Perform outcome and/or process surveillance to determine rates of infection and compliance with processes to prevent NVHAP. Patients with nasal or gastric tubes, swallowing disorders, aspiration history, oral suctioning, continuous NPO status, bi-level positive airway pressure masks, or tracheostomy were automatically considered high risk for HAP and received a score of 6. 42(4), 363-372. doi: 10.1097/NAQ.0000000000000308. Abe S, Ishihara K, Adachi M, Okuda K. Oral hygiene evaluation for effective oral care in preventing pneumonia in dentate elderly. J Hosp Infect. Dr. Shannon Munro is an advanced practice nurse and the national implementation lead for HAPPEN (Hospital-Acquired Pneumonia Prevention by Engaging Nurses) for the U.S. Department of Veterans Affairs Diffusion of Excellence Initiative. Few studies have reported on NV patients in the acute care setting. Pneumonia in nonambulatory patients. In addition, the research demonstrates the importance of proper education and implementation practices to increase awareness and make oral care a priority for nursing staff. A cross-sectional study. The Early Mobility Bundle: A Simple Enhancement of Therapy Which May Reduce Incidence of Hospital-Acquired Pneumonia and Length of Hospital Stay. Translation of oral care practice guidelines into clinical practice by intensive care unit nurses. The role of oral bacteria and oral hygiene. 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. Wolters Kluwer Health, Inc. and/or its subsidiaries. 2020 May 20;20(1):149. doi: 10.1186/s12903-020-01138-y. 2020 Jul 10;19:63. doi: 10.1186/s12912-020-00457-3. J Neurosci Nurs 2008;40(5):291-298. doi:10.1097/01376517-200810000-00007, Giuliano K, Baker D, Quinn B. J Am Dent Assoc. 3. Relevance to clinical practice:
oral patient education card ventilated patients non systems hygiene pneumonia The .gov means its official. Data is temporarily unavailable. 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.
medline denture Accessibility Statement, Privacy standardized definitions such as those promulgated by the CDC.
2007;138 suppl 15S-20S. In addition, the study didn't control for other factors affecting hospital LOS, resulting in large standard deviations from the mean that made the acquisition of statistically significant data difficult. Systematic literature review of oral hygiene practices for intensive care patients receiving mechanical ventilation. Bookshelf In addition, clinically significant findings suggested that a structured oral care program can reduce HAP incidence, length of NPO status, and overall LOS. 1 (2022): Patient Safety-March 2022, Clinical and Nonclinical Implications of Misplaced Nasogastric Tubes: Tools for Implementation of Standardized Best Practices, Patient Safety: Vol. Nursing Management47(12):42-48, December 2016. Unable to load your collection due to an error, Unable to load your delegates due to an error. Evaluate workflows from a systems perspective and establish processes that facilitate the prevention of NVHAP (e.g., ensuring efficient access to supplies, and providing job aids where necessary). 8600 Rockville Pike This site uses cookies and other tracking technologies to assist with navigation, providing feedback, analyzing your use of our products and services, assisting with our promotional and marketing efforts, and provide content from third parties. Reducing Missed Oral Care Opportunities to Prevent Non-Ventilator Associated Hospital Acquired Pneumonia at the Department of Veterans Affairs. Postintervention patients had an average initial HAP risk score of 0.87 upon entering the study. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. Providing you tools and solutions on your journey to high reliability. Data collection and analysis: Data were collected via retrospective chart review by nurse data collectors after patient discharge. The call to action includes launching a national health care conversation about NVHAP prevention and encouraging researchers to develop new strategies for NVHAP surveillance and prevention. The four medical units consisted of one progressive medical unit, one stroke unit, and two medical units as follows: This was a quasi-experimental study, with posttest-only analysis and nonequivalent comparison groups. BMC Nurs. The average LOS was 9.45 days for the preintervention group and 6.92 days for patients who participated in the structured oral care program. 13. To explore current oral care practices in nonmechanically ventilated ICU patients. We help you measure, assess and improve your performance.
