Comparative evaluation of non mercury thermometers in a hospital setting and healthcare staff preferences
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Comparative evaluation of non mercury thermometers in a hospital setting and healthcare staff preferences

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A research study about finding the most accurate, economically viable, and user friendly alternative to mercury thermometer for the Lebanese healthcare industry

A research study about finding the most accurate, economically viable, and user friendly alternative to mercury thermometer for the Lebanese healthcare industry

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  • including neuropathy, hypertension, renal damage, depressed immunity, and infertility, among others ,In addition to its teratogenic effects
  • All thermometers were calibrated by the medical engineering department before use Departments include peds, med/surg, ICU, delivery, ICN Calibration A 110 beds hospital
  • Bland-Altman (1986) analysis
  • Independent sample t-test

Comparative evaluation of non mercury thermometers in a hospital setting and healthcare staff preferences Comparative evaluation of non mercury thermometers in a hospital setting and healthcare staff preferences Presentation Transcript

  • Comparative Evaluation of Non-Mercury Thermometers in a Hospital Setting Rafic Hariri School of Nursing June 1, 2011 1
  • Background Purpose Literature review Research Methods Results Recommendations Limitations Outline 2
  • Phasing out MERCURY WHY???  Toxic  Pollutant  Bioaccumulative 3
  • Phasing out MERCURY Mercury in the atmosphere has increased 20 times since 1840 Human activities account for about 70% of the mercury emissions compared to natural sources [Source: US Geological Survey, 2002] 4
  • Phasing out MERCURY Mercury Baseline Information from LEBANON (2001 – 2005) Average Mass Imported (Kg Hg per year) 214 Quantity of Thermometers Imported 427517 Estimated Releases (Kg Hg per year) 31 Percentage Releases 14.5 United Nations Development Programme (August, 2007). UNDP project document: Government of Argentina, India, Latvia, Lebanon, Philippines, Senegal, Kingdom of Tanzania and Vietnam. Retrieved on November 20, 2010 from http://gefmedwaste.org/downloads/ProDoc.pdf 5
  • WHO Policy on Mercury in Health Care (August 2005)  Short Term: Address mercury clean up, waste handling and storage procedures. Develop and implement plans to reduce the use of mercury equipment and replace with mercury free alternatives.  Medium Term: Increase efforts to reduce use of unnecessary mercury equipment  Long Term: Support a ban of mercury containing devices and promote alternatives. 6
  • Purpose The objectives of the study are:  To determine the available thermometry technologies available in the Lebanese market and their cost effectiveness for a model healthcare facility.  To determine the suitability of use of two alternative thermometers in a hospital setting based on differences in their essential characteristics and preferences of healthcare professional staff. 7
  • 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. 8
  • Research Methods  Market survey  Nursing leadership preferences  Comparative costing  Clinical comparison - comparative accuracy - ease of use  Nursing staff perspective 9
  • Market survey  Ten vendors were identified and contacted  Brands available - 10 compact electronic - one electronic - 5 infrared tympanic - 3 infrared temporal - one Galinstan-in-glass 10
  • Nursing Leadership Preferences  Eight nurse managers  questionnaire (seven multiple-choice questions + add on) 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. ELECTRONIC or COMPACT ELECTRONIC 11
  • Selection of the two non-mercury thermometers  Electronic Suretemp Plus 690 (Welch Allyn – USA) 12
  • 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) 13
  • Comparative costing of thermometers Types of costs included in the analysis are: Alexander, D., & Kelly, B. (1991). Cost effectiveness of tympanic thermometry in the pediatric office setting. Clinical Pediatrics, 30(4 Suppl), 57-59. Cost type Examples Sources of data thermometer costs Thermometer, accessories Vendor’s quotations disposable supply costs Batteries, Alcohol swabs, Probe covers Hospital data personnel costs Nurses' time User manual equipment service costs medical engineer time, Maintenance, Calibration Personal experience 14
  • 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 15
  • Clinical evaluation: accuracy o 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 16
  • Clinical evaluation: accuracy 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) 0.775 (0.47) 0.31 (0.41) Range of difference of readings -0.7 to +2.2 -0.7 to +1.4 0 to +2.2 -0.4 to +1.3 95% confidence interval 0.37-0.53 0.11-0.29 0.65-0.89 0.15-0.46 t-test 11.27 4.46 12.64 4.11 P value ˂ 0.001 ˂ 0.001 ˂ 0.001 ˂ 0.001 Correlation coefficient (Pearson R) 0.64 0.7 0.65 0.81 17
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  • Clinical evaluation: accuracy Total sample Oral Axillary Rectal Limits of agreement [-0.534, 1.434] [-0.505, 0.905] [-0.194, 1.724] [-0.510, 1.136] Number with 0.5°C or more difference (%) 45 (31.3) 8 (13.3) 33(55) 6(20) Number of readings higher with compact electronic (%) 127 (84.6) 45(75) 59(98.3) 23(76.6) Number of identical readings (%) 7 (4.6) 5 (8.3) 1(1.6) 1(3.3) Number of lower readings (%) 16 (10.6) 10 (16.6) 0 6(20) 19
  • Clinical evaluation: ease of use o Ten healthcare staff (RNs & PNs) took the temperature of a volunteer three times by each thermometer. o Such a difference translates to a 1392 $ in savings from personnel cost annually. Comparison of the measurement time of both thermometers in seconds Thermometer type Mean (SD) Mean difference Level of significance Number of steps (range) Electronic 21.55 (2.07) 14.84 P<0.001 6 to 7 Compact electronic 36.39 (4.45) 6 to 7 20
  • Healthcare personnel perspective  Five healthcare personnel (practical nurses)  Five days Question Compact electronic Electronic Both are the same Which 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% - 21
  • 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 losing the MT200 because of its small size.” “Removal of the probe cover of MT200 may pose a risk of contamination.” 22
  • Healthcare personnel perspective “Adult patients were pleased more with the electronic thermometer” “Probes of electronic thermometer are thick causing discomfort for the neonates.” 23
  • 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. 24
  • Limitations  The study was done in a rural governmental hospital that may differ from other Lebanese healthcare institutions in various ways.  the clinical evaluation of the thermometers regarding accuracy lacked a standard reference thermometer for comparison thereby limiting the validity of the comparison. 25
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