REDUCTION IN VANCOMYCIN-RESISTANT ENTEROCOCCUS AND CLOSTRIDIUM-DIFFICILE INFECTIONS FOLLOWING CHANGE TO TYMPANIC THERMOMETERS

OBJECTIVE: To contain a nosocomial outbreak of vancomycin-resistant En terococcus (VRE). DESIGN: Intervention study, with comparison of incid ence rates before and after intervention to assess whether changes in incidence followed the intervention and were greater than expected bas ed on trends observed before the intervention. SETTING: A 343-bed acut e-care hospital serving a predominantly elderly population referred fr om nursing homes, as well as patients admitted from the community. MET HODS: Interventions strategies were tested on three high-risk nursing stations. These included enhanced environmental sanitation; intensive staff retraining in Universal Precautions, body substance isolation, a nd proper use of gloves; and the use of tympanic thermometers to avoid possible rectal or oral VRE transmission during temperature taking. R ESULTS: Nosocomial VRE infections were reduced by 48% 9 months after s witching to tympanic thermometers; incidence of Clostridium difficile infections also was reduced. As a result, tympanic thermometers were i ntroduced facilitywide; additional observation for 20 months showed a risk reduction of 60% for VRE and 40% for C difficile. CONCLUSION: Cro ss-transmission of VRE and C difficile during temperature taking may r esult in bowel colonization, placing the patient at increased risk for infection. This risk may be reduced by the use of tympanic thermomete rs (Infect Control Hosp Epidemiol 1998;19:333-336).