Patient Safety Tip of the Week
November 14, 2017
Tracking C. diff to a CT Scanner
Weve previously noted that your CT or MRI scanner could be a source of infection to patients (see our October 22, 2013 Patient Safety Tip of the Week How Safe Is Your Radiology Suite?). And a recent study showed a CT scanner was a potential source for nosocomial transmission of C. difficile infections in a large university hospital (Murray 2017). Those authors found that passing through the CT scanner in the ED within 24 hours after a patient with C. difficile had been there was associated with increased risk of developing C. diff infection (CDI).
But the real story in the Murray study is not that the CT scanner was a source of nosocomial transmission but rather they manner in which they identified it as a source. They used their EHR (electronic health record) as a tool to identify potential sources!
They first identified patients who had proven C. diff infections and then tracked all the places within the hospital that they had been. Places or spaces were considered potentially contaminated for 24 hours after a patient with CDI visited them. All hospitalized patients who had not yet tested positive for CDI and passed through a space while it was potentially contaminated were considered exposed to C. difficile, while patients who occupied the same space at any other time served as the unexposed control group.
CDI-positive patients moved through a mean of 4.2 hospital locations, potentially contaminating those spaces. Being exposed to CDI in the CT scanner in the emergency department was significantly associated with the development of CDI (OR 2.5). That remained significant even after adjustment for covariates and in sensitivity analyses that extended the incubation period to 72 hours. There were no trends in other areas of the hospital that reached statistical significance. Once they identified this increased risk of nosocomial transmission they found that the cleaning practices for the scanner table of the CT scanner in the ED had not yet been updated to match the standardized methods applied in other radiology suites.
The study shows the value of the EHR in tracking patients in time and space can be leveraged as a tool in infection control and hospital epidemiology. Many dont realize that the location and time stamps available in most EHRs can be used to track patient movements within the hospital.
The study also serves as a reminder that the standards which apply to one area of the hospital (such as the radiology suite) should also apply to any components that may be housed in separate areas of the hospital.
To our mind, it also highlights another possibility: compared to patients already hospitalized, patients in the ED are less likely to be diagnosed with CDI or considered at risk for CDI. Hence, some of the precautions taken with patients with known or suspected CDI may not be taken when the patient first arrives at the ED.
Previous studies have shown that patients in rooms occupied by other patients with CDI are at increased risk for CDI (Echaiz 2014). Also patients in rooms previously occupied by patients who had received antibiotics were also at risk for CDI (Freedberg 2016). All these studies emphasize the role environmental surfaces may play in transmission of CDI.
Some of our prior columns on patient safety issues in the radiology suite:
- October 16, 2007 Radiology as a Site at High-Risk for Medication Errors
- February 19, 2008 MRI
Safety
- September 16, 2008 More on Radiology as a High Risk Area
- October 7, 2008 Lessons
from Falls....from Rehab Medicine
- October 2008 Preventing
Infection in MRI
- March 17, 2009 More on MRI Safety
- March 2009 Risk of Burns during MRI Scans from Transdermal Drug Patches
- August 11, 2009 The Radiology Suite Again!
- January 2010 Falls in the Radiology Suite
- August 2010 Sedation
Costs for Pediatric MRI
- January 25, 2011 Procedural Sedation in Children
- February 1, 2011 MRI Safety Audit
- October 25, 2011 Renewed Focus on MRI Safety
- March 13, 2012 Medical Emergency Team Calls to Radiology
- August 2012 Newest MRI Hazard: Ingested Magnets
- October 22, 2013 How Safe Is Your Radiology Suite?
- February 25, 2014 Joint Commission Revised Diagnostic
Imaging Requirements
- July 2014 New MRI Risks: for Staff!
- July 1, 2014 Interruptions and Radiologists
- November 2014 More Radiologist Interruptions
- October 21, 2014 The Fire Department and Your Hospital
- June 23, 2015 Again! Mistaking Antiseptic Solution for
Radiographic Contrast
- August 25, 2015 Checklist for Intrahospital Transport
- March 22, 2016 Radiology
Communication Errors May Surprise You
- August 2016 Guideline
Update for Pediatric Sedation
- October 2016 MRI Safety: Theres an App for That!
- January 17, ,2017 Pediatric
MRI Safety
- August 8, 2017 Sedation
for Pediatric MRI Rising
References:
Murray SG, JWL, Croci R, et al. Using Spatial and Temporal Mapping to Identify Nosocomial Disease Transmission of Clostridium difficile. JAMA Intern Med 2017; Published online October 23, 2017
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2659323
Echaiz JF, Veras L, Zervos M, Dubberke E, Johnson L. Hospital roommates and development of health care-onset Clostridium difficile infection. Am J Infect Control 2014; 42(10): 1109-1111
http://www.ajicjournal.org/article/S0196-6553(14)00938-9/abstract
Freedberg DE, Salmasian H, Cohen B, et al. Receipt of Antibiotics in Hospitalized Patients and Risk for Clostridium difficile Infection in Subsequent Patients Who Occupy the Same Bed. JAMA Intern Med 2016; 176(12): 1801-1808
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2565687
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