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.

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 Oral Care for Non-Ventilator Associated Hospital-Acquired Pneumonia Prophylaxis: Optimizing Clinical Outcomes and Organizational Effectiveness

2020 ◽  
pp. 78-81
Author(s):  
Olivia Lounsbury ◽  
Shannon Munro
Keyword(s):  
Risk Factors ◽  
Organizational Effectiveness ◽  
Oral Care ◽  
Prevention Measures ◽  
Frontline Staff ◽  
Profound Impact ◽  
Healthy Habits ◽  
Hospital Acquired Pneumonia ◽  
Traditional Risk Factors ◽  
Hospital Acquired

Non-ventilator-associated hospital-acquired pneumonia (NV-HAP) is a largely preventable illness. Quality improvement efforts including prevention measures, such as oral care, are incorporated into most standard clinical workflows but may be performed in an inconsistent manner. Oral care can have a profound impact on rates of pneumonia when performed in a systematic manner for all hospitalized patients, regardless of “traditional” risk factors. Furthermore, oral care can be performed by patients themselves in many cases, thereby relieving frontline staff of this task. Introducing patient education for sustained oral care efforts postdischarge and encouraging healthy habits to aid in achievement of their recovery goals is essential.

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

scholarly journals 1267. Nonventilator Hospital Acquired Pneumonia (NV-HAP) Prevention Initiative in Colombia, Bogotá

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S386-S386
Author(s):  
Sandra Valderrama ◽  
Claudia Janneth Linares Miranda ◽  
Maria Juliana Soto ◽  
Estefania Mckinley ◽  
Juan Pablo Morcillo ◽  
...  
Keyword(s):  
Oral Care ◽  
Adult Patients ◽  
University Hospital ◽  
Care Bundle ◽  
Healthcare Associated Infection ◽  
Oral Rinse ◽  
Patients At Risk ◽  
Hospital Acquired Pneumonia ◽  
Second Year ◽  
Hospital Acquired

Abstract Background Pneumonia is the second most common healthcare-associated infection worldwide. Non ventilator – Hospital Acquired Pneumonia (NV-HAP) affects more people than VAP, has a comparable mortality rate (18.7% vs. 18.9%), and has higher total costs ($156 million vs. $86 million), respectively. The objective of this study was to describe the result of the implementation of a bundle of measures for the prevention of NV-HAP in adult patients in a University Hospital in Colombia. Methods Descriptive study. In a period of 2 years, a care bundle for prevention of NV-HAP was implemented in adult patients in a university hospital that consisted of: (1) identification of patients at risk (patients over 60 years of age, or with altered consciousness, or swallowing disorder, or patients with tracheostomy), (2) marking the patient with a sticker on the head of the bed, and (3) implementation of the following measures: head of the bed elevation to 30°–45°, oral care every 12 hours, chlorhexidine oral rinse decontamination every 12 hours and aspiration of secretions as needed. In the first 6 months, training was carried out for all staff, the monthly adherence to the strategy was measured. Results During 2016, 1,045 patients were included, with 10,011 observations, bundle adherence during the first year was 33%. in the second year, 1,400 patiens were included, with 13,198 observations, the bundle adherence increased to 90% throughout the hospital. The rate of NV-HAP decreased from 4.2 (96 cases) to 3.4 (89 cases) per 1,000 patient-days, in the second year compared with the previous intervention year. Conclusion The strategy of prevention of NV-HAP decreased the cases of nosocomial pneumonia in a university hospital, through the education a high adherence to the strategy was achieved. Studies with a better design should be done to confirm the findings. Disclosures All authors: No reported disclosures.

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&lt; 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)

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