Mobilizing outcomes: implementation of a nurse-led multidisciplinary mobility program.

The safety and efficacy of mobility programs for the ventilated patient and the ability to improve outcomes related to immobility of the critically ill are well documented in the literature. Early mobility programs have been proven safe and effective in study. However, a lack of literature describing application of the therapy and integration at the bedside exists. This article describes the multidisciplinary change process and partnerships necessary to provide the innovation of early mobility to ventilated intensive care unit patients. Early mobility targets ventilated patients upon admission to ensure that interventions are performed that promote physical therapy at first possible moment. In order to accomplish this innovation, evidence-based practice was used to guide culture change in an intensive care unit and build partnerships among disciplines that worked to achieve the same goals independently.

Evaluation of hospital room assignment and acquisition of Clostridium difficile infection.

BACKGROUND AND OBJECTIVE: Clostridium difficile spores persist in hospital environments for an extended period. We evaluated whether admission to a room previously occupied by a patient with C. difficile infection (CDI) increased the risk of acquiring CDI. DESIGN: Retrospective cohort study. SETTING: Medical intensive care unit (ICU) at a tertiary care hospital. METHODS: Patients admitted from January 1, 2005, through June 30, 2006, were evaluated for a diagnosis of CDI 48 hours after ICU admission and within 30 days after ICU discharge. Medical, ICU, and pharmacy records were reviewed for other CDI risk factors. Admitted patients who did develop CDI were compared with admitted patients who did not. RESULTS: Among 1,844 patients admitted to the ICU, 134 CDI cases were identified. After exclusions, 1,770 admitted patients remained for analysis. Of the patients who acquired CDI after admission to the ICU, 4.6% had a prior occupant without CDI, whereas 11.0% had a prior occupant with CDI (P = .002). The effect of room on CDI acquisition remained a significant risk factor (P = .008) when Kaplan-Meier curves were used. The prior occupant's CDI status remained significant (p = .01; hazard ratio, 2.35) when controlling for the current patient's age, Acute Physiology and Chronic Health Evaluation III score, exposure to proton pump inhibitors, and antibiotic use. CONCLUSIONS: A prior room occupant with CDI is a significant risk factor for CDI acquisition, independent of established CDI risk factors. These findings have implications for room placement and hospital design.