Safely driving a BMW: the impact of electronic medical record implementation upon infection risk at a large hospital

Mrs Kaye Bellis1, Ms Daniela  Karanfilovska1, Ms Pauline  Bass1

1Alfred Health, Melbourne, Australia


Implementation of an electronic medical record (EMR) necessitates the use of bedside mobile workstations (BMWs) and other hand-held devices to support clinical care, and represents a significant change in workflow. Mobile devices pose a recognised risk for transmission of infections if appropriate hand hygiene (HH) is not practiced and device disinfection not adequately performed. We report the impact of EMR implementation with respect to timing of a CPE outbreak.


Clinical staff received education regarding EMR implementation prior to the ‘go live’ date in September 2018. However, infection prevention practices related to BMWs were not prioritised prior to implementation. Standardised methods were employed for CPE monitoring and reporting prior to and following EMR roll-out.


Implementation of BMW corresponded with an increase in numbers of CPE isolates. (17 cases pre implementation in 7 months, 108 cases in 9 months post implementation). Observational audits demonstrated that staff were unaware of cleaning protocols for BMWs, appropriate use with regard to medication administration, procedures, waste management, and the storage of personal items. Infection prevention (IP) staff facilitated the development of clinical guidelines and policies regarding HH and cleaning of BMWs, together with supportive promotional materials (e.g. an instructional DVD, screensavers, factsheets).


BMWs are an integral aspect of daily workflows with an EMR. Ensuring IP are actively involved and IP measures are integrated from the outset is essential. Specific guidelines and auditing tools are required to ensure appropriate use, maintenance and cleaning of BMWs in order to reduce risk for infection transmission.


Kaye has worked in Infection Prevention for 20 plus years across many large tertiary facilities. Her dedication to Hand hygiene over these years has not waned . She loves to try new concepts and innovations to motivate all classifications of staff.

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