Hostname: page-component-586b7cd67f-tf8b9 Total loading time: 0 Render date: 2024-11-24T21:23:06.087Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  21 June 2016

Steven E. Brooks ,
Rebecca O. Veal ,
Martin Kramer ,
Laura Dore ,
Nicole Schupf  and
Masasumi Adachi
Steven E. Brooks*
Affiliation:
Department of Laboratories, New York
Rebecca O. Veal
Affiliation:
Department of Laboratories, New York
Martin Kramer
Affiliation:
Infectious Disease, New York
Laura Dore
Affiliation:
Nursing, New York
Nicole Schupf
Affiliation:
Kingsbrook Jewish Medical Center, Brooklyn, and the Laboratory of Epidemiology, NYS. Institute for Basic Research in Developmental Disabilities, Staten Island, and the Gertrude H. Sergievsky Center, Columbia University School of Medicine, New York
Masasumi Adachi
Affiliation:
Department of Laboratories, New York
*
Department Laboratories, Kingsbrook Jewish Medical Center, 585 Schenectady Ave., Brooklyn, NY 11203
Get access Rights & Permissions [Opens in a new window]

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.

Design:

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.

Setting:

The study took place in a 343-bed acute hospital and a 538-bed skilled nursing facility.

Patients:

All patients who underwent routine microbiological evaluation for nosocomially acquired diarrhea over a l-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, distention, 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 0.1 1/1,000 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.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 13 , Issue 2 , February 1992 , pp. 98 - 103
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1992

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Barlett, JG, Chang, TW, Gurwith, M, Gorbach, SL, Onderdonk, AB. Antibiotic-associated pseudomembranous colitis due to toxin-producing Clostridia . N Engl J Med. 1978;298:531–534.CrossRefGoogle Scholar
2. Barlett, JG. Antimicrobial agents implicated in Clostridium difficile toxin-associated diarrhea or colitis. Johns Hopkins Medical Journal. 1981;149:6–9.Google Scholar
3. George, WL, Rolfe, RD, Sutler, VL, Feingold, SM. Diarrhea and colitis associated with antimicrobial therapy in man and animals. Am J Clin Nutr. 1979;32:251–257.CrossRefGoogle ScholarPubMed
4. Gerding, DN, Olson, MM, Peterson, LR, et al. Clostridium difficile-associated diarrhea and colitis in adults: a prospective case-controlled epidemiologic study. Arch Intern Med. 1986;146:95–100.CrossRefGoogle ScholarPubMed
5. Barlett, JG. Antibiotic-associated pseudomembranous colitis. Rev Infect Dis. 1979;1:530–539.CrossRefGoogle Scholar
6. Bender, BS, Bennett, R, Laughon, BE, et al. Is Clostridium difficile endemic in chronic care facilities? Lancet. 1986;ii:11–13.CrossRefGoogle Scholar
7. Bentley, DW. Clostridium difficile-associated disease in long-term care facilities. Infect Control Hosp Epidemiol. 1990;11:434–438.CrossRefGoogle ScholarPubMed
8. McFarland, LV, Mulligan, ME, Kwok, RRY, Stamm, WE. Nosocomial acquisition of Clostridium difficile infection. N Engl J Med. 1989;320:204–210.CrossRefGoogle ScholarPubMed
9. Heard, SR, O'Farrell, S, Holland, D, Crook, S, Barnett, MJ, Tabaqchali, S. The epidemiology of Clostridium difficile with use of a typing scheme: nosocomial acquisition and cross-infection among immunocompromised patients. J Infect Dis. 1986;153:159–162.CrossRefGoogle ScholarPubMed
10. Savage, AM, Alford, RH. Nosocomial spread of Clostridium difficile . Infect Control. 1983;4:31–33.CrossRefGoogle ScholarPubMed
11. Kim, KH, Fekety, R, Batts, DH, et al. Isolation of Clostridium difficile from the environment and contacts of patients with antibiotic-associated colitis. J Infect Dis. 1981;143:42–50.CrossRefGoogle ScholarPubMed
12. Brown, E, Talbot, GH, Axelrod, P, Provencher, M, Hoegg, C. Risk factors for Clostridium difficile toxin-associated diarrhea. Infect Control Hosp Epidemiol. 1990;11:283–290.CrossRefGoogle ScholarPubMed
13. Brooks, S, Veal, R, Kramer, M, Adachi, M. Clostridium difficile-associated diarrhea. Infect Control Hosp Epidemiol. 1990;11:574.Google ScholarPubMed
14. Lennette, EH, Balows, A, Hausler, WJ Jr, Shadomy, HJ. Manual of Clinical Microbiology. 4th ed. Washington DC: American Society for Microbiology; 1985.Google Scholar
15. Lynch, P, Cummings, MJ, Roberts, PL, et al. Implementing and evaluating a system of generic infection control precautions: body substance isolation. Am J Infect Control 1990;18:1–12.CrossRefGoogle ScholarPubMed
16. Rothman, KJ. Modern Epidemiology. Boston, Mass: Little, Brown, and Company. 1986.Google Scholar
17. Kofsky, P, Rosen, L, Reed, J, Tolmie, M, Ufberg, D. Clostridium difficile-a common and costly colitis. Dis Col Rectum. 1991;34:244–248.CrossRefGoogle Scholar
18. Smith, L, Prince, HN, Johnson, E. Bacteriologic studies on electronic hospital thermometers. Infect Control. 1981;2:315–316.CrossRefGoogle ScholarPubMed