title: Reduction in the incidence of Clostridium difficile-associated diarrhea in an acute care hospital and a skilled nursing facility following replacement of electronic thermometers with single-use disposables.
abstract: OBJECTIVE
  To determine if the spread of Clostridium difficile-associated diarrhea is related to the use of electronic thermometers in an acute hospital and a chronic healthcare facility.
  
  
  METHODS
  After finding that a significant percentage (20.8%) of electronic rectal thermometer handles were contaminated with C difficile, all electronic thermometers were replaced with disposables. A before/after trial was conducted to determine if the change to disposable thermometers would reduce the incidence of C difficile-associated diarrhea.
  
  
  METHODS
  The study took place in a 343-bed acute hospital and a 538-bed skilled nursing facility.
  
  
  METHODS
  All patients who underwent routine microbiological evaluation for nosocomially acquired diarrhea over a 1-year period were included in the study. Nosocomial diarrhea was defined as 3 or more loose stools per day for 2 consecutive days and/or abdominal findings such as pain, distension, and ileus occurring 3 or more days after admission.
  
  
  RESULTS
  During the 6-month postintervention period, the incidence of C difficile-associated diarrhea was reduced from 2.71/1,000 patient days to 1.76/1,000 patient days in the acute hospital and from 0.41/1,000 patient days to 0.11/1,000 patient days in the skilled nursing facility. The protective effect of the intervention was statistically significant for both facilities.
  
  
  CONCLUSIONS
  Replacement of electronic thermometers with single-use disposables significantly reduced the incidence of C difficile-associated diarrhea in both acute care and skilled nursing care facilities. Data suggest that the rectal route may be important in the transmission of C difficile in these settings.
authors.affiliation: Department of Laboratories, Kingsbrook Jewish Medical Center, Brooklyn, NY 11203.
authors.forename: S E
authors.initials: SE
authors.lastname: Brooks
authors.forename: R O
authors.initials: RO
authors.lastname: Veal
authors.forename: M
authors.initials: M
authors.lastname: Kramer
authors.forename: L
authors.initials: L
authors.lastname: Dore
authors.forename: N
authors.initials: N
authors.lastname: Schupf
authors.forename: M
authors.initials: M
authors.lastname: Adachi
mesh_terms: D000368:Aged; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000517:prevention & control / Q000635:transmission*; D003365:Costs and Cost Analysis; D003428:Cross Infection / Q000209:etiology* / Q000517:prevention & control; D003967:Diarrhea / Q000382:microbiology* / Q000517:prevention & control; D004209:Disposable Equipment / Q000191:economics; D006764:Hospitals, Community; D006801:Humans; D012866:Skilled Nursing Facilities; D013821:Thermometers / Q000191:economics