oral care for non ventilated patientsclubman pinaud cologne

doi: https://doi.org/10.1016/j.jhin.2014.05.006. You may be trying to access this site from a secured browser on the server. 2018;46(1). Matching organisms have been found in dental plaque and bronchoalveolar lavage fluid from patients with HAP, implicating aspiration of organisms within dental plaque as the etiology of HAP in these patients.9 This is thought to occur via a mechanism in which aspirated respiratory pathogens shed from oral biofilm access into the lower airway, increasing the risk of pneumonia.10, Given the excess costs of treating HAP, along with increased morbidity and mortality, numerous studies have investigated clinical practices that can reduce its incidence. As shown in Table 4, the mean time for NPO status for stroke patients decreased from 2.4 days to 0.24 days (p = 0.069). While NVHAP is a significant patient safety and quality of care concern, it is not currently recognized as one of the National Database of Nursing Quality indicators for which hospitals are held accountable; nor is it one of the conditions that the Centers for Medicare & Medicaid Services (CMS) requires hospitals to report to the Centers for Disease Control & Prevention (CDC) National Healthcare Safety Network; and it is not integrated into the CMS current pay-for-reporting or performance programs.1 As a result, this leaves NVHAP a health care-acquired condition without national tracking or accountability, and, most likely, is unaddressed by health care organizations. Special diagnostic and therapeutic considerations. Its estimated that one in every 100 hospitalized patients will be affected by non-ventilator hospital-acquired pneumonia (NVHAP). While NVHAP is a significant patient safety and quality of care concern, it is not currently recognized as one of the National Database of Nursing Quality indicators for which hospitals are held accountable; nor is it one of the conditions that the Centers for Medicare & Medicaid Services (CMS) requires hospitals to report to the Centers for Disease Control & Prevention (CDC) National Healthcare Safety Network; and it is not integrated into the CMS current pay-for-reporting or performance programs. FOIA Nurs Adm Q. Laressa Bethishou, PharmD, APh, BCPS, Yoneyama T, Yoshida M, Ohrui T, et al; Oral Care Working Group. For information on cookies and how you can disable them visit our Privacy and Cookie Policy. your express consent. The progressive care unit reported that five patients acquired HAP before oral care program implementation. Since the development of NVHAP requires a complex interaction of events that includes aspiration of microorganisms present in the oral cavity and a vulnerable host, most prevention measures target primary source control, and may include: Reducing the use of acid-suppressing medications, Performing dysphagia screening in high-risk patients, Using modified diets and feeding strategies for patients with abnormal swallowing, Following standardized processes to place and manage feeding tubes, Educating the patient and family about NVHAP prevention. An estimated 200,000 cases of aspiration pneumonia occur every year in the United States, resulting in more than 15,000 deaths.1 HAP causes unnecessary patient suffering, mortality as high as 20% to 30%, and significantly increased length and cost of hospital stay.2,3 As reported by the American Thoracic Society and the Infectious Diseases Society of America, treatment of HAP costs approximately $40,000 per patient.4 Most of this incidence and outcome information is collected from patients with ventilator-associated pneumonia (VAP). Baker D, Quinn B. Kalisch BJ, Landstrom G, Williams RA. Regarding LOS, an independent samples t-testwas performed to compare the mean scores of stroke patients admitted and discharged before the structured oral care program and patients who received the structured oral care program. Despite these limitations and challenges, there are actions that hospitals and medical centers can take to prevent NVHAP while improving the quality of care and patient safety, lowering the risk of sepsis, reducing health care costs, and saving lives.1. 2014;88(1). The site is secure. Relevance to clinical practice: Before 48-57. https://www.michigandental.org/Portals/pro/Journals/July%202019/html5/index.html?page=1&noflash, Munro S, Baker D. (2018). 