Abstract:
The purposes of this pilot study were to 1) examine the documented compliance to infection prevention procedures in the electronic medical record (EMR) by healthcare providers caring for war-wounded U.S. service members, and 2) assess patient factors that related to compliance. It was an observational retrospective cohort study of EMRs between June 1, 2009 and May 31, 2011. The study identified documentation of provider compliance / noncompliance with 1) active surveillance cultures (ASC), 2) isolation (ISO) precautions, and 3) administration of chlorhexidine gluconate (CHG) baths in relation to available patient factors from the Trauma Infectious Diseases Outcomes Study (TIDOS) data. A survey form was devised to gather compliance data related to ISO precautions and CHG baths documented in each subject’s EMR. A total of 236 traumatic U.S. war-wounded EMRs were surveyed covering 489 inpatient Sequences of
Admission, Transfer, or Readmission. 226 (95.8%) of ASCs obtained upon Admission were fully compliant with the protocol that required submission of groin cultures to detect Gm (-) multidrug resistant organisms (MDROs) and other potentially transmissible pathogens within the first 48 hours following admission. Documentation of adherence to protocols related to ISO was 61.4% and administration of CHG cloth baths was 56.9%. The overall logistic regression model for patient factors related to ISO compliance (n = 286) was not statistically significant (χ2 = 3.7, df = 5, p = 0.59). CHG bath administration compliance was also not statistically significant (χ2 = 10.87, df = 5, p = 0.054).
Infection Preventionists were more likely to document the initiation of ISO via Contact Precautions, responsible for most of the Progress Notes/Nursing Orders (90.3%, n = 334) communicating the need for Isolation Precautions to be initiated plus Progress Notes/Nursing Orders (90.5%, n = 306) communicating no further need for Isolation Precautions.
Replication of this pilot utilizing the entire number of 599 war-wounded would help validate findings of this study. Additionally, hospitals need to rapidly progress in standardization of basic clinical content in the EMR in relation to evidence-based practices. Standardization will result in capabilities for Nursing, Infection Prevention, Medical Staff, Risk Management and Quality Improvement to query the EMR for compliance reports on best practices that are necessary for ever-increasing demands to provide transparency and target zero healthcare-associated infection rates.
