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A Randomized Crossover Study of Disposable Thermometers for Prevention of Clostridium difficile and Other Nosocomial Infections

Published online by Cambridge University Press:  02 January 2015

John A. Jernigan
University of Virginia Health Sciences Center, Charlottesville, Virginia Emory University School of Medicine, Atlanta, Georgia
Yardena Siegman-Igra
University of Virginia Health Sciences Center, Charlottesville, Virginia Tel-Aviv University, Tel-Aviv, Israel
Richard C. Guerrant
University of Virginia Health Sciences Center, Charlottesville, Virginia
Barry M. Farr*
University of Virginia Health Sciences Center, Charlottesville, Virginia
University of Virginia Health Sciences Center, Box 473, Charlottesville, VA 22908



To test the hypothesis that use of disposable thermometers would result in lower rates of nosocomial Clostridium difficile diarrhea and of total nosocomial infections, compared with electronic thermometers.


Prospective randomized crossover trial.


A 700-bed university hospital providing primary and tertiary care.


All patients admitted to a group of 20 inpatient nursing units.


20 nursing units were randomized into two groups. One group randomly was assigned exclusive use of single-use disposable thermometers for patient temperature measurement, and the other group was assigned exclusive use of electronic thermometers. After 6 months, the assignments were reversed.


Rates of C difficile infections, total nosocomial diarrheal episodes, and total nosocomial infections were prospectively followed in each study unit over 11 months.


26,350 patients were admitted to the study units and hospitalized for 120,529 patient days. There were 947 nosocomial infections (7.86 per 1,000 patient days). Nosocomial C difficile- associated diarrhea defined by positivity to both toxin B (titer ≥1:10) and toxin A was detected in 32 patients (3.4% of all nosocomial infections). A significantly lower rate of nosocomial C difficile-associated diarrhea was observed with disposable thermometer use (0.16 per 1,000 patient days) compared with electronic thermometer use (0.37 per 1,000 patient days, relative risk [RR]=0.44; 95% confidence interval [CI95], 0.21-0.93, P=.026). There was no difference in overall rates of nosocomial infection between the disposable and electronic groups (8.03 and 7.68 infections per 1,000 patient days, respectively; RR, 1.04; CI95, 0.92-1.19; P=.52) or in the overall rate of nosocomial diarrhea (3.34 and 3.40 per 1,000 patient days, respectively; RR, .98; CI95, 0.81-1.19; P=.87).


The incidence of nosocomial C difficile diarrhea was reduced significantly by using single-use, disposable thermometers as compared with electronic thermometers, but there was no effect on either the overall rate of nosocomial diarrhea or the rate of total nosocomial infections.

Original Articles
Copyright © The Society for Healthcare Epidemiology of America 1998

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