1. Demographic data are presented in Table 1. Preventing nosocomial pneumonia: routine oral care reduced the risk of infection at one facility. To date, a large amount of research has focused on decreasing the incidence of pneumonia in ICU patients and preventing VAP. 2014;46(1), 11-19. doi: 10.1111/jnu.12050. Pneumonia in the elderly. On implementation of the structured oral care program, five fewer cases of HAP were reported than before implementation. Results: The call to action acknowledges that strategies to improve the prevention, recognition, and treatment of NVHAP are currently limited by gaps in understanding of the pathogenesis of NVHAP. 18. A Nurse-Driven Oral Care Protocol to Reduce Hospital-Acquired Pneumonia. The 2.5-day reduction in LOS had a p value of 0.122; however, the reduction in LOS was clinically significant. Wren SM, Martin M, Yoon JK, Bech F. Postoperative pneumonia-prevention program for the inpatient surgical ward. Kollef MH, Shorr A, Tabak YP, et al. | Standout nurse leadersWhat's in the research? 11. Medical-surgical nurses are in a position to influence outcomes related to oral care. Epidemiology and outcomes of health-care-associated pneumonia: results from a large US database of culture-positive pneumonia. The work cannot be changed in any way or used commercially. 2020 Feb 12;13:165-173. doi: 10.2147/JMDH.S224453. 4 No. Pediatr Nurs. HAP prevention for nonventilated adults in acute care: Can a structured oral care program reduce infection incidence? All rights reserved. It's possible that a larger sample size and a unit with a higher initial incidence of HAP may yield data showing statistical significance. In the stroke unit, one case of HAP was reported during both the pre- and postintervention periods. The breadth of bacterial diversity in the human periodontal pocket and other oral sites. Before implementation of the oral care program, RNs and unlicensed assistive personnel (UAPs) caring for patients on a progressive care unit, a stroke unit, and two medical units attended a training session with content that included the following: impact of HAP on patients and families, the role of the RN and UAP in HAP prevention, step-by-step review of the oral care program, electronic medical record documentation, and demonstrated use of the oral hygiene kit. Regarding NPO status, an independent samples t-test was performed to compare the mean scores of patients admitted and discharged in 2010, before the structured oral care program, and patients who received the structured oral care program. Sage provided support for manuscript development, but the authors maintained total editorial control. Learn more about why your organization should achieve Joint Commission Accreditation. Nursing Management47(12):42-48, December 2016. Please enable it to take advantage of the complete set of features! 10. Criteria for HAP diagnosis were developed according to the CDC/National Healthcare Safety Network clinically defined pneumonia criteria.20 For diagnosis, a patient must have had two or more serial chest radiographs with a new or progressive and persistent infiltrate, consolidation, and/or cavitation. The Epidemiology of Nonventilator Hospital-Acquired Pneumonia in the United States. Berry AM, Davidson PM, Masters J, Rolls K. Am J Crit Care. Hospital-acquired pneumonia (HAP) has become a costly and dangerous healthcare issue. My Account 8600 Rockville Pike Careers. 885, Improving Oral Care in Hospitalized Non-Ventilated Patients: Standardizing Products and Protocol, Hillary Jenson, Providence Portland Medical Center, Portland, OR; DNP-FNP student, University of Portland, Portland, OR. Donna Prosser, DNP, RN. Oral care is a disease preventive and cost-effective measure for patients, particularly in ICU patients. The purpose of our study was to determine the efficacy of an oral care program for NV stroke and medical-surgical patients to reduce the incidence of HAP, risk of acquiring HAP, length of NPO (nothing by mouth) status, and hospitalization length of stay (LOS). Rello J, Ollendorf DA, Oster G, et al; VAP Outcomes Scientific Advisory Group. sharing sensitive information, make sure youre on a federal 13. Talley, Louise PhD, RN; Lamb, Jennifer MS, RN, GCNS; Harl, Jami MS, CCC-SLP; Lorenz, Heather MSN, RN; Green, Lindsey MN, APRN-CNS, CCNS, RNC-NIC. Successful programs should also include implementation of policies that allow for adequate time, proper oral care supplies, ease of access to supplies, standardized procedures, and outcome monitoring to ensure that patients are protected from NV-HAP. 2 No. | 2 (2020): Patient Safety Journal - June 2020, How to Write a Quality Improvement Project, Patient Safety: Vol. No member of the research team or their family members had a relevant financial relationship with Sage Products, Inc. All aspects of the study, including planning, implementing, and data analysis, were controlled exclusively by the research associates. An