title: Reduction in vancomycin-resistant Enterococcus and Clostridium difficile infections following change to tympanic thermometers.
abstract: OBJECTIVE
  To contain a nosocomial outbreak of vancomycin-resistant Enterococcus (VRE).
  
  
  METHODS
  Intervention study, with comparison of incidence rates before and after intervention to assess whether changes in incidence followed the intervention and were greater than expected based on trends observed before the intervention.
  
  
  METHODS
  A 343-bed acute-care hospital serving a predominantly elderly population referred from nursing homes, as well as patients admitted from the community.
  
  
  METHODS
  Interventions strategies were tested on three high-risk nursing stations. These included enhanced environmental sanitation; intensive staff retraining in Universal Precautions, body substance isolation, and proper use of gloves; and the use of tympanic thermometers to avoid possible rectal or oral VRE transmission during temperature taking.
  
  
  RESULTS
  Nosocomial VRE infections were reduced by 48% 9 months after switching to tympanic thermometers; incidence of Clostridium difficile infections also was reduced. As a result, tympanic thermometers were introduced facilitywide; additional observation for 20 months showed a risk reduction of 60% for VRE and 40% for C difficile.
  
  
  CONCLUSIONS
  Cross-transmission of VRE and C difficile during temperature taking may result in bowel colonization, placing the patient at increased risk for infection. This risk may be reduced by the use of tympanic thermometers.
authors.affiliation: Department of Laboratories, Kingsbrook Jewish Medical Center, Brooklyn, NY 11203-1891, USA.
authors.forename: S
authors.initials: S
authors.lastname: Brooks
authors.forename: A
authors.initials: A
authors.lastname: Khan
authors.forename: D
authors.initials: D
authors.lastname: Stoica
authors.forename: J
authors.initials: J
authors.lastname: Griffith
authors.forename: L
authors.initials: L
authors.lastname: Friedeman
authors.forename: R
authors.initials: R
authors.lastname: Mukherji
authors.forename: R
authors.initials: R
authors.lastname: Hameed
authors.forename: N
authors.initials: N
authors.lastname: Schupf
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D016360:Clostridioides difficile / Q000187:drug effects*; D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D004352:Drug Resistance, Microbial; D016983:Enterococcus / Q000187:drug effects*; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D006745:Hospital Bed Capacity, 300 to 499; D006764:Hospitals, Community; D006801:Humans; D015994:Incidence; D016012:Poisson Distribution; D013821:Thermometers / Q000382:microbiology; D014481:United States; D014640:Vancomycin / Q000494:pharmacology*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin