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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

  • Steven E. Brooks (a1), Rebecca O. Veal (a1), Martin Kramer (a2), Laura Dore (a3), Nicole Schupf (a4) and Masasumi Adachi (a1)...



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.


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.


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


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.


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.


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.


Corresponding author

Department Laboratories, Kingsbrook Jewish Medical Center, 585 Schenectady Ave., Brooklyn, NY 11203


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