Quinn, Barbara
(Zeta Eta, Clinical Nurse Specialist, Integrated Quality Services, Sutter Health Medical Center, Sacramento, CA, USA)
,
Baker, Dian L.
(Zeta Eta, Associate Professor, School of Nursing, California State University Sacramento, Sacramento, CA, USA)
,
Cohen, Shannon
(Tau Phi, Manager, Health Promotion, Disease Prevention Program, Department of Veterans Affairs Medical Center, Salem, VA, USA)
,
Stewart, Jennifer L.
(Clinical Nurse Educator, Clinical Education, Practice, and Informatics, Kaiser Permanente‐)
,
Lima, Christine A.
(South Sacramento Service Area, Sacramento, CA, USA)
,
Parise, Carol
(Director, Clinical Education, Practice, and Informatics, Kaiser Permanente‐)
AbstractPurposeNonventilator hospital‐acquired pneumonia (NV‐HAP) is an underreported and unstudied disease, with potential for measurable outcomes, fiscal savings, and improvement in quality of life. The purpose of our study was to (a) identify the incidence of NV‐HAP in a conveni...
AbstractPurposeNonventilator hospital‐acquired pneumonia (NV‐HAP) is an underreported and unstudied disease, with potential for measurable outcomes, fiscal savings, and improvement in quality of life. The purpose of our study was to (a) identify the incidence of NV‐HAP in a convenience sample of U.S. hospitals and (b) determine the effectiveness of reliably delivered basic oral nursing care in reducing NV‐HAP.DesignA descriptive, quasi‐experimental study using retrospective comparative outcomes to determine (a) the incidence of NV‐HAP and (b) the effectiveness of enhanced basic oral nursing care versus usual care to prevent NV‐HAP after introduction of a basic oral nursing care initiative.MethodsWe used the International Statistical Classification of Diseases and Related Problems (ICD‐9) codes for pneumonia not present on admission and verified NV‐HAP diagnosis using the U.S. Centers for Disease Control and Prevention diagnostic criteria. We completed an evidence‐based gap analysis and designed a site‐specific oral care initiative designed to reduce NV‐HAP. The intervention process was guided by the Influencer Model™ (see Figure？) and participatory action research.FindingsWe found a substantial amount of unreported NV‐HAP. After we initiated our oral care protocols, the rate of NV‐HAP per 100 patient days decreased from 0.49 to 0.3 (38.8%). The overall number of cases of NV‐HAP was reduced by 37% during the 12‐month intervention period. The avoidance of NV‐HAP cases resulted in an estimated 8 lives saved, $1.72 million cost avoided, and 500 extra hospital days averted. The extra cost for therapeutic oral care equipment was $117,600 during the 12‐month intervention period. Cost savings resulting from avoided NV‐HAP was $1.72 million. Return on investment for the organization was $1.6 million in avoided costs.ConclusionsNV‐HAP should be elevated to the same level of concern, attention, and effort as prevention of ventilator‐associated pneumonia in hospitals.Clinical RelevanceNursing needs to lead the way in the design and implementation of policies that allow for adequate time, proper oral care supplies, ease of access to supplies, clear procedures, and outcome monitoring ensuring that patients are protected from NV‐HAP.
AbstractPurposeNonventilator hospital‐acquired pneumonia (NV‐HAP) is an underreported and unstudied disease, with potential for measurable outcomes, fiscal savings, and improvement in quality of life. The purpose of our study was to (a) identify the incidence of NV‐HAP in a convenience sample of U.S. hospitals and (b) determine the effectiveness of reliably delivered basic oral nursing care in reducing NV‐HAP.DesignA descriptive, quasi‐experimental study using retrospective comparative outcomes to determine (a) the incidence of NV‐HAP and (b) the effectiveness of enhanced basic oral nursing care versus usual care to prevent NV‐HAP after introduction of a basic oral nursing care initiative.MethodsWe used the International Statistical Classification of Diseases and Related Problems (ICD‐9) codes for pneumonia not present on admission and verified NV‐HAP diagnosis using the U.S. Centers for Disease Control and Prevention diagnostic criteria. We completed an evidence‐based gap analysis and designed a site‐specific oral care initiative designed to reduce NV‐HAP. The intervention process was guided by the Influencer Model™ (see Figure？) and participatory action research.FindingsWe found a substantial amount of unreported NV‐HAP. After we initiated our oral care protocols, the rate of NV‐HAP per 100 patient days decreased from 0.49 to 0.3 (38.8%). The overall number of cases of NV‐HAP was reduced by 37% during the 12‐month intervention period. The avoidance of NV‐HAP cases resulted in an estimated 8 lives saved, $1.72 million cost avoided, and 500 extra hospital days averted. The extra cost for therapeutic oral care equipment was $117,600 during the 12‐month intervention period. Cost savings resulting from avoided NV‐HAP was $1.72 million. Return on investment for the organization was $1.6 million in avoided costs.ConclusionsNV‐HAP should be elevated to the same level of concern, attention, and effort as prevention of ventilator‐associated pneumonia in hospitals.Clinical RelevanceNursing needs to lead the way in the design and implementation of policies that allow for adequate time, proper oral care supplies, ease of access to supplies, clear procedures, and outcome monitoring ensuring that patients are protected from NV‐HAP.
