scholarly journals 93. Enhanced Oral Care as Prevention for Non-ventilator Hospital Acquired Pneumonia

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S177-S178
Author(s):  
Karen K Giuliano ◽  
Daleen Penoyer ◽  
Aurea Middleton ◽  
Dian Baker
Keyword(s):  
Effect Size ◽  
Oral Care ◽  
Primary Source ◽  
Source Control ◽  
Research Support ◽  
Chi Square ◽  
Care Protocol ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired ◽  
Surgical Unit

Abstract Background Non ventilator hospital-acquired pneumonia (NVHAP) is now the most common HAI. The purpose was to test primary source control through reduction of germs in the mouth as a modifiable risk factor for in NVHAP prevention. Methods The 12-month study (10/1/18–9/31/19) was conducted at an 800-bed tertiary medical center. 1 medical and 1 surgical unit were randomized to enhanced oral care (intervention) and matched with 1 medical and 1 surgical unit providing usual oral care (control). An American Dental Association oral care protocol was delivered by nurses/nursing assistants (Intervention) vs. usual care. Frequency of oral care was tracked. Pneumonia cases were identified using ICD-10 codes and confirmed using CDC criteria. Results For medical control (n=2059) v. intervention (n=2706), oral care/day increased from .96 to 2.2; there was an 85% reduction in NVHAP (1.41 to 0.21)/1000 patient days which was significant by Chi-square (p< 0.001), and Cramer’s V effect size of 0.52. Using logistic regression, the odds of NVHAP were 7.1 times higher on the on the control unit v. intervention (OR:7.1 [CI 2.01:24.1] p=.002). For surgical control (n=2075) v. intervention (n=1830), oral care frequency/day increased from 1.2 to 2.1. There was a 56% reduction in NVHAP which was NS by Chi-square (p=.289), Cramer’s V effect size of 0.02, and this group was underpowered to detect a difference (post hoc actual power=.61). NVHAP demographics NVHAP incidence NVHAP secondary outcomes Conclusion These findings add to the growing body of evidence that oral care as primary source control is likely to have a role in NVHAP prevention. Disclosures Karen K. Giuliano, PhD, Medline (Grant/Research Support) Daleen Penoyer, PhD, RN, Medline (Grant/Research Support) Aurea Middleton, MS, RN, Medline (Grant/Research Support) Dian Baker, PhD, RN, Medline (Grant/Research Support)

A Nurse-Driven Oral Care Protocol to Reduce Hospital-Acquired Pneumonia

2019 ◽  
Vol 119 (2) ◽  
pp. 44-51 ◽  
Author(s):  
Chastity Warren ◽  
Mary Kathryn Medei ◽  
Brooke Wood ◽  
Debra Schutte
Keyword(s):  
Oral Care ◽  
Care Protocol ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

Oral Care as Prevention for Nonventilator Hospital-Acquired Pneumonia

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Karen K. Giuliano ◽  
Daleen Penoyer ◽  
Aurea Middleton ◽  
Dian Baker
Keyword(s):  
Oral Care ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

scholarly journals 1181. Significant Reduction of Non-Ventilator Hospital-Acquired Pneumonia (HAP) with a Prevention Bundle and Clinical and Leadership Feedback in a Large Integrated Healthcare System

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S423-S423
Author(s):  
Sejal Naik ◽  
Cristine Lacerna ◽  
Yulia Kevorkova ◽  
Jessica Galin ◽  
Donna Patey ◽  
...  
Keyword(s):  
Healthcare System ◽  
Oral Care ◽  
Antibiotic Use ◽  
Altered Mental Status ◽  
Feeding Tube ◽  
Healthcare Associated Infection ◽  
Integrated Healthcare ◽  
Benzodiazepine Use ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