independent t-test with a significance level of p = 0.05 was performed to compare group means of interval-level data for the intervention and comparison groups. Stay up to date with all the latest Joint Commission news, blog posts, webinars, and communications. In addition, clinically significant findings suggested that a structured oral care program can reduce HAP incidence, length of NPO status, and overall LOS. 2 No. Implement processes that make oral care and mobility an expectation for routine care of non-ventilated patients. To measure the impact of the structured oral care program on HAP incidence, we used Cohen's d formula.22 The calculated effect size was 0.20, indicating that the oral care program did, in fact, have a small effect on HAP incidence, although no statistically significant reduction in HAP incidence was observed. At St. John Medical Center in Bixby, Okla., Louise Talley is a clinical educator, Jennifer Lamb and Lindsey Green are clinical nurse specialists, Jami Harl is a speech and language pathologist, and Heather Lorenz is the RN stroke coordinator. J Nurs Scholarsh. 5. A systematic review of the preventive effect of oral hygiene on pneumonia and respiratory tract infection in elderly people in hospitals and nursing homes: effect estimates and methodological quality of randomized controlled trials. Dry Mouth and Its Effects on the Oral Health of Elderly People. As discussed, decreases in HAP incidence, length of NPO status, and hospital LOS were clinically, but not statistically, significant. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. User-friendly thumb port tools provide easy suction control and quick tool changes, Simple tools work with standard suction equipment, Burst pouch dispenses solution in seconds to moisten tools right in the package. Changes in Prevalence of Health Care Associated Infections in U.S. Jenson, Hillary; Maddux, Sandra; and Waldo, Mary, "Improving Oral Care in Hospitalized Non-Ventilated Patients: Standardizing Products and Protocol" (2018). Designed to address pneumonia risk factors for non-ventilated dependent and independent patients. PUBLICATIONS Colonization of dental plaque by respiratory pathogens in medical intensive care patients. J Neurosci Nurs 2008;40(5):291-298. doi:10.1097/01376517-200810000-00007, Giuliano K, Baker D, Quinn B. For each patient, we collected demographic data, LOS, daily average for number of times oral care was provided in three consecutive days, number of NPO days, and presence or absence of HAP. Patient Safety (online ISSN 2641-4716), Vol 4 No 2 published June 2022. HAP risk. Few studies have reported on NV patients in the acute care setting. This site needs JavaScript to work properly. Despite these limitations and challenges, there are actions that hospitals and medical centers can take to prevent NVHAP while improving the quality of care and patient safety, lowering the risk of sepsis, reducing health care costs, and saving lives. Please enable scripts and reload this page. PMC Its estimated that one in every 100 hospitalized patients will be affected by non-ventilator hospital-acquired pneumonia (NVHAP). Disclaimer, National Library of Medicine Fein AM. may email you for journal alerts and information, but is committed 1 (2022): Patient Safety-March 2022, Clinical and Nonclinical Implications of Misplaced Nasogastric Tubes: Tools for Implementation of Standardized Best Practices, Patient Safety: Vol. Donna M. Prosser, DNP, RN, Nurses should provide oral care to all hospitalised patients and follow oral care guidelines specific to their population, if available. Centers for Disease Control & Prevention. 19. No cases of HAP were reported pre- or postintervention on the two medical units. By continuing to use this website you are giving consent to cookies being used. Methodology: Aging Clin Exp Res. NPO days represented those days that the patient was at high risk for aspiration of nutrition or medication via the oral route. Wolters Kluwer Health NV patients age 18 or older from the four participating nursing units were selected for this study. Furthermore, oral care can be performed by patients themselves in many cases, thereby relieving frontline staff of this task. standardized definitions such as those promulgated by the CDC. 7. MeSH Feb 2019;119(2); 44-51. Wood W, Tschannen D, Trotsky A, et al. Olivia Lounsbury ([email protected]) is a clinical research coordinator for the Patient Safety Movement Foundation. Methodological limitations included lack of randomization. Doi: 10.1016/j.apnr.2018.09.004. 