Creating an Oral Care Protocol to Prevent Non-Ventilator Hospital-Acquired Pneumonia

Purpose: The purpose of this study is to identify the impact of an oral care protocol on the incidence of non-ventilator hospital-acquired pneumonia (NV-HAP) in medical-surgical patients at an acute care community hospital. Hospitalized patients are at increased risk for non-ventilator hospital-acquired pneumonia (NV-HAP), leading to significant morbidity and mortality due to a variety of factors. Combined with immobility, a weakened host, and a lack of performing oral hygiene, pathogens can enter the lungs through aspiration and micro-aspiration to cause pneumonia.

Background/significance: Hospital-acquired infections (HAI) are detrimental to patient quality and safety because of morbidity and mortality risks, combined with large financial burden to the health care institution. Hospital-acquired pneumonia (HAP) is identified as the most frequent HAI within acute care hospitals (Munro & Baker, 2018), with NV-HAP accounting for the majority of HAP. Oral hygiene is frequently omitted by hospitalized patients. Knowledge of oral care is lacking among nursing staff, resulting in a lack of prioritization when inundated with competing priorities. Patients may not be able to perform oral care independently due to cognitive ability, decline of functional ability, and lack of energy. If microorganisms are aspirated into the lung, pneumonia can ensue. Studies show that improved oral care practices can lead to meaningful reduction of NV-HAP (Quinn & Baker, 2015).

Method(s): Approved by the Hallmark Health System IRB in February 2017, this quantitative study collected data on the NV-HAP rate pre- and post-implementation of an oral care protocol within a licensed 208-bed organization. A gap analysis identified the need for changes to oral care products, oral care frequency, the creation of an oral care protocol, and the design of patient teaching material. The oral care protocol proposed by Quinn and Baker (2015) was adopted by the organization in May 2017. An algorithm was created to identify patients at risk for aspiration, as well as the type of oral care product needed.

Result(s): After implementation of the oral care protocol, the rate of NV-HAP cases declined greater than 50%, sustained over two fiscal years. A total rate decrease of NV-HAP of 58% occurred over 30 months. Results were determined utilizing the National Healthcare Safety Network (NHSN) pneumonia criteria. The study demonstrated that hospital-acquired pneumonia decreased through comprehensive oral care.

Conclusions/implications: Data collected after establishing a daily oral care protocol and educating patients and staff, showed significant improvement in the incidences of NV-HAP. This achievement can greatly impact both safety of patients and quality of patient care. Preventing pneumonia should be at the forefront of infection prevention for hospitalized patients and recognized as equally important as other hospital-acquired infections. Prevention of NV-HAP leads to better health outcomes for patients.

References
1. Munro, S., & Baker, D. (2018). Reducing missed oral care opportunities to prevent non-ventilator associated hospital-acquired pneumonia at the Department of Veterans Affairs. Applied Nursing Research, 44, 48-53. doi:10.1016/j.apnr.2018.09.004
2. Quinn, B., & Baker, D. (2015). Using oral care to prevent non-ventilator hospital-acquired pneumonia. American Nurse Today, 10(3). Retrieved from https://www.americannursetoday...