Literature

Comparative Evaluation of Non-Mercury Thermometers in a Hospital Setting and

Healthcare Staff Preferences

EcOrient & 4th Lebanon Sustainability Week Conference June 6, 2012

Literature incomprehensive and inconclusive

difficult for meta-analysis because studies target different patient populations and utilize a variety of devices

Overall, electronic thermometers have the widest support as reliable, accurate, and safe alternatives to mercury thermometers.

The problem is that they are thought to be expensive

Crawford, D. C., Hicks, B., & Thompson, M. J. (2006). Which thermometer? Factors influencing best choice for intermittent clinical temperature assessment. Journal of Medical Engineering & Technology, 30(4), 199 – 211.

Research Methods Market survey

Nursing leadership preferences

Comparative costing

Clinical comparison

- comparative accuracy

- ease of use

Nursing staff perspective

7

Selection of the two non-mercury thermometers Market survey of mercury-free thermometers

10 brands compact electronic, one single brand electronic, 5 brands infrared tympanic, 3 brands infrared temporal, and one brand Galinstan-in-glass.

Nursing Leadership Preferences

Analysis of preferred criteria showed that the selected thermometer should display the result digitally and have the ability to measure the temperature from different sites.

Selection of the two non-mercury thermometers Electronic

Suretemp Plus 690 (Welch Allyn – USA)

Selection of the two non-mercury thermometers Compact Electronic 10 brands

Peak temperature alarm Fever warning

Flexible probe tip Start-up self-check

Memory function  Meet standards

MT 200 (Microlife, Switzerland)

Comparative costing of thermometers (USD)

Type of thermometers

Electronic Compact electronic

Infrared tympanic

Infrared temporal

Mercury

Total investment cost

10,029 2,719 3,292 6,580 23,092

Total annual running cost 8,807 15,603 30,543 33,556 31,213

Total cost at year one 18,836 18,322 33,835 40,136 54,305

Total cost at year ten 98,099 158,749 308,722 342,140 543,050

Evaluating Accuracy of the Two Alternative Thermometerso 150 readings from five clinical departments (30 each)o Measurement sites included oral cavity (40 %), axilla

(40%), and rectum (20%) o 62% of readings were taken on female patients

Age Frequency Percentage

≤ 1 month 30 20

1 month – 18 years 32 21

19 years – 60 years 61 41

≥60 years 27 18

Evaluating Accuracy of the Two Alternative Thermometers

Total sample Oral Axillary Rectal

Sample Size (readings) 150 60 60 30

Mean difference of readings (SD*) 0.45 (0.49) 0.2 (0.35) 0.7 (0.47) 0.3 (0.41)

t-test 11.27 4.46 12.64 4.11

P= ˂ 0.001 ˂ 0.001 ˂ 0.001 ˂ 0.001

Correlation coefficient (Pearson R)

0.64 0.7 0.65 0.81

Evaluating Ease of Use of the Two Alternative Thermometerso Ten healthcare staff (RNs & PNs) took the temperature

of a volunteer three times by each thermometer.

Thermometer type

Mean (SD) Mean difference

Level of significance

Electronic 21.55 (2.07) 14.84 P<0.001Compact electronic

36.39 (4.45)

Healthcare personnel perspective Five healthcare personnel (practical nurses) Five days

Question Compact electronic Electronic Both are the

sameWhich thermometer is more likely to be broken during use?

- 80% 20%

Which thermometer do you think is more accurate? 20% 40% 40%

Which thermometer is easier to use? 20% 80% -

18

Healthcare personnel perspective

“The nylon probe covers of the MT200 are not enough protection from nosocomial infections since micro-tears may happen to the probe cover during measurement which might affect its integrity.”

“Equipments used on isolation patients are kept in their rooms, which might increase the possibility of loosing the MT200 because of its small size.”

“Removal of the probe cover of MT200 may pose a risk of contamination.”

“Probes of electronic thermometer are thick causing discomfort for the neonates.”

Recommendations Electronic thermometers are the most cost-effective type

of thermometers in the Lebanese setting. Compact electronic thermometers cannot replace

electronic thermometers from the accuracy point of view. Electronic thermometers are easier to use than compact

electronic thermometers. Most of healthcare personnel's comments favor the

electronic thermometer.

The Electronic thermometer is the recommended replacement for the mercury thermometer in Lebanon.