Evidence-Based Practice Poster Session (Posters #11-#20)
13 - Medical Charts: A Potential Risk for Cross-contamination in the Perioperative Area
Description: Clinical Problem/Significance: Surgical Site Infections (SSIs) are the most common and costly healthcare-associated infections. Approximately 160,000-300,000 SSIs occur each year in the United States. Up to 60% of SSIs have been estimated to be preventable by using evidence-based guidelines. According to the Association of periOperative Registered Nurses guidelines: "briefcases, backpacks, and other personal items that are taken into the semi-restricted or restricted areas should be cleaned with a low-level disinfectant." However, there are no guidelines regarding the cleaning process of medical charts circulating in the hospital. BackgroundThe use of a medical chart is still in existence in our hospital even after the implementation of an electronic medical record. Essential preoperative requirements such as patient surgical consent, laboratory results coming from outside, and the traditional history & physical exists in paper forms. Therefore, medical charts are still necessary despite the effort of eliminating it.Clinical Question1. Are medical charts considered a fomite that can pose a threat of cross-contamination in the perioperative environment?2. How can we determine if the medical charts circulating in the hospital are clean or not?Description of Evidenced-Based ProtocolThe purpose of this initiative was to evaluate the cleanliness of the medical charts. Due to the circulation of the medical charts throughout the hospital, there is an excellent potential for accumulation of bioburden and possible cross-contamination. As this is a potential risk for patient safety, we use the adenosine triphosphate (ATP) test. Implementation of Evidenced-Based ProtocolTo fully grasp the issue, we used the ATP test on 25 medical charts before and after cleaning. The Infection Preventionist provided education and cleaning instructions to the perioperative staff in maintaining the cleanliness of the medical charts. The use of label stickers on the chart has been eliminated. Medical charts are cleaned with an approved disinfectant before going into the OR, before going to the recovery room, and after discharge.ResultsThe amount of bioburden on 72% of the medical charts before cleaning are above the ATP threshold. After cleaning with the PDI AF3 wipes, 92% of the medical charts had significantly reduced the bioburden.Conclusions/DiscussionIn conclusion, proper cleaning and disinfection greatly reduce the amount of bioburden on medical charts in the perioperative environment. The chain of infection is interrupted, thus prevent cross-contamination to the staff and the patient.Perioperative Nursing ImplicationsHand hygiene is critical in the perioperative environment. However, it is compromised when cleanliness of medical chart is questionable.Frequent cleaning is essential to the standard touch object, such as the medical chart.