Abstract Background Non-Ventilator Hospital-acquired Pneumonia (HAP) is a prevalent healthcare-associated infection with mortality of 21%. HAP prevention literature is scant. We developed a definition enabling accurate surveillance to support this effort and implemented a prevention bundle based on available literature and characteristics of our high-performing centers. Methods Kaiser Permanente Northern California is an integrated healthcare system providing care for 4.4 million patients at 21 medical centers. Discharge diagnoses of HAP cases were reviewed for accuracy and factors permitting programmatic confirmation. A natural language extraction program identified new and persisting imaging findings, providing specificity. No other surveillance factors added specificity. Surgery, altered mental status, sedation, albumin <3 g/dl and tube feedings were identified as predictive risks. Seven interventions became part of a new pneumonia prevention order set for automatically identified high-risk patients: aggressive mobilization, upright posture for meals, swallowing evaluation before feeding, sedation restriction, elevated head of bed, oral care and feeding tube care. The project was fully implemented in 2015. Results Results were reported by 1,000 admissions and by 100,000 members served, to address a rapidly growing population. HAP decreased from 5.92 to 1.79/1000 admissions and 24.57 to 6.49/100,000 members and HAP case mortality remained stable (18–19%) while overall HAP mortality decreased from 1.05 to 0.34/1000 admissions (4.37 to 1.24 /100,000 members) (Figure 1 and 2). Carbapenem, quinolone, aminoglycoside and vancomycin use all decreased significantly (Figure 3). Benzodiazepine use decreased from 10.4% of all inpatient-days in 2014 to 8.8% of inpatient-days in 2016. Conclusion HAP rates, mortality and broad-spectrum antibiotic use were all reduced significantly, despite the absence of clinical practice guidelines or strong supportive literature for guidance. Some interventions had limited support, but most augmented basic nursing care. None had risks of adverse consequences. This supports the need to examine practices to improve care despite absent literature and even more so supports a need to study these difficult nebulous areas of care. Disclosures All authors: No reported disclosures.

Oral Care in Critically Ill Patients Requiring Noninvasive Ventilation: An Evidence-Based Review

2021 ◽  
Vol 41 (4) ◽  
pp. 66-70
Author(s):  
Jace D. Johnny ◽  
Zachary Drury ◽  
Tracey Ly ◽  
Janel Scholine
Keyword(s):  
Critically Ill ◽  
Noninvasive Ventilation ◽  
Critically Ill Patients ◽  
Oral Care ◽  
Preventive Measure ◽  
Standard Of Care ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

Topic Hospital-acquired pneumonia commonly develops after 48 hours of hospitalization and can be divided into non–ventilator-acquired and ventilator-acquired pneumonia. Prevention of non–ventilator-acquired pneumonia requires a multimodal approach. Implementation of oral care bundles can reduce the incidence of ventilator-acquired pneumonia, but the literature on oral care in other populations is limited. Clinical Relevance Use of noninvasive ventilation is increasing owing to positive outcomes. The incidence of non–ventilator-acquired pneumonia is higher in patients receiving noninvasive ventilation than in the general hospitalized population but remains lower than that of ventilator-acquired pneumonia. Non–ventilator-acquired pneumonia increases mortality risk and hospital length of stay. Purpose To familiarize nurses with the evidence regarding oral care in critically ill patients requiring noninvasive ventilation. Content Covered No standard of oral care exists for patients requiring noninvasive ventilation owing to variation in study findings, definitions, and methods. Oral care decreases the risk of hospital-acquired pneumonia and improves comfort. Nurses perform oral care less often for nonintubated patients, as it is perceived as primarily a comfort measure. The potential risks of oral care for patients receiving noninvasive ventilation have not been explored. Further research is warranted before this practice can be fully implemented. Conclusion Oral care is a common preventive measure for non–ventilator-acquired pneumonia and may improve comfort. Adherence to oral care is lower for patients not receiving mechanical ventilation. Further research is needed to identify a standard of care for oral hygiene for patients receiving noninvasive ventilation and assess the risk of adverse events.

