Intervention to Reduce the Risk of Hospital Acquired Pneumonia - - PowerPoint PPT Presentation

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Interprofessional Collaboration and Expansion of an Oral Care Intervention to Reduce the Risk

• f Hospital Acquired Pneumonia

Among Older Veterans

Shannon Munro, PhD, APRN, BC, NP; Owais Farooqi, DDS, MDS; Shikha Vasudeva, MD Department of Veterans Affairs Medical Center, Salem, Virginia

Contact: Shannon.munro@va.gov

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Acknowledgments

• The opinions expressed herein are those of the

authors and do not necessarily reflect those of the U.S. Government or any of its agencies.

• This material is the result of work supported with

Office of Strategic Integration, Veterans Engineering Resource Center, and VA Diffusion of Excellence Initiative funding and the use of facilities at the Department of Veterans Affairs Medical Center in Salem, Virginia.

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Objectives

In this session the learner will be able to:

• Identify how daily oral care helps prevent non-

ventilator associated hospital acquired pneumonia

• Utilize the national VA oral care implementation

toolkit to facilitate dissemination.

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Scope of the problem

• 60% of hospital acquired pneumonia occurs among

non-ventilated patients

• Average cost of $40,000 per case
• Mortality rates for NV-HAP range from 18-30%
• 50% of sepsis cases initiate as pneumonia
• Only 34.5% of Veterans who develop NV-HAP

return home after admission

• NV-HAP occurs among all types of patients on all

types of hospital units

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Most hospital acquired pneumonia starts in the mouth

Dental plaque bacteria replicate 5 times every 24 hours. Biofilm images supplied by: DG Allison & IW Sutherland http://archive.bio.ed.ac.uk/jdeacon/microbes/biofilm.htm

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Missed nursing care is a risk factor

0% 20% 40% 60% 80% 100% IS/C&DB Oral Care Mobility Elevated HOB Missed Achieved

Kalisch, B. (2013). Am J Med Qual.- consistent with Salem VA findings

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Literature: Oral care and pneumonia prevention

Study Type Method Outcomes

Yoneyama (2002) Oral care reduced pna, JNL AM GER SOC RCT; control group vs. oral care group Experimental: brushed teeth after each meal, dental hygienist visit 1X/week Decrease in pna, febrile days, death from pna; improved ADLs, cognitive function Watando (2004) Daily oral care in elderly, CHEST, 126:1066-1070 RCT Experimental: brushed teeth after each meal X 30 days Improved cough reflex (p<0.05) Akutsu 2010 Preop dental brushing reduced risk of post op pna, SURGERY, 497. RCT, 86 esophageal cancer pts divided into control & experimental groups Experimental: Brushed teeth 5X/day prior to surgery Decrease post op pna from 32% to 9% (p=0.013) Quinn, Baker, Munro (2014) JNL NSG SCHOL Quasi-experimental, retrospective, pre/post Universal oral care protocol for all pts, increased frequency 3X/day Decreased NV-HAP by 37% in first 12 months. Kaneoka (2015) Prev. of HCAP with oral care, INF CTL HOSP EPID Systematic Review & Meta Analysis: 5 RCTs Oral care to prevent NV-HAP RR for NV-HAP (P=.02) RR for fatal pna (P=.002)

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PNA=pneumonia, ADL= activities of daily living, NV-HAP nonventilator associated hospital acquired pneumonia, HCAP= health care associated pneumonia; RCT= randomized controlled trial

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1 2 3 4 5 6 7 2014 Jan 2014 Feb 2014 Mar 2014 Apr 2014 May 2014 Jun 2014 Jul 2014 Aug 2014 Sept 2014 Oct 2014 Nov 2014 Dec 2016 Oct 2016 Nov 2016 Dec 2017 Jan 2017 Feb 2017 Mar 2017 Apr 2017 May 2017 Jun 2017 Jul 2017 Aug 2017 Sep 2017 Oct 2017 Nov 2017 Dec 2018 Jan 2018 Feb 2018 Mar 2018 Apr Number of Cases

NV-HAP down 90% from baseline, estimated $2.84M and 13 lives saved, October 2016-April 2018

Mean UCL LCL

Salem VAMC CLC units control chart for NV-HAP, 50 beds combined

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0.5 1 1.5 2 2.5 3 3.5 2016 Jan 2016 Feb 2016 Mar 2016 Apr 2016 May 2016 June 2016 July 2016 Aug 2016 Sep 2016 Oct 2016 Nov 2016 Dec 2017 Jan 2017 Feb 2017 Mar 2017 Apr 2017 May 2017 Jun 2017 Jul 2017 Aug 2017 Sep 2017 Oct 2017 Nov 2017 Dec 2018 Jan 2018 Feb 2018 Mar Number of Cases

NV-HAP down 100% from baseline, estimated $144,000 saved, October 2017-March 2018

Mean UCL LCL

Salem VAMC medical surgical units (4H & 4J) control chart for NV-HAP, 44 beds combined

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0.5 1 1.5 2 2.5 3 3.5 4 4.5 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17

Number of Cases

NV-HAP down 100% from baseline, estimated $480,000 and 2 lives saved, February-July 2017

Mean UCL LCL

Houston VAMC CCU and 3D SDU control chart for NV-HAP, 45 beds combined

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VA national implementation toolkit

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Next steps

• Evaluate current practices including

input from interdisciplinary team

• Simplify standard operating procedures.
• Assure oral care supplies are readily

available.

• Share evidence: educate patient, family,

& staff.

• Actively monitor & celebrate progress

and successes.

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Questions?

Contact: Shannon.munro@va.gov