capture that data, researchers between 2013 and 2016 used EHR time stamps—entered whenever patients had a procedure or changed locations in the hospital—to map 435,000 patient location shifts across UCSF Medical Center at Parnassus.

    Specifically, researchers used the data to build a map identifying where and when all patients with C. diff had moved throughout the hospital over that time frame. They then examined what happened to non-infected patients who moved through the same locations within 24 hours of an infected patient.

    The researchers categorized patients who had moved through a potentially infected location as "exposed" to C. diff. Then, the researchers determined the likelihood of C. diff infection stemming from that exposure by comparing infection rates over two months between those categorized as exposed and those who had moved through the same locations during a time when it wasn't considered a potential source of infection.

    Key findings

    The researchers identified 1,152 cases of diagnosed C. diff infections between 2013 and 2016, with C. diff-infected patients moving through an average of four locations while in the hospital.

    Ultimately, the researchers discovered that one particular CT scanner in the ED was a likely source of C. diff infections, as non-infected patients who entered the CT scanner within 24 hours of C. diff-infected patients were more than twice as likely to become infected themselves. According to the researchers, a subsequent investigation showed that the cleaning practices employed in the hospital on the ED CT scanner didn't match the standardized cleaning practices in other radiology suites, which prompted UCSF to immediately update their cleaning protocols.

    The researchers did not identify any other locations in the hospital as potential sources for C. diff transmission.


    Russ Cucina, senior author on the study and chief health information officer at UCSF Health System, said the study methods were distinct from other EHR-focused assessments on hospital infections. "Most studies looking at C. diff in hospitals typically only look at whether patients were on the same hospital floor," he said. "If we just look at transmission in their room, we're missing potential opportunities for disease transmission."

    Separately, Robert Wachter—chair of the UCSF Department of Medicine, who was not involved in the study—said the study demonstrates the potential for EHR data. "The [EHR] is a treasure trove of clinical data and insights, but we are just beginning to discover how to unlock its secrets," he said. "This study demonstrates the potential to transform patient care when innovative clinicians and technology experts join hands to tackle healthcare's hardest problems" (Bachert, MedPage Today, 10/23; Thielking, STAT News, 10/24; Kurtzman, UCSF release, 10/23).

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