Abstract P246: Hospital Acquired Pneumonia and Dysphagia Screening in Patients With Acute Ischemic Stroke: Findings From Get With the Guidelines-Stroke

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Shihab Masrur ◽  
Eric E Smith ◽  
Mathew Reeves ◽  
Xin Zhao ◽  
DaiWai Olson ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Oral Intake ◽  
Stroke Patients ◽  
Chi Square ◽  
Hospital Acquired Pneumonia ◽  
Get With The Guidelines ◽  
Hospital Acquired ◽  
The Relationship ◽  
Hospital Characteristics

National guidelines recommend dysphagia screening (DS) before any oral intake in hospitalized stroke patients to reduce the risk of hospital-acquired pneumonia (HAP). We examined the relationship between DS and HAP in acute ischemic stroke patients in the Get With the Guidelines-Stroke (GWTG-S) program. Methods: Data from 1251 GWTG-S hospitals from 04/01/2003 to 03/01/2009 were analyzed. GWTG-S defines HAP as a clinical diagnosis of pneumonia requiring antibiotics. Use of a bedside, evidence-based swallow screen prior to any oral intake qualified as a DS. Univariate analyses (chi-square for categorical variables or Wilcoxon for continuous variables) and multivariate logistic regression analyses were performed to examine the relationship between DS and HAP, adjusting for patient and hospital characteristics Results: Among 365,726 ischemic stroke patients, 213097 (59.83%) underwent DS, and 25,166 (6.88%) developed HAP. When compared to patients without pneumonia ( Table 1 ), patients with HAP were older and more frequently had CAD/MI, diabetes, prior stroke/TIA, dyslipidemia, atrial fibrillation. They, underwent DS less often, and had increased length of stay, morbidity and in-hospital mortality. Among the subgroup who had NIHSS recorded (n=160,837, 44%), HAP patients had higher median NIHSS (13 vs. 5). Among patients with NIHSS<2, 3.3% developed HAP. In multivariate analysis, factors independently associated with a lower risk of HAP were DS (OR 0.86 [0.83-0.90]), female (OR 0.83 [0.81-0.85]), dyslipidemia (OR 0.84 [0.82-0.86]), and hypertension (OR 0.96 [0.94-0.98]). Discussion: Our data suggests that dysphagia screening is associated with a lower likelihood of HAP, but screening rates remain low. Strategies that increase the rate of dysphagia screening among all stroke patients, even those with mild strokes, should be more broadly implemented. Prospective validation of these findings is warranted. Table 1. Unadjusted associations between patient and hospital characteristics and clinical outcomes Overall(% or value) HAP(% or value) No HAP(% or value) Study Population 365726 (100%) 25166(6.9%) 340560(93.1%) Age (years) Median (IQR) 73(61, 82) 77(66, 85) 73(61,82) Female 52.5 49.2 52.8 Dysphagia Screen Performed 59.8 54.8 60.2 In Hospital Death 5.7 18.1 4.8 P-values are <.0001 for all comparisons and are based on Chi-square test (for dichotomous and nominal factors) or Wilcoxon test (for ordinal and continuous factors)

Oral Care Clinical Trial to Reduce Non–Intensive Care Unit, Hospital-Acquired Pneumonia

2019 ◽  
Vol 41 (1) ◽  
pp. 1-9 ◽  
Author(s):  
Edel McNally ◽  
Gintas P. Krisciunas ◽  
Susan E. Langmore ◽  
Janet T. Crimlisk ◽  
Jessica M. Pisegna ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Oral Care ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

scholarly journals ANALISIS FAKTOR-FAKTOR YANG MEMPENGARUHI OUTCOME TERAPI PASIEN PNEUMONIA DI RUMAH SAKIT UMUM PUSAT FATMAWATI JAKARTA

2019 ◽  
Vol 5 (3) ◽  
pp. 18
Author(s):  
Feri Setiadi ◽  
Shirly Kumala ◽  
Hesty Utami R ◽  
Ahmad Subhan
Keyword(s):  
Case Fatality Rate ◽  
Case Fatality ◽  
Community Acquired Pneumonia ◽  
Fatality Rate ◽  
Chi Square ◽  
Cross Sectional ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

