Session: The importance of performing oral care with our patients and how to establish an oral care committee within your facility to facilitate education and completion of oral care
(81) Oral Care: The Missing Piece to the Patient Management Puzzle
Medical Speech Pathologist University of Rochester Medical Center & Rochester Regional Health ROCHESTER, New York, United States
Disclosure(s):
Erin McCarthy, SLPD, CCC-SLP, BCS-S: Illinois Speech-Language-Hearing Association: Financial - Honoraria (Ongoing); Rochester Regional Health: Financial - Salary (Ongoing); Stryker Medical Company: Financial - Consulting Fee (Ongoing), Financial - Speaking Fee (Ongoing); University of Rochester Medical Center: Financial - Salary (Ongoing). No non-financial relationships to disclose
ABSTRACT: Hospital acquired pneumonia or HAP, has become one of the most common types of hospital acquired infections in the acute care setting. It is in the best interest, financially, of the healthcare system to implement and integrate potential solutions and practice policies that will mitigate the risk for HAP as well as improve the overall quality of patient care offered at their facility. Oral care is becoming an increasingly recognized intervention with positive patient benefits and can help mitigate the risk for patients to develop hospital acquired pneumonia.
SUMMARY:
Hospital acquired pneumonia or HAP, has become one of the most common types of hospital acquired infections in the acute care setting (Talley et al., 2016; Kaneoka et al., 2015). Some authors have estimated that it costs a health care system between $40,000-$65,000 to treat a bout of pneumonia for just one patient, adding between 7 to 9 days to their length of stay and increasing mortality rates by 50% (Quinn et al., 2014; Talley et al., 2016; ATS, 2005). In addition, analysts report that preventing 100 cases of HAP could save a hospital up to $4 million, 500-900 hospital days and up to 30 patient lives (Quinn et al., 2014; ATS, 2005; Talley et al., 2016). Much of this incidence and outcome information is collected from patients with ventilator-associated pneumonia, or VAP. Therefore, by deduction, information regarding VAP can be applied to patients with HAP (Talley et al., 2016). It is in the best interest, financially, of the healthcare system to implement and integrate potential solutions and practice policies that will mitigate the risk for HAP as well as improve the overall quality of patient care offered at their facility. Non-ventilator hospital acquired pneumonia (NV-HAP) is a subset of the diagnosis of hospital acquired pneumonia, as is ventilator acquired pneumonia (VAP). NV-HAP is not as well studied as VAP due to the fact that historically, hospitals have focused primarily on VAP since they are mandated to document and report their incidence rates for this type of infection. However, NV-HAP is considered to be more common and occur more regularly than VAP (Quinn et al., 2014; Talley et al., 2016). VAP is often treated with bundles of nursing care, for example the ABCDE bundle, which does include dedicated oral care. However, at this point in time, there is no pre-defined oral care program that is designed to mitigate the risk for NV-HAP (Quinn et al., 2014; Fong et al., 2007; Wren et al., 2010). Dependency for completion of oral care as well as activities of daily living have been highlighted as primary risk factors for developing pneumonia (Langmore et al., 1998). Patients who are in acute care are often unable to effectively perform their own oral care on a regular basis and given their immunocompromised state, they are more vulnerable to developing hospital acquired infections, including HAP. During a hospital stay, significant changes occur within the mouth and a patient’s oral biofilm (Quinn & Baker, 2015). Bacteria found in dental plaques have been found to be the causative agent in HAP in several studies, with a reduction in pneumonia incidence following institution of an oral care regimen for patients (Quinn et al.,2014). Current research tends to examine the efficacy of oral care programs to mitigate the risk for VAP, but few articles focus on dedicated oral care regimens for NV-HAP or how to develop and implement such programs.
The purpose of this presentation is to discuss the role of oral care in the management of our medically fragile patients and to outline how to build and develop an effective oral care program at your facility.
References: American Thoracic Society. (2005). Guidelines for the management of adults with hospital acquired, ventilator associated, and healthcare associated pneumonia. American Journal of Respiratory Therapy, 171, 388–416. Fong, J. J., Cecere, K., Unterborn, J., Garpestad, E., Klee, M., & Devlin, J. W. (2007). Factors influencing variability in compliance rates and clinical outcomes among three different severe sepsis bundles. Annals of Pharmacotherapy, 41, 929–936. Kaneoka, A., Pisegna, J.M., Miloro, K.V., Lo M, S.H., Riquelme, L.F., LaValley, M.P., & Langmore, S.E. (2015) Prevention of healthcare-associated pneumonia with oral care in individuals without mechanical ventilation: A systematic review and meta-analysis of randomized control trial. Infect Control Hosp Epidemiol. 36(8):899-906. Langmore S.E., Terpenning, M.S., Schork, A., Chen, Y, Murray, J.T., Lopatin, D., & Loesche, W.J. (1998). Predictors of aspiration pneumonia: How important is dysphagia? Dysphagia. 13:69-81. Talley, L., Lamb, J., Harl, J., Lorenz, H., Green, Lindsey, M. (2016). HAP prevention for nonventilated adults in acute care. Nursing Management. 47(12):42-48. doi: 10.1097/01.NUMA.0000508259.34475.4c Quinn B, MSN, Baker DL, Cohen S, Stewart JL, Lima CA, & Parise C. (2014). Basic nursing care to prevent non-ventilator hospital-acquired pneumonia. Journal of Nursing Scholarship. 46:1, 11–19. Quinn, B. & Baker, D.L. (2015). Comprehensive oral care helps prevent hospital acquired non-ventilator pneumonia. American Nurse Today. 10(3). Wren, S. M., Martin, M., Yoon, J. K., & Bech, F. (2010). Postoperative pneumonia-prevention program for the inpatient surgical ward. Journal of the American College of Surgeons, 210(4), 491–495.
Learning Objectives:
At the completion of this activity, participants should be able to:
Upon completion of the session, participants will be able to define non-ventilator hospital acquired pneumonia (NV-HAP) and the impact that it has on the healthcare system.
Upon completion of the session, participants will be able to define oral care and discuss the impact that consistent oral care can have on the mitigation of non-ventilator hospital acquired pneumonia.
Upon completion of the session, participants will be able to describe how to develop an effective oral care program at their facility.