The challenge of combating Clostridium difficile infections (CDI) is a major problem within many health care organizations as CDI adds to the cost of care and is an uncomfortable and sometimes fatal complication of hospitalization for the patient. The practice-focused question for this doctoral project was targeted at patients in hospital settings on a medical surgical floor and asked if clostridium difficile preventive bundles reduce the incidence of CDI compared with nonstandardized preventative methods. Using the plan-do-study-act framework, the purpose of this DNP project was to use a clostridium difficile bundle approach to study the effects of clostridium difficile incidence (CDI) decrease on a medical-surgical unit with high CDI incidences. Standardized environmental cleaning practices resulted in improvement of the patient environment. High-touch cleaning improved from 43.7% to 83.3%. Time between CDI events lengthened from 19.9 days to 30.2, environmental cleaning with the use of Dazo auditing improved from 33.4% to 81.6%, isolation practices improved from 62.7% to 90%, and with the implementation of the nurse-driven CD testing protocol, unnecessary testing improved. Results showed that the CDI incidence on an acute care medical surgical unit was reduced through the use of a clostridium difficile preventive bundle in this DNP project. Reducing the incidence of CDI is a significant contribution to social change as this unwanted complication of hospitalization causes discomfort and pain and adds unnecessary cost to health care.

Hospitalized children are vulnerable to pressure injuries. Multiple methods are available to decrease pressure injuries. One specific method is the pediatric pressure injury prevention bundle, which includes device rotation, moisture management, positioning, skin assessment, and support surface management. Although this prevention bundle is available nationwide, it is not known if this type of bundled methodology helps decrease pressure injuries in hospitalized children. Secondary data regarding nursing interventions implemented as a bundle and pressure injury rates from a large pediatric hospital consortium were used to address this gap in the literature. The research questions explored the impact of the pressure injury prevention bundle on pressure injury rates over time and further dissected the data to determine the significance of each intervention in the treatment bundle. Benoit and Mion's model for performance improvement along with the continuous quality improvement model used by the hospital consortium guided the study. The secondary data sample included 102 children's hospitals participating in the national initiative Solutions for Patient Safety. Pearson correlation statistics revealed a significant inverse relationship between nursing interventions and pressure injury rates for hospitalized children. The findings indicated a 57% reduction in rates of pressure injuries over 5 years with nursing participation in implementing the pediatric pressure injury prevention bundle. The impact of any one intervention over the bundle was inconclusive. Positive social change is seen in the ability to decrease pressure injuries in hospitalized children by nurses' implementation of a pediatric pressure injury prevention bundles.