Connecting Interprofessional Research With Practice to Reduce Non-Ventilator Hospital-Acquired Pneumonia

Purpose:
Non-ventilator hospital acquired pneumonia (NV-HAP) is an understudied disease, with potential for improved health and fiscal impacts. We sought to: (1) determine the incidence of NV-HAP in three large hospital systems and (2) implement and sustain an oral care intervention to reduce NV-HAP.

Background/Significance:
Because it is not required by regulatory agencies, most hospitals do not monitor NV-HAP. However, recent studies indicate that NV-HAP is now a leading cause of hospital-acquired infections. In our study, we found unreported rates of 1.22–8.9 per 1,000 hospital days, mean excess stay of 14 days, and NV-HAP on all types of hospital units. Factors that contributed to NV-HAP included patient characteristics and missed opportunities for nursing care, including oral care (73 % missed oral care).

Methods:
Based on the CDC's recommendation to select modifiable risk factors to prevent hospital acquired infections, we implemented a universal (i.e., every patient) new oral care protocol at a 600-bed community hospital. Our team designed new oral care monitoring and protocols, selected oral care equipment that met American Dental Association standards, and educated patient and their families and over 2,000 nurses about the importance of oral care. We used a descriptive, quasi-experimental, retrospective comparative study to determine changes in oral care delivery and prevalence of NV-HAP. The Influencer Model™ was used to manage the complexity of the multi-levels of intervention required.

Results:
Implementation of a universal oral care protocol and education of staff and families resulted in a 37% decrease of NV-HAP. Oral care frequency improved from a baseline of 27% of patients receiving oral care once each shift, to receiving oral care each shift 80% of the time. The extra cost for new therapeutic oral care equipment was $117,600. Cost savings resulting from 43 avoided NV-HAP cases was $1.72 million. Thus, return on investment for the organization was $1.6 million in avoided costs and an estimated eight lives saved. Importantly we have sustained and continued to improve these positive outcomes over a two-year period of time, and for December 2014 we had zero cases of NV-HAP.

Conclusions and Implications for Practice:
NV-HAP is one of the most common hospital-acquired infections and it occurs on every type of hospital unit. Nurses, using a team-based, interprofessional approach, can lead their hospitals in monitoring and implementing effective NV-HAP prevention programs.