American Thoracic Society . ( 2005 ). Guidelines for the management of adults with hospital acquired, ventilator associated, and healthcare associated pneumonia . American Journal of Respiratory Therapy , 171 , 388 – 416 .
Blinkforn , F. A. , Weingarten , L. , Boivin , L. , Plain , J. , & Kay , M. ( 2011 ). An intervention to improve the oral health of residents in an aged care facility led by nurses . Health Education Journal , 71 ( 4 ), 527 – 535 .
Centers for Disease Control and Prevention . ( 2013 ). National health safety network. Hospital‐associated infections definitions: Surveillance definition of healthcare‐associated infection and criteria for specific types of infections in the acute care setting . Retrieved from http://www.cdc.gov/nhsn/pdfs/pscmanual/17pscnosinfdef_current.pdf.
Chan , E. Y. , Lee , Y. K. , Poh , T. H. , Ling , I. H. , & Prabhakaran , L. ( 2011 ). Translating evidence into nursing practice: Oral hygiene for care dependent adults . International Journal of Evidence‐Based Healthcare , 9 , 172 – 183 .
Davis , J. , & Finley , E. ( 2012 ). The breadth of hospital‐acquired pneumonia: Non‐ventilated versus ventilated patients in Pennsylvania . Pennsylvania Patient Safety Advisory , 9 ( 3 ), 99 – 105 .
Edis , C. , Hatipoglu , O. N. , Yilman , I. , Eker , A. , Tansel , O. , & Sut , N. ( 2009 ). Hospital‐acquired pneumonia developed in non‐intensive care units . Respiration , 78 ( 4 ), 416 – 422 .
Esperatti , M. , Ferrer , M. , Theessen , A. , Liapikou , A. , Valencia , M. , Saucedo , L. M. , Torres , A. ( 2010 ). Nosocomial pneumonia in the intensive care acquired by mechanically ventilated versus nonventilated patients . American Journal of Respiratory Critical Care Medicine , 182 , 1533 – 1539 .
Feider , L. L. , Mitchell , P. , & Bridges , E. ( 2010 ). Oral care practices for orally intubated critically ill adults . American Journal of Critical Care , 19 ( 2 ), 175 – 183 .
Fields , L. B. ( 2008 ). Oral care intervention to reduce incidence of ventilator associated pneumonia in the neurologic intensive care unit . Journal of Neuroscience Nursing , 40 ( 5 ), 291 – 298 .
Fong , J. J. , Cecere , K. , Unterborn , J. , Garpestad , E. , Klee , M. , & Devlin , J. W. ( 2007 ). Factors influencing variability in compliance rates and clinical outcomes among three different severe sepsis bundles . Annals of Pharmacotherapy , 41 , 929 – 936 .
Fortaleza , C. M. , Abati , P. A. , Batista , M. R. , & Dias , A. ( 2009 ). Risk factors for hospital‐acquired pneumonia in nonventilated adults . Brazilian Journal of Infectious Diseases , 13 ( 4 ), 284 – 288 .
Fuchshuber , P. R. , Greif , W. , Tidwell , C. , Klemm , M. S. , Frydel , C. , Wali , A. , . . . Clopp , M. P. ( 2012 ). The power of the national surgical quality improvement program, achieving a zero pneumonia rate in general surgery patients . Permanente Journal , 16 ( 1 ), 39 – 45 .
Herzig , S. J , Howell , M. D. , Ngo , L. H. , & Marcantonio , E. R. ( 2009 ). Acid‐suppressive medication use and the risk for hospital‐acquired pneumonia . Journal of the American Medical Association , 301 ( 20 ), 2120 – 2128 .
Hutchinson , A. M. , Wilkinson , J. E. , Kent , B. K. , & Harrison , M. B. ( 2011 ). Using the promoting action on research implementation in health services framework to guide research use in the practice setting . Worldviews on Evidence‐Based Nursing , 1 , 59 – 61 .
Kalisch , B. J. , Landstrom , G. , & Williams , R. A. ( 2009 ). Missed nursing care: Errors of omission . Nursing Outlook , 57 , 3 – 9 .
Kalsekar , I. , Amsden , J. , Kothari , S. , Shorr , A. F. , & Zilberber , M. D. ( 2010 ). Economic and utilization burden of hospital‐acquired pneumonia (HAP): A systematic review and meta‐analysis . Chest , 138 (4, meeting abstracts), 739A .
