The Infectious Disease Society of America defines hospital-acquired pneumonia (HAP) as pneumonia in a patient 48 hours post-admission. According to a European point prevalence survey, the nosocomial infection ranks second amongst other healthcare associated infections (HAI). HAP incidences in the United States are 20 patients out of 1000 hospitalized convalescents, with high rates being experienced amongst children and older adult populations under inpatient clinical care. Healthcare facilities, such as senior citizen nursing homes, can prevent hospital-acquired pneumonia through clinical evidence-based interventions. The extensive study of HAP, prevention strategies, and integration of quality improvement and value-based care show how clinics can attain positive patient outcomes in today’s healthcare environment.
Healthcare-associated pneumonia is caused by the aspiration of pathogens, such as Staphylococcus aureus¸, Acinetobacter baumannii, and Escherichia coli. HAP patients exhibit symptoms, such as purulent sputum, fever, impaired oxygenation, and tachypnea. Additionally, patient blood cultures in a laboratory assessment would reveal inflammation results, such as C-reactive protein and increased white cell count (Russel et al., 2016). Furthermore, radiology tests in HAP patients often reveal the development of progressive or new lung infiltrates. Older adults in nursing homes are most susceptible to HAP because of their weak immune systems and intubation for feeding purposes. However, healthcare-acquired pneumonia can be treated using various ways.
Delegate your assignment to our experts and they will do the rest.
Nursing Prevention Strategies
Senior resident clinical facilities can prevent the development of HAP in patients using various strategies. For instance, nursing homes can ensure older resident adults incorporate hand hygiene in their daily routines to prevent the acquisition of HAP pathogens. Nurses should place antibacterial hand wash on convalescents’ bedsides and emphasize its use before meals, after visiting the washroom, or every time the patient touches a contaminated surface. According to Pássaro, Harbarth, and Landelle (2016), the implementation of hand hygiene reduces nosocomial prevalence in clinical facilities to 9.9% from 16.9%. Additionally, nurses in older adult nursing homes can use oral care to prevent patients from contracting healthcare-associated pneumonia. Oral care prevents the development of HAP from risk factors, such as saliva’s periodontal bacteria, dental decay, and dental plaque. Nursing oral care interventions include emphasizing patient use of chlorhexidine mouth wash at a 0.12% concentration, applying chlorhexidine gel, scrubbing the pharynx with 1% povidone-iodine, and topically applying non-absorbable antiseptic. Further, nurses should encourage older adults susceptible to acquiring HAP from poor oral