Batiha AM, Bashaireh I, Albashtawy M, Shennaq S. Glob J Health Sci. Nurses should provide oral care to all hospitalised patients and follow oral care guidelines specific to their population, if available. Magill SS, OLeary E, Janelle SJ, et al. 12. Do nurses have barriers to quality oral care practice at a generalized hospital care in Asmara, Eritrea? may email you for journal alerts and information, but is committed
| 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. By not making a selection you will be agreeing to the use of our cookies. Pearson LS, Hutton JL. 4 No. Munro S, Baker D. (2019). Overcome beliefs that NVHAP prevention strategies such as oral hygiene and mobility are optional tasks rather than standard-of-care interventions. BMC Oral Health. Magill, S. et al. FAQ | 7. Standout nurse leadersWhat's in the research? Colonization of dental plaque by respiratory pathogens in medical intensive care patients. Sage provided support for manuscript development, but the authors maintained total editorial control.
sage care hair patient llc Obtain buy-in from leadership and health care providers about the importance of NVHAP prevention. Background: Please enable scripts and reload this page. Emerging Infections Program Healthcare-Associated Infections and Antimicrobial Use Prevalence Survey Team. Federal government websites often end in .gov or .mil. doi: 10.1016/j.ajic.2017.08.036. For information on cookies and how you can disable them visit our Privacy and Cookie Policy. > 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. 885. eCollection 2020. | 21. The site is secure. March 2014; 370:1198-208. In one study, more than half of patients with pneumonia were non-ventilated patients.1 Our patient-specialized systems and kits are designed specifically to remove plaque, debris, and oral secretions. Jennifer Tatro, MSN, RN, Beth Lyman, MSN, RN, Postintervention patients were assessed every 12 hours for oral status and deemed low risk (score 0-5) or high risk (score >6). This study alone saved four units approximately $200,000 in the first year of implementation. critical care; critical illness; documentation; intensive care units; mouth; nonmechanically ventilated; oral hygiene; patient acuity; self-report. 1.
Accessibility Aims and objectives: A fairly simple oral care quality improvement initiative can save multiple livesand billions of dollars a year for the healthcare industry. Obtain useful information in regards to patient safety, suicide prevention, pain management, infection control and many more. Due to evidence supporting the benefits of oral care in nonmechanically ventilated patients, it would be beneficial to examine the literature for oral care practices in this population. 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. Literature searches of the following databases were performed: CINAHL Plus, MEDLINE, PsychInfo, Academic Search Premier, Cochrane Database of Systematic Reviews, and Web of Science. 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 official website of the United States government. Am J Infect Control. Rello J, Ollendorf DA, Oster G, et al; VAP Outcomes Scientific Advisory Group. Weitzel T, Robinson SB, Holmes J. Jenson, Hillary; Maddux, Sandra; and Waldo, Mary, "Improving Oral Care in Hospitalized Non-Ventilated Patients: Standardizing Products and Protocol" (2018). Yoneyama T, Yoshida M, Ohrui T, et al; Oral Care Working Group. Aging Clin Exp Res. Health benefits and reductions in bacteria from enhanced oral care. As discussed, decreases in HAP incidence, length of NPO status, and hospital LOS were clinically, but not statistically, significant. doi: https://doi.org/10.1016/j.ajic.2017.09.005, Turner M, Ship J. 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. Tang X, Shen Y, Pan X, Liao J, Xu Y, Luo W, Zhang X, Li C, Wan Q, Cai X, Zhang X, Wang T, Zhang G. Syst Rev.