Kieninger , A. , & Lipsett , P. ( 2009 ). Hospital‐acquired pneumonia: Pathophysiology, diagnosis, and treatment . Surgical Clinics of North America , 89 ( 2 ), 439 – 461 .
Kollef , M. H. ( 2007 , September). Prevention of postoperative pneumonia . Hospital Physician, Surgical Patient Care Series , 47 – 60 .
Lee , J. S. , Collar , H. R. , Raghu , G. , Sweet , M. P. , Hays , S. R. , Campos , G. M. , & King , T. ( 2010 ). Does chronic microaspiration cause idiopathic pulmonary fibrosis ? American Journal of Medicine , 123 ( 4 ), 304 – 311 .
Minkler , M. , & Wallerstein , N. (Eds.). ( 2003 ). Community‐based participatory research for health . San Francisco, CA : Jossey‐Bass .
Overend , T. J. , Anderson , C. M. , Lucy , S. D. , Bhatia , C. , Jonsson , B. I. , & Timmermans , C. ( 2001 ). The effect of incentive spirometry on postoperative pulmonary complication: A systematic review . Chest , 120 , 971 – 978 .
Pasquina , P. , Tramer , M. R. , Granier , J. , & Walder , B. ( 2006 ). Respiratory physiotherapy to prevent pulmonary complications after abdominal surgery . Chest , 130 , 1887 – 1899 .
Patterson , K. , Grenny , J. , Maxfield , D. , McMillan , R. , & Switzler , A. ( 2007 ). Influencer: The power to change anything . New York, NY : McGraw‐Hill .
Raghavendran , K. , Mylotte , J. M. , & Scannapeico , F. A. ( 2007 ). Nursing home‐associated pneumonia, hospital‐acquired pneumonia and ventilator‐associated pneumonia: The contribution of dental biofilms and periodontal inflammation . Periodontology , 44 , 164 – 177 .
Resar , R. , Griffin , F. A. , Haraden , C. , & Nolan , T. W. ( 2012 ). Innovation series 2012: Using care bundles to improve health care quality . Institute for Healthcare Improvement . Retrieved from http://www.ihi.org/knowledge/Pages/IHIWhitePapers/UsingCareBundles.aspx
Rotstein , C. , Evans , G. , Born , A. , Grossman , R. , Light , R. B. , Magder , S. , & Zhanel , G. G. ( 2008 ). Clinical practice guidelines for hospital acquired pneumonia and ventilator associated pneumonia in adults . Canadian Journal of Infectious Diseases and Medical Microbiology , 19 ( 1 ), 19 – 53 .
Sarin , J. , Balasubramaniam , R. , Corcoran , A. M. , Laudenbach , J. M. , & Stoopler , E. T. ( 2008 ). Reducing the risk of aspiration pneumonia among elderly patients in long term care facilities through oral health interventions . Journal of the American Medical Directors Association , 9 ( 2 ), 128 – 135 .
Sopena , N. , & Sabria , M. ( 2005 ). Multicenter study of hospital‐acquired pneumonia in non‐ICU patients . Chest Journal , 127 ( 1 ), 213 – 219 .
Tablan , O. C. , Anderson , L. J. , Besser , R. , Bridges , C. , & Hajjeh , R. ( 2003 ). Guidelines for preventing healthcare‐associated pneumonia, 2003: Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee . Morbidity and Mortality Recommendation Report , 53 (RR‐ 3 ), 1 – 36 . Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5303a1.htm
Tada , A. , & Miura , H. ( 2012 ). Prevention of aspiration pneumonia with oral care . Archives of Gerontology and Geriatrics , 55 , 16 – 21 .
Tarsia , P. , Aliberti , S. , Cosentini , R. , & Balsi , F. ( 2005 ) Hospital‐acquired pneumonia . Breathe , 1 ( 4 ), 298 – 301 .
Terezakis , E. , Needleman , I. , Kumar , N. , Moles , D. , & Agudo , E. ( 2011 ). The impact of hospitalization on oral health: A systematic review . Journal of Clinical Periodontology , 28 ( 7 ), 628 – 636 .
Terpenning , M. ( 2005 ). Geriatric oral health and pneumonia risk . Aging and Infectious Diseases , 40 , 1807 – 1810 .
Wren , S. M. , Martin , M. , Yoon , J. K. , & Bech , F. ( 2010 ). Postoperative pneumonia‐prevention program for the inpatient surgical ward . Journal of the American College of Surgeons , 210 ( 4 ), 491 – 495 .
Zwarenstein , M. , Treweek , S. , Gagnier , J. J , Altman , D. G. , Tunis , S. , Haynes , B. , … Practihc groups . ( 2009 ). Improving the reporting of pragmatic trials: an extension of the CONSORT statement . British Medical Journal , 337 ( a2390 ), 1 – 8 .
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