RESEARCH POSTER PRESENTATION DESIGN © 2012

www.PosterPresentations.com

•To determine incidence and significance of non-ventilator hospital-

acquired pneumonia (NV-HAP) in the ICU setting.

•Ventilator-associated pneumonia (VAP) has been well-studied.

•Ventilator prevention bundles have dramatically reduced the incidence of

VAP across the nation and in our institute.

•However, little is known about the incidence of NV-HAP in the ICU

PURPOSE

BACKGROUND/SIGNIFICANCE

•HAP is occurring in non-ventilated patients, resulting in loss of dollars

and lives.

•Non-ventilated ICU patients may be at higher risk to develop NV-HAP

when compared to adult patients on a medical/surgical unit and ventilated

patients with a ventilator prevention bundle in place.

•Prevention efforts and best practice should be rigorously applied.

•Recommended focus: increase the frequency of basic nursing care to at-

risk patients.

CONCLUSIONS

•“Identify modifiable risk factors and develop programs to reduce the

risk of pneumonia by changing those risk factors.” (CDC, 2003)

•Reducing pathogens in the mouth/throat is a simple, modifiable risk

factor for pneumonia – we chose to start here.

PREVENTION OF NV-HAP OUTCOMES

•Improved knowledge regarding oral care.

•Increased frequency of oral care for ventilated and non-ventilated

patients.

•Decreased incidence and rate of NV-HAP in the ICU.

ACKNOWLEDGEMENTS

•We appreciate the grant from Sage to help us with costs of data collection

and analysis.

•A special “thank you” to our ICU leaders and oral care champions: Tracy

Chu, RN, Educator and Traci Sheesley, RN, ICU Director.

•We could not have made this much progress without the tireless efforts of

our Hospital-Acquired Pneumonia Prevention Initiative (HAPPI) team and

all our bedside nursing staff: you are making a difference for our

patients!—thank you!

•Currently, there are no requirements to monitor NV-HAP.

•Limited studies available indicate that NV-HAP is an emerging factor in

prolonged hospital stays of 7-9 days, patient mortality of 19.8%, and

increased cost of $40,000.

•New studies by Esperatti (2010) and Davis (2012) indicate that VAP and

NV-HAP share similar pathogens and mortality rates, and NV-HAP occurs

more frequently than VAP.

•Hospital-acquired pneumonia is generally considered a preventable

condition, and may be subject to loss of reimbursement in the future.

INTERVENTIONS:

•Revised Oral Care Protocol to include non-ventilated patients.

•Purchased therapeutic oral care tools.

•Educated staff

•Monthly data collection of oral care process and NV-HAP outcome.

•Nursing care known to prevent pneumonia was frequently missed.

•A total of 24,482 patients and 94,247 patient days were eligible for study

inclusion.

•There were 14,396 adult ICU days: 35 NV-HAP cases, with an infection

rate of 2.43 per 1000 non-ventilated days.

•There were 79,851 adult medical/surgical days: 80 NV-HAP, cases, with

an infection rate of 1.0 per 1000 patient days.

•The rate of VAP was 0.19 per ventilation day.

•Demographics and risk factors for NV-HAP were similar between groups.

•Estimated cost of NV-HAP in ICU over the one year period:

• $1.4 million, 280 extra days, 7 deaths.

•This was a descriptive, quasi-experimental study using retrospective data

to determine the incidence, demographics, and clinical factors of NV-HAP.

•NV-HAP data were obtained from a large, urban hospital’s electronic

integrated medical management system.

•Inclusion criteria: all adult discharges between January 1, 2010 and

December 31, 2010, with ICD-9 codes of pneumonia-not present on

admission, AND meeting the Centers for Disease Control and Prevention’s

(CDC’s) definition for HAP.

•NV-HAP were then attributed to either medical/surgical or ICU, based on

date of clinical onset.

IMPROVING ORAL CARE IN THE ICU

MISSED NURSING CARE

PREVENTION OF NV-HAP

RESULTS

METHOD

Sutter Medical Center, Sacramento; California State University, Sacramento; Sutter Institute for Medical Research

*Barbara Quinn, RN, ACNS-BC; Dian Baker, RN, PhD; Carol Parise, PhD

Non-Ventilator Hospital-Acquired Pneumonia (NV-HAP) in the ICU: Incidence and Prevention

0

0.5

1

1.5

2

2.5

Vent Med/Surg NV-ICU

Rate of Nonventilator Hospital-Acquired Pneumonia

Rate

Germs in Mouth

•Dental plaque provides a microhabitat

•Replicate 5X/24 hrs.

Aspirated

•Most common route

•50% of healthy adults micro-aspirate in sleep

Weak Host

•Poor cough

• Immunosuppressed

•Multiple co-morbidities

Hospital-Acquired Pneumonia

PATHOGENESIS OF NV-HAP

Germs in Mouth

• Comprehensive oral care

• Oral care protocol that includes all patients.

Aspirated

• Swallow screens

• Tube feeding protocols

• Up in chair for meals

• Head of bed elevated

Weak Host

• Lung expansion

• Early mobilization

• Serum glucose in target range

Prevent Hospital-Acquired Pneumonia

0.00

1.00

2.00

3.00

4.00

5.00

6.00

Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13

0% 20% 40% 60% 80% 100%

IS/C&DB

Oral Care

Mobility

Elevated HOB

Missed

Achieved

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

Baseline May June July Aug Sept Oct Nov Dec Jan-13 Feb-13 Mar-13

ICUs

0

10

20

30

40

50

60

70

80

90

100

Yes No Don't Know

Apr-12

Apr-13

“Does your hospital have an oral care protocol?” “Do you have adequate knowledge regarding oral care?”

Frequency of Oral Care / 24 Hours in ICU

Incidence of NV-HAP in ICU

“We are preventing pneumonia and saving lives, one clean mouth at a time.” (HAPPI Team, 2012)

0

10

20

30

40

50

60

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80

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100

Apr-12 Apr-13

Yes

No