Hospitals are falling short when it comes to preventing patients from acquiring pneumonia during their stays, and it's costing millions every year, a new study from the Journal of Infection Control suggests. What's more, the solutions are as simple as making patients brush their teeth and move around more.
Several methods effectively help prevent hospital-acquired pneumonia, in fact, and some are part of hospital care patients should be already receiving anyway. These include oral care, elevating the head of the bed anywhere from 30 to 45 degrees, patient mobility and deep breathing and coughing exercises. When these services aren't provided, that mistake is referred to as missed care.
Missed care has been previously linked to numerous harmful outcomes for patients and increased cost for hospitals, the study said, and oral care was shown to be the most beneficial in preventing hospital-acquired pneumonia -- but it is also among the most frequent type of missed care. Additionally, while HAP is frequently associated with patients who catch it while on a ventilator thanks to bacteria in the machine's tubing, nonventilator hospital-acquired pneumonia is a bigger threat than previously recognized, the study said.
Researchers looked at data from 21 hospitals of varying geographic regions, size and type that had applied to participate in the study and were selected based on the following criteria: no previous hospital-wide NV-HAP monitoring; no specific NV-HAP prevention interventions within the last 5 years; no implemented change in systematic oral care in the last 5 years; and provision of a letter of support from nursing administration.
Not only did the study show that NV-HAP could be acquired from multiple areas of a hospital, but it also showed a serious lack of commitment to preventative measures. For 58.6 percent of patients, oral care had not been performed more than two times. Almost 36 percent did not have their head properly elevated, and almost about 29 percent were out of bed only twice in 24 hours if permitted. In fact, 55.4 percent were out of bed less than two times and roughly 67 percent did not perform cough and deep breathing exercises in the 24-hour period before pneumonia diagnosis, and overall, most prevention efforts were focused on ventilator-acquired pneumonia.
Based on estimates of $28,000-$40,000 in additional costs, the cases in this study would generate $36.4 -$52.56 million in extra costs and additional 9,198-11,826 inpatient days.
With appropriate interventions aimed at a 50 percent reduction in NV-HAP cases, however, approximately 9,886 lives could be saved, 487,622 extra hospital days could be cut, and $2.43 billion could be saved annually, the study authors predicted.
Hospital staff would do well to implement or enforce standards wherein patients are compelled to brush their teeth multiple times a day to cleanse their mouths of bacteria and germs. They also need to move around more if possible and engage in coughing or deep breathing exercises so as to cleanse their airways of lingering germs. Though seemingly simple, science has shown these methods to be effective in cutting the rate of hospital acquired pneumonia, which would would have a positive ripple effect in quality of outcomes, length of stay and cost of care.
"When the mortality rate from a preventable hospital harm is as high as 14-31 percent, it is time for a call to action," the study said. "NV-HAP should be elevated to the same level of concern, attention, and effort as prevention for other types of HAIs."