Clostridium difficile [klo-STRID-ee-um dif-uh-SEEL] is a bacterium that causes diarrhea and more serious intestinal conditions such as colitis. It can range from uncomplicated diarrhea to sepsis and even death. Transmission of C diff occurs primarily in health care facilities via the fecal-oral route following transient contamination of the hands of health care workers and patients; contamination of the patient care environment also plays an important role.

A pressure ulcer is a localized injury to the skin or underlying tissue as a result of unrelieved pressure. They commonly form where the bones are close to the skin, such as the ankles, back, elbows, heels and hips. Patients at risk for pressure ulcers are those who are bedridden, use a wheelchair, or are unable to change their position. Prevention includes identifying at-risk persons and implementing specific prevention measures, such as following a patient repositioning schedule; keeping the head of the bed at the lowest safe elevation to prevent shear; using pressure-reducing surfaces; and assessing nutrition and providing supplementation, if needed. When an ulcer occurs, documentation of each ulcer and appropriate staging (I through IV, nonstageable, or deep-tissue injury) are essential to the wound assessment. Treatment involves management of local and distant infections, removal of necrotic tissue, maintenance of a moist environment for wound healing, and possibly surgery.

Sepsis isn’t as much an infection, as it is a condition where the body is continuously harmed by both the infection and the body’s aggressive defense against it (this aggressive defense is known as SIRS – Systemic Inflammatory Response System). This two-punch assault sets off a cascade of events that can lead to widespread inflammation and blood clotting throughout the body. As the body snowballs through a series of stages, the patient may eventually experience organ failure and death.

Policies and procedures (P&Ps) have been suggested as one possible strategy for moving research evidence into practice among nursing staff in hospitals. Research in the area of P&Ps is limited, however. This paper explores: 1) nurses' use of eight specific research-based practices (RBPs) and RBP overall, 2) nurses' use and understanding of P&Ps, and 3) the role of P&Ps in promoting research utilization.

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Evidence-based practice is defined as the use of current best evidence by clinicians when making patient care decisions. Barriers to an evidence-based practice are well identified in the literature and significantly impact the use of research findings in practice. A key feature of a practice environment that supports and promotes the use of best evidence is requiring clinical practice policies and procedures to be evidence-based. The authors describe the structure and process developed to facilitate evidence-based policies and the outcomes of the initiative.

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