Berdasarkan data Riset Kesehatan Dasar (Riskesdas)2018 prevalensi pneumonia di jakarta 2.3 %. Pneumoni mempunyai case fatality rate (CFR) yang tinggi yaitu 7.6% sehingga beresiko mempunyai outcome terapi yang tidak baik. Oleh karena itu penelitian ini bertujuan menganalisis faktor-faktor yang mempengaruhi outcome terapi pasien pneumonia di RSUP Fatmawati. Penelitian ini dilakukan secara retrospektif dengan metode cross sectional pada pasien pneumonia (hospital acquired pneumonia/HAP dan community-acquired pneumonia/CAP) yang memenuhi kriteria inklusi selama periode januari-september 2018. Penelitian ini dilakukan dengan pengkajian data rekam medis pasien. Ada dua jenis outcome terapi yang digunakan yaitu pasien pulang/sembuh dan pasien meninggal. Analisis faktor yang mempengaruhi outcome dilakukan dengan uji chi square menggunakan SPSS. Selama penelitian didapatkan 40 pasien memenuhi kriteria inklusi terdiri dari 22 HAP dan 18 CAP. Hasil umur pasien (65.0%) berada pada kelompok usia 17-65 tahun. Lebih banyak pasien laki-laki (57.5%) dibandingkan pasien perempuan (42.5%). Sebagian besar pasien (37.5%) di rawat selama 8-14 hari. Penggunaan antibiotik (35.0%) terbanyak digunakan antibiotik ceftriaxone golongan sefalosporin. Proporsi pasien dengan outcome sembuh/pulang sebanyak (52.5%) dan pasien meninggal ( 47.5%). Hasil analisis statistik menunjukkan faktor yang signifikan mempengaruhi outcome adalah penyakit penyerta (P=0.022) Adapun faktor yang tidak ada hubungan bermakna terhadap outcome pasien pneumonia  yaitu: usia pasien, lama perawatan dan kerasionalan antibiotik.

scholarly journals Influencing Factors of Hospital-Acquired Pneumonia Infection in the Middle-Aged and Elderly Patients With Schizophrenia

2021 ◽  
Vol 12 ◽  
Author(s):  
Mi Yang ◽  
Qiwen Li ◽  
Chunzhi Wang ◽  
Li Li ◽  
Min Xu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Elderly Patients ◽  
Infection Rate ◽  
Large Scale ◽  
Antipsychotic Drugs ◽  
Personal Characteristics ◽  
Middle Aged ◽  
Chi Square ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

Introduction: Pneumonia is an important cause of death in patients with schizophrenia. It is critical to understand the risk factors of hospital-acquired pneumonia (HAP) and determine prevention strategies to reduce HAP. The aim of this study is to elucidate the risk factors for HAP in the middle-aged and elderly hospitalized patients with schizophrenia.Methods: We retrospectively reviewed the medical records of 2,617 the middle-aged and elderly patients (age ≥ 50) with schizophrenia who were admitted for the first time to a large-scale psychiatric hospital between 2016 and 2020. The factors related to the incidence of HAP in patients were analyzed, including personal characteristics, antipsychotics, and non-antipsychotics.Results: The HAP infection rate of hospitalized the middle-aged and elderly patients with schizophrenia was 7.8%. Chi-square analyses showed that older age, male, and ≥60 days of hospitalization were risk factors for HAP infection (χ2 = 94.272, p &lt; 0.001; χ2 = 22.110, p &lt; 0.001; χ2 = 8.402, p = 0.004). Multivariate logistic regression showed that quetiapine, clozapine, and olanzapine significantly increased the incidence of HAP (OR = 1.56, 95% CI = 1.05–2.32, p = 0.029; OR = 1.81, 95% CI = 1.26–2.60, p = 0.001; OR = 1.68, 95% CI = 1.16–2.42, p = 0.006). Antipsychotic drugs combined with aceglutamide had an effect on HAP (OR = 2.19, 95% CI = 1.38–3.47, p = 0.001).Conclusion: The high HAP infection rate in hospitalized the middle-aged and elderly patients with schizophrenia may be related to the increase of age and the use of antipsychotic drugs. The types and dosages of antipsychotic drugs should be minimized while paying attention to the mental symptoms of patients.

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