44, 48-53. Wolters Kluwer Health
It's possible that a larger sample size and a unit with a higher initial incidence of HAP may yield data showing statistical significance. Epidemiology and outcomes of ventilator-associated pneumonia in a large US database. 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. Our facility's Institutional Review Board approved the study and provided a waiver due to the deidentified nature of the data. Dagnew ZA, Abraham IA, Beraki GG, Mittler S, Achila OO, Tesfamariam EH. 2020 Feb 12;13:165-173. doi: 10.2147/JMDH.S224453. Bethesda, MD 20894, Web Policies Before Donna Prosser, DNP, RN. 2022 Jan 5;11(1):5. doi: 10.1186/s13643-021-01878-0. Multistate Point-Prevalence Survey of Health Care-Associated Infections. A controlled trial to compare the ability of foam swabs and toothbrushes to remove dental plaque. Learn about the development and implementation of standardized performance measures. Data were analyzed using predictive analytics software. 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. Multistate point-prevalence survey of health care-associated infections. HAP incidence was documented before and after implementation of the oral care program. Wren SM, Martin M, Yoon JK, Bech F. Postoperative pneumonia-prevention program for the inpatient surgical ward. Fein AM. 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. Oral hygiene care in the pediatric intensive care unit: practice recommendations. 2013 Dec;45(4):355-62. doi: 10.1111/jnu.12039. Three peer-reviewed articles were included in the review after inclusion criteria were applied. Methodological limitations included lack of randomization.
Olivia Lounsbury, 2. Keywords: This site needs JavaScript to work properly. Oral Health Knowledge Level of Nursing Staff Working in Semi-Intensive Heart Failure Units. Empower patients and family members to ask for assistance with oral care, feeding, and mobility and obtaining any needed supplies. government site. Wren SM, Martin M, Yoon JK, et al. The mortality for HAP is high, and the cost and financial burden of HAP treatment are great. In a systematic review of evidence for an association between oral health and pneumonia, experts found that cariogenic and periodontal pathogens, dental decay, and poor oral hygiene are potential risk factors for pneumonia.6 In addition, poor oral hygiene has been linked to significant increases in the numbers of febrile days and cases of pneumonia.7, Specifically, dental plaque is composed of a complex population of more than 700 different bacterial species.8 Poor dental hygiene can result in continual bacterial cell growth and increased bacterial diversity within dental plaque. Evaluate patients for swallowing issues and adjust nutrition and feeding assistance based on this evaluation.
doi: https://doi.org/10.1016/j.jhin.2014.05.006. your express consent. Impact of an education program on the performance of nurses in providing oral care for mechanically ventilated children. The https:// ensures that you are connecting to the Some error has occurred while processing your request. 4. View them by specific areas by clicking here. Pennsylvania nursing continuing education credits, Vol. Torres A, Rello J. Update in community-acquired and nosocomial pneumonia 2009. and transmitted securely. Epidemiology and outcomes of health-care-associated pneumonia: results from a large US database of culture-positive pneumonia. Lounsbury, O., & Munro, S. (2020). In the absence of these conditions, patients received a score of 0 to 2, with 0 being normal and 2 severe, for each of the following: condition of the gums, condition of the lips/corners of the mouth, swallowing and chewing ability, and feeding/oral care ability. As shown in Table 2, a 25% reduction in HAP risk score was observed for patients after participating in the oral care program. We found that implementation of a structured oral care program reduced patients' risk for acquiring a life-threatening HAP infection. Develop operational NVHAP tracking systems to assess the impact of prevention initiatives. Apply today! HAP incidence. 2019. https://doi.org/10.1007/s40520-019-01437-7. Set expectations for your organization's performance that are reasonable, achievable and survey-able. The New England Journal of Medicine.
medline Olivia Lounsbury (olivia.lounsbury@patientsafetymovement.org) is a clinical research coordinator for the Patient Safety Movement Foundation. Strategies to influence RN specialty certification, An alternative approach to nurse manager leadership, Keeping the peace: Conflict management strategies for nurse managers, Barriers to Implementing a Quality Improvement Program. Learn about the "gold standard" in quality. Furthermore, oral care can be performed by patients themselves in many cases, thereby relieving frontline staff of this task. In general, oral care is often omitted by nurses, despite its importance in preventing infection.19 Any successful initiative to reduce HAP incidence should incorporate a strategy for increasing participation of all nursing staff. 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. 16. NV patients age 18 or older from the four participating nursing units were selected for this study. This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. 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. Criteria for HAP risk assessment were developed and optimized for this study. The Epidemiology of Nonventilator Hospital-Acquired Pneumonia in the United States. Oral Care for Non-Ventilator Associated Hospital-Acquired Pneumonia Prophylaxis: Optimizing Clinical Outcomes and Organizational Effectiveness. Wood W, Tschannen D, Trotsky A, et al. Home The patient must also have had at least two of the following: 1) new onset of purulent sputum or change in character of sputum, increased respiratory secretions, or increased suctioning requirements; 2) new onset or worsening cough, dyspnea, or tachypnea; 3) crackles or bronchial breath sounds; and 4) worsening gas exchange or increased oxygen requirements. Systematic reviews indicate a positive preventive impact of oral hygiene on pneumonia and respiratory infections.6,11 Supporting this finding, one group of researchers recently reported that the rate of nonventilated (NV)-HAP per 100 patient days decreased from 0.49 to 0.3 (38.8%) after implementation of an oral care program.12 The overall number of cases of NV-HAP was reduced by 37% during a 12-month intervention period. Patient Safety (online ISSN 2641-4716), Vol 4 No 2 published June 2022.
