Marion K. Jenkins, PhD, FHIMSS

When we think of computers and viruses, we typically think of Klez, Code Red, Chernobyl, Blaster, ILoveYou, and others. This article is about a different type of computer virus (or bacteria) - the actual medical kind.

Although healthcare in general has generally lagged behind other industries in its adoption and use of information technology, recent advances in new, feature-rich end-user technology such as smart phones and touchscreen tablet PCs have gotten the attention of providers, other clinical staff and even business office staff clamoring for use of these devices throughout the healthcare practice setting.

With the increased adoption of EHRs and other clinical information systems, it is increasingly necessary (and productive) for clinical staff to carry around portable electronic devices throughout the practice to access patient records and perform other labor-saving and even life-saving functions. This includes using them in patient areas, and even in sterile clinical areas such as operating theaters and emergency departments. Therefore it hasn’t taken very long for there to be a focus on sterilization procedures for using portable electronic devices in healthcare.

Some facilities are banning or restricting the use of laptops, tablet PCs and smart phones in patient/sterile areas, because those devices can’t be sterilized. If you look at the screen of a tablet PC or a smart phone, you can easily see the fingerprints. Eeeeewwww - it’s obvious that that thing needs to be cleaned. But an autoclave oven wouldn’t be a very good environment for a $2,000 tablet PC.

The irony is that in a typical medical practice there are thousands of paper charts, some with 50 or 100 or more sheets of paper, which have easily been handled by literally hundreds of different people over many years. Some patients, possibly while they were very sick, perhaps even signed or handled some of the forms, so this is also part of the paper chart’s handling - and infection - history. In addition, those files have likely sat on someone’s desk while that person ate lunch or a snack, have found their way into a gym bag or onto the floorboards of a doctor’s car on the way to a soccer game or swim meet, have been sneezed on, spilled on, dropped on the floor or left in the practice break room or a file cart for days or weeks waiting to be sorted and filed.

It is not uncommon to see patient files in open boxes in a hallway, or even stacked directly on the floor itself. If they have been sent offsite for storage, and then later retrieved, there is a whole other chain of events that might contaminate the files. If you have had an ROI (Release of Information) for a file and have had to take apart the file and copy or fax it, there is a great possibility of contamination to/from the copy/fax machine. And the supplies making up the files themselves - starting with the manila folder, plus all the labels, metal brads, paper clips, and colored tabs and labels - didn’t exactly arrive from the office supply store in sterile fashion to begin with. (And lastly, we won’t even comment on how many people have the habit of licking their finger or thumb as they flip through the pages of a medical chart.)

So you walk into a patient exam room with a stack of papers that has - shall we call it? - a “rich” history, from an infection control standpoint.

Paper records thus represent such a huge potential for transmission of disease - not just to patients but to staff as well - that this fact alone should speed the adoption of electronic health records.

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Is your practice’s computer infected? Perhaps, but that stack of papers on your desk might have a richer history of contamination.

Marion K. Jenkins, PhD, FHIMSS

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