Advertisement

The Early Mobility Bundle: a simple enhancement of therapy which may reduce incidence of hospital-acquired pneumonia and length of hospital stay

      Summary

      Background

      Early mobility facilitated by physiotherapy has been shown to reduce the incidence of hospital-acquired pneumonia (HAP) in patients with hip fractures but its effect on HAP incidence in medical patients has not yet been studied.

      Aim

      To determine whether early mobility aided by physiotherapy reduces the incidence of HAP and length of stay in patients on medical wards.

      Methods

      One respiratory and one elderly care medicine ward in one hospital association in Birmingham, UK, received the ‘Early Mobility Bundle’. The bundle consisted of extra targeted physiotherapy and collaboration with ward staff to encourage and promote activity. The incidence of HAP, falls, pressure sores, length of stay (LOS) and activity level were then compared to two matched wards within the same hospital association.

      Results

      HAP incidence was significantly lower in the intervention group (P < 0.0001) and remained so after adjusting for confounders (P = 0.001). Activity levels were higher (P = 0.04) and patients' LOS was more likely to fall in the lowest quartile (OR: 1.44; P = 0.009) in the intervention group. There was no significant difference in other outcomes.

      Conclusion

      The Early Mobility Bundle demonstrates a promising method to reduce the incidence of HAP and to increase activity in medical inpatients.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Hospital Infection
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia.
        Am J Respir Crit Care Med. 2005; 171: 388-416
        • Steer J.
        • Norman E.M.
        • Afolabi O.A.
        • Gibson G.J.
        • Bourke S.C.
        Dyspnoea severity and pneumonia as predictors of in-hospital mortality and early readmission in acute exacerbations of COPD.
        Thorax. 2012; 67: 117-121
        • Sligl W.I.
        • Majumdar S.R.
        How important is age in defining the prognosis of patients with community-acquired pneumonia?.
        Curr Opin Infect Dis. 2011; 24: 142-147
        • Ntoumenopoulos G.
        • Presneill J.J.
        • McElholum M.
        • Cade J.F.
        Chest physiotherapy for the prevention of ventilator-associated pneumonia.
        Intensive Care Med. 2002; 28: 850-856
        • Varela G.
        • Ballesteros E.
        • Jimenez M.F.
        • Novoa N.
        • Aranda J.L.
        Cost-effectiveness analysis of prophylactic respiratory physiotherapy in pulmonary lobectomy.
        Eur J Cardiothorac Surg. 2006; 29: 216-220
        • Nakamura M.
        • Iwahashi M.
        • Nakamori M.
        • et al.
        An analysis of the factors contributing to a reduction in the incidence of pulmonary complications following an esophagectomy for esophageal cancer.
        Langenbecks Arch Surg. 2008; 393: 127-133
        • Kamel H.K.
        • Iqbal M.A.
        • Mogallapu R.
        • Maas D.
        • Hoffmann R.G.
        Time to ambulation after hip fracture surgery: relation to hospitalization outcomes.
        J Gerontol A Biol Sci Med Sci. 2003; 58: 1042-1045
        • Mundy L.M.
        • Leet T.L.
        • Darst K.
        • Schnitzler M.A.
        • Dunagan W.C.
        Early mobilization of patients hospitalized with community-acquired pneumonia.
        Chest. 2003; 124: 883-889
        • Nolan J.
        • Thomas S.
        Targeted individual exercise programmes for older medical patients are feasible, and may change hospital and patient outcomes: a service improvement project.
        BMC Health Serv Res. 2008; 8: 250
        • Centers for Disease Control and Prevention/National Healthcare Safety Network
        Surveillance definitions for specific types of infections.
        CDC, Atlanta2014
        • Stone S.P.
        • Fuller C.
        • Savage J.
        • et al.
        Evaluation of the national Cleanyourhands campaign to reduce Staphylococcus aureus bacteraemia and Clostridium difficile infection in hospitals in England and Wales by improved hand hygiene: four year, prospective, ecological, interrupted time series study.
        BMJ. 2012; 344: e3005
        • Torres A.
        • Peetermans W.E.
        • Viegi G.
        • Blasi F.
        Risk factors for community-acquired pneumonia in adults in Europe: a literature review.
        Thorax. 2013; 68: 1057-1065
        • Meyer K.C.
        The role of immunity and inflammation in lung senescence and susceptibility to infection in the elderly.
        Semin Respir Crit Care Med. 2010; 31: 561-574
        • Cilloniz C.
        • Polverino E.
        • Ewig S.
        • et al.
        Impact of age and comorbidity on cause and outcome in community-acquired pneumonia.
        Chest. 2013; 144: 999-1007
        • Agboado G.
        • Peters J.
        • Donkin L.
        Factors influencing the length of hospital stay among patients resident in Blackpool admitted with COPD: a cross-sectional study.
        BMJ Open. 2012; 2 (pii: e000869)
        • Trotter C.L.
        • Stuart J.M.
        • George R.
        • Miller E.
        Increasing hospital admissions for pneumonia, England.
        Emerg Infect Dis. 2008; 14: 727-733
        • Gill T.M.
        • Murphy T.E.
        • Gahbauer E.A.
        • Allore H.G.
        Association of injurious falls with disability outcomes and nursing home admissions in community-living older persons.
        Am J Epidemiol. 2013; 178: 418-425
        • Pitta F.
        • Troosters T.
        • Probst V.
        • Spruit M.
        • Decramer M.
        • Gosselink R.
        Quantifying physical activity in daily life with questionnaires and motion sensors in COPD.
        Eur Resp J. 2006; 27: 1040
        • Rogers C.
        • Balanos G.
        • Wood A.M.
        Validation of an activity monitor for use in COPD.
        Thorax. 2011; 66: A101
        • Luke A.
        • Dugas L.R.
        • Durazo-Arvizu R.A.
        • Cao G.
        • Cooper R.S.
        Assessing physical activity and its relationship to cardiovascular risk factors: NHANES 2003–2006.
        BMC Public Health. 2011; 11: 387
        • Van Remoortel H.
        • Raste Y.
        • Louvaris Z.
        • et al.
        Validity of six activity monitors in chronic obstructive pulmonary disease: a comparison with indirect calorimetry.
        PLoS One. 2012; 7: e39198
        • Rabinovich R.A.
        • Louvaris Z.
        • Raste Y.
        • et al.
        Validity of physical activity monitors during daily life in patients with COPD.
        Eur Respir J. 2013; 42: 1205-1215
        • Pitta F.
        • Troosters T.
        • Spruit M.A.
        • Probst V.S.
        • Decramer M.
        • Gosselink R.
        Characteristics of physical activities in daily life in chronic obstructive pulmonary disease.
        Am J Respir Crit Care Med. 2005; 171: 972-977
        • Department of Health
        Physical activity guidelines for adults (19–64 years).
        Department of Health; 11, LondonJuly 2011 (Available from:)
        • National Health Service
        The 10,000 steps challenge.
        NHS, London2007 (Available from:)