February 25, 2020
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EHR data show contact with HCWs a risk factor for VRE acquisition

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Eili Y. Klein, PhD
Eili Y. Klein

Using electronic health records, researchers showed that connection through health care workers to patients colonized with vancomycin-resistant enterococci, or VRE, is a significant risk factor for VRE acquisition among uncolonized patients.

“Health care workers have a lot of contact with patients and are considered an important source of transmission, yet there [are] limited data on how these workers connect [with] patients,” Eili Y. Klein, PhD, assistant professor of emergency medicine at the Johns Hopkins University School of Medicine, told Healio.

“Models of health care facilities suggested that these networks likely play an important role in transmission, but the only way to measure them was largely through direct observation of workers, which is both labor intensive and expensive,” Klein said. “By utilizing routinely collected information in hospital electronic medical records, we realized we could develop an approximation of the network structure and test that system for its relation to transmission of an infectious disease.”

Klein and colleagues performed a retrospective analysis of VRE acquisitions between July 1, 2016, and June 30, 2018. According to the study, they collected clinical and demographic patient data from the EHR system, including all recorded health care worker contact with patients.

Results showed that among 2,952 hospitalizations by 2,364 patients who had two or more VRE surveillance swabs, 4.7% (112 patients) had incident nosocomial acquisitions. The researchers found that patients had a median of 24 recorded health care worker contacts per day, of which nine (approximately 40%) were connections that occurred less than 1 hour after another patient contact. Additionally, the study revealed that connection with a VRE-positive patient was associated with increased odds of acquiring VRE (OR = 1.64; 95% CI, 1.39-1.92).

According to Klein, these results confirmed the importance of interventions to reduce transmission of pathogens in the hospital, such as hand hygiene and contact precautions. He said the findings suggested alternative interventions such as cohorting — which would restrict health care worker connections between colonized and uncolonized patients.

“Health care workers are indeed important to the transmission of pathogens, and interventions to reduce rates of hospital-acquired infections should focus on strategies that can reduce the connectivity between patients,” Klein concluded. – by Caitlyn Stulpin

Disclosure: Klein reports no relevant financial disclosures.