Its estimated that one in every 100 hospitalized patients will be affected by non-ventilator hospital-acquired pneumonia (NVHAP). 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. Sampling of two NV adult study groups from four nursing units yielded data on 347 preintervention patients who were admitted and discharged in 2010, before the structured oral care program was implemented, and 337 postintervention patients, who participated in the structured oral care program. 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. In addition, this program implemented a convenient oral care bundle, which made providing oral care to patients more convenient and accessible. 11. (See Table 3.) Its estimated that one in every 100 hospitalized patients will be affected by non-ventilator hospital-acquired pneumonia (NVHAP). It also improved the oral care that patients received from the nursing staff, most likely by increasing awareness of the importance of proper oral care in reducing HAP and other respiratory infections. Hospital Acquired Pneumonia Prevention Initiative-2: Incident of Nonventilator Hospital-Acquired Pneumonia in the United States. Paster BJ, Olsen I, Aas JA, Dewhirst FE. Review the efficacy of an oral care program in reducing hospital-acquired pneumonia incidence in nonventilated stroke and medical-surgical patients. Am J Infect Control. Results: Dry Mouth and Its Effects on the Oral Health of Elderly People. About 5. Laressa Bethishou, PharmD, APh, BCPS, See what certifications are available for your health care setting. 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. https://pubmed.ncbi.nlm.nih.gov/30180083/. Genetic relationships between respiratory pathogens isolated from dental plaque and bronchoalveolar lavage fluid from patients in the intensive care unit undergoing mechanical ventilation. Lacerna CC, Patey D, Block L, et al. DOI 10.1056/NEJMoa1306801. N Engl J Med 2018: 379(18), 1732-1744. doi: 10.1056/NEJMoa1801550. Donna M. Prosser, DNP, RN, Olivia Lounsbury , 2012 Dec 24;5(1):203-13. doi: 10.5539/gjhs.v5n1p203. In the stroke unit, one case of HAP was reported during both the pre- and postintervention periods. 20. Hospital-acquired pneumonia (HAP) has become a costly and dangerous healthcare issue. HHS Vulnerability Disclosure, Help Copyright. Warren C, Medei MK, Wood B, et al. Scannapieco FA. Aust Crit Care. American Thoractic Society; Infectious Diseases Society of America. 48-57. https://www.michigandental.org/Portals/pro/Journals/July%202019/html5/index.html?page=1&noflash, Munro S, Baker D. (2018).
Nurses' attitude towards oral care and their practicing level for hospitalized patients in Orotta National Referral Hospital, Asmara-Eritrea: a cross-sectional study. This study stresses the importance of providing proper oral care for patients. Doi: 10.1016/j.apnr.2018.09.004. to allow for aggregation of data and comparison infection rates with other organizations. https://pubmed.ncbi.nlm.nih.gov/30389059/, Munro S, Haile-Mariam A, Greenwell C, Demirci S, Farooqi O, Vasudeva S. (2018). 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. 2014;88(1). If you choose to logout it will log you out from all the applications. PMC > Implementation and Dissemination of a Department of Veterans Affairs Oral Care Initiative to Prevent Hospital Acquired Pneumonia Among Non-Ventilated Patients.
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