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NV-HAP criteria. During data collection, team members statistical tests were applied to all parametric data.
collaborated to clarify any ambiguous criteria, for ex- NV-HAP incidence was calculated as follows:
ample, language used in radiologic findings for diag-
nosis of pneumonia. Team meetings were held Rate of NV HAP per 1000 patientdays
8 9
throughout the data collection process to assess progress > No: of NV HAPcase >
¼> : >
; 1000
and address any issues. One team member participated in Total no: of adult patientdays
a webinar for REDCap training and assumed responsi-
bility for all data entry into the REDCap software.
that missed nursing care is associated with adverse prevention and implemented a universal oral care nurs-
events18,19 and in this case may have relevance for ing protocol designed for NV-HAP prevention.15,26
NV-HAP prevention. Data collected at this research Guidelines recommend oral care for patients 65 years
site revealed an incidence of NV-HAP of 0.47 per or older every morning and evening and, as neces-
1000 patient-days with 32 transfers to the ICU, a sary, and recommend that patients in acute care or
mean hospital LOS of 24 days, and a 9.2% increase long-term care or home settings receive oral hygiene
in SNF-level care requirements compared with before at least once every 8 hours.27,28 However, practices
admission, as well as an in-hospital mortality rate of vary among hospitals, and although these recom-
19%, a 30-day readmission rate of 24.9%, and an mendations can be generalized to other populations,
excess cost of $8.2 million. NV-HAP incidence rates there is currently no standard for frequency of oral
at this site are consistent with the other sites in the care for nonventilated patients. The protocol used by
HAPPI-2 study that found rates of 0.12 to 2.28 per Quinn et al15 involved more frequent oral care than is
1000 patient-days.20 currently recommendedV4 times a day for all adult
The CDC recommends a focus on modifiable risk nonventilated patients and every 6 hours for patients
factors for the prevention of HAIs.8 NonYventilator- being tube fed or not eating.15
associated HAP incidence may be reduced with imple- Similar to its role in VAP prevention, it is likely
mentation of fundamental nursing care procedures. that oral care serves an important role in NV-HAP
This study identified a lack in documentation of prevention and may also improve overall patient sat-
implemented nursing care (oral care, elevation of isfaction.29 Chipps et al29 assessed the difference in
head of bed, out-of-bed activity, incentive spirome- patient satisfaction between 2 groups of postY
try, and coughing and deep breathing) 24 hours prior mechanically ventilated patients. One group received
to an NV-HAP diagnosis for many patients included
in this study (Figure 2, Table 2). Incentive spirometry,
coughing and deep breathing, head-of-bed elevation,
and out-of-bed activities may help to increase lung
volume, mobilize secretions, and prevent atelecta-
sis.21-23 Unfortunately, studies have identified that
these and other nursing care activities are often missed
or not documented.19,24 Oral care is standard prac-
tice to prevent VAP while patients are ventilated;
however, for medical/surgical units, oral care has long
been considered a comfort measure in caring for pa-
tients.25 This may be one of the reasons that oral care
is consistently found to be missing from patient care.
In the pilot study preceding this chart review, Figure 2. Frequency of documented oral healthcare in the
Quinn et al15 concluded that decreasing the oral bac- 24 hours before pneumonia diagnosis for patients with
terial load is the most modifiable factor for NV-HAP NV-HAP.
References
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