EHR Helped Hospital Track C.Diff
Spatial, temporal analytics may aid infection control in hospitals.
This article first appeared October 23, 2017 on MedPage Today
By Alexandria Bachert, MPH
Using electronic health record (EHR) data on time and location allowed researchers to identify a source of a Clostridium difficile at the University of California San Francisco Medical Center.
Exposure to C. difficile infection (CDI) in the computed tomography scanner in the emergency department (CT-ED) was associated with a 4% incidence of CDI (OR 2.5 versus unexposed individuals in the same space; 95% CI 1.2-5.2), reported Russ Cucina, MD, senior study author and chief health information officer at UCSF, and colleagues.
Writing online in JAMA Internal Medicine, they noted that the association remained significant even after adjusting for covariates such as antibiotic use and length of hospital stay (OR 2.7; 95% CI 1.3-5.7), as well as in sensitivity analyses in which the incubation period was extended from 24 to 72 hours (OR 2.8; 95% CI 1.2-6.3).
“Most studies looking at C. diff in hospitals typically only look at whether patients were on the same hospital floor,” stated Cucina. “If we just look at transmission in their room, we’re missing potential opportunities for disease transmission.”
Our novel analytic methods identify a previously undiscovered opportunity for real-world practice change, explained Cucina and colleagues.
Robert Wachter, MD, chair of the UCSF Department of Medicine, who was not involved in the study, agreed: “The electronic health record is a treasure trove of clinical data and insights, but we are just beginning to discover how to unlock its secrets. This study demonstrates the potential to transform patient care when innovative clinicians and technology experts join hands to tackle healthcare’s hardest problems,” he stated in a press release.
Cucina and colleagues examined EHR data on time and location to map 434,745 patient location changes throughout the UCSF Medical Center at Parnassus from January 2013 to December 2015.
Patients with a CDI were considered C. difficile positive from the time the positive test was ordered until hospital discharge and places were considered potentially contaminated for 24 hours after a patient with CDI visited them.
The researchers noted that hospitalized patients who hadn’t yet tested positive for CDI but passed through a potentially contaminated space were considered exposed to C. difficile, while those who were in the same space at any other time were seen as the unexposed group.
Cucina and colleagues found a total of 1,152 cases of laboratory-documented CDI, with CDI-positive patients moving through an average of four locations while hospitalized.
Aside from CT-ED, there were no other significant sources of exposure-related infections and the effect was not significant in an adjusted hospital-wide analysis.
The researchers also reported that a subsequent investigation showed that cleaning practices for the CT-ED didn’t match the standardized methods in other radiology suites, spurring the hospital to update the cleaning practices.
Cucina concluded that leveraging EHR data for spatial and temporal analytics may be a widely applicable strategy for infection control and quality improvement.
The researchers reported no financial disclosures of interest.