2. A Successful Program Preventing Nonventilator Hospital-Acquired Pneumonia in a Large Hospital System. Magill SS, OLeary E, Janelle SJ, et al. https://digitalcommons.psjhealth.org/publications/885, Home A cross-sectional study. A fairly simple oral care quality improvement initiative can save multiple livesand billions of dollars a year for the healthcare industry. This study was conducted on four adult medical-surgical nursing units in an acute care medical center. 2022 Jan 5;11(1):5. doi: 10.1186/s13643-021-01878-0. In addition, an estimated eight lives were saved, $1.72 million in costs were avoided, and 500 extra hospital days were averted.12, In another study, implementation of an oral care protocol for nonICU medical patients demonstrated that an oral care protocol aided in reducing HAP incidence and may have improved nutritional intake.13 Patients in pre- and postintervention groups received oral care based on assessment of their risk level. 2012 Dec 24;5(1):203-13. doi: 10.5539/gjhs.v5n1p203. eCollection 2020. The statistically significant difference (p = 0.013) in HAP risk score during hospitalization indicates that the oral care program was effective in reducing HAP risk. Epidemiology and outcomes of ventilator-associated pneumonia in a large US database. Am J Infect Control. Also, surveillance is challenging because the clinical criteria for NVHAP are subjective, often inaccurate, variably documented, and labor intensive to apply. 885. After participation in the structured oral care program, the mean final HAP risk score was 0.65. Dagnew ZA, Abraham IA, Beraki GG, Mittler S, Achila OO, Tesfamariam EH. 2020 Jul 10;19:63. doi: 10.1186/s12912-020-00457-3. government site. 2010 Mar-Apr;36(2):85-96; quiz 97. Three peer-reviewed articles were included in the review after inclusion criteria were applied. For each patient, the scores were combined and recorded as the patient's HAP risk score. Munro SC, Baker D, Giuliano KK, et al. 9. Unable to load your collection due to an error, Unable to load your delegates due to an error. Integrating Oral Healthcare Into Patient Management to Prevent Hospital-Acquired Pneumonia- A Team Approach. The role of oral bacteria and oral hygiene. Adoption of this method may help reduce HAP risk at other hospitals, ultimately reducing patient pain and suffering, while simultaneously reducing the financial burden of hospital-acquired infections on the healthcare industry. Evidence was appraised using the Johns Hopkins Nursing Evidence-based Practice Rating Scale. 2018;46(3). Data were analyzed using predictive analytics software. Azarpazhooh A, Leake JL. J Mich Dent Assoc. Quinn B, Baker DL, Cohen S, Stewart JL, Lima CA, Parise C. Basic nursing care to prevent nonventilator hospital-acquired pneumonia. 4. Gain an understanding of the development of electronic clinical quality measures to improve quality of care. Am J Infect Control. Online ISSN 2641-4716 | Print ISSN 2689-0143. NPO status was defined operationally as preventing the patient from any oral intake in the form of nutrition, medication, ice chips, or sips of water. Impact of an education program on the performance of nurses in providing oral care for mechanically ventilated children. Implement processes to sustain NVHAP prevention for the long term. Genetic relationships between respiratory pathogens isolated from dental plaque and bronchoalveolar lavage fluid from patients in the intensive care unit undergoing mechanical ventilation. Ferozali F, Johnson G, Cavagnaro A. Do nurses have barriers to quality oral care practice at a generalized hospital care in Asmara, Eritrea? Educate patients on risks and prevention methods that are implemented in the health care setting and should be continued after discharge. For more information, please refer to our Privacy Policy. The present results support those of previous studies, which suggest that improved oral care can reduce the occurrence of pneumonia and other respiratory infections. March 2014; 370:1198-208. A recent article in the journal Infection Control & Hospital Epidemiology (ICHE) detailed a call to action from national organizations, including The Joint Commission, to address NVHAP. Multistate Point-Prevalence Survey of Health Care-Associated Infections. This issue of Quick Safety focuses on the calls challenge to health care systems to implement and support NVHAP prevention, and to add NVHAP prevention measures to education for patients, health care professionals and students. Disclosures: Sage Products, Inc., provided the oral care kits for this study and a $500.00 grant to cover incidental costs associated with the study. Nonventilator hospital-acquired pneumonia: A call to action.. official website and that any information you provide is encrypted