title: Contamination of medical charts: an important source of potential infection in hospitals.
abstract: OBJECTIVE
  This prospective study aims to identify and compare the incidence of bacterial contamination of hospital charts and the distribution of species responsible for chart contamination in different units of a tertiary hospital.
  
  
  METHODS
  All beds in medical, surgical, pediatric, and obstetric-gynecologic general wards (556) and those in corresponding special units (125) including medical, surgical, pediatric intensive care units (ICUs), the obstetric tocolytic unit and delivery room were surveyed for possible chart contamination. The outer surfaces of included charts were sampled by one experienced investigator with sterile cotton swabs rinsed with normal saline.
  
  
  RESULTS
  For general wards and special units, the overall sampling rates were 81.8% (455/556) and 85.6% (107/125) (p = 0.316); the incidence of chart contamination was 63.5% and 83.2%, respectively (p<0.001). Except for obstetric-gynecologic charts, the incidence was significantly higher in each and in all ICUs than in corresponding wards. Coagulase-negative staphylococci was the most common contaminant in general wards (40.0%) and special units (34.6%) (p>0.05). Special units had a significantly higher incidence of bacterial contamination due to Staphylococcus aureus (17.8%), Methicillin-resistant Staphylococcus aureus (9.3%), Streptococcus viridans (9.4%), Escherichia coli (11.2%), Klebsiella pneumoniae (7.5%), and Acinetobacter baumannii (7.5%). Logistic regression analysis revealed the incidence of chart contamination was 2- to 4-fold higher in special units than in general wards [odds ratios: 1.97-4.00].
  
  
  CONCLUSIONS
  Noting that most hospital charts are contaminated, our study confirms that a hospital chart is not only a medical record but also an important source of potential infection. The plastic cover of the medical chart can harbor potential pathogens, thus acting as a vector of bacteria. Additionally, chart contamination is more common in ICUs. These findings highlight the importance of effective hand-washing before and after handling medical charts. However, managers and clinical staff should pay more attention to the issue and may consider some interventions.
authors.affiliation: Department of Obstetrics and Gynecology, Taipei Tzu-Chi Hospital, The Buddhist Tzu-Chi Medical Foundation, Taipei, Taiwan ; School of Medicine, Tzu-Chi University, Hualien, Taiwan.
authors.forename: Kuo-Hu
authors.initials: KH
authors.lastname: Chen
authors.affiliation: Mackay Memorial Hospital, Taipei, Taiwan ; Department of Mechanical Engineering, National Chiao-Tung University, Hsinchu, Taiwan.
authors.forename: Li-Ru
authors.initials: LR
authors.lastname: Chen
authors.affiliation: Department of Nursing, Taipei Tzu-Chi Hospital, The Buddhist Tzu-Chi Medical Foundation, Taipei, Taiwan.
authors.forename: Ying-Kuan
authors.initials: YK
authors.lastname: Wang
mesh_terms: D040981:Acinetobacter baumannii / Q000302:isolation & purification; D001424:Bacterial Infections / Q000453:epidemiology*; D003428:Cross Infection / Q000453:epidemiology*; D004866:Equipment Contamination; D004926:Escherichia coli / Q000302:isolation & purification; D050456:Fomites / Q000382:microbiology*; D006235:Hand Disinfection; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007711:Klebsiella pneumoniae / Q000302:isolation & purification; D008499:Medical Records; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D011446:Prospective Studies; D013211:Staphylococcus aureus / Q000302:isolation & purification; D062606:Tertiary Care Centers; D034363:Viridans Streptococci / Q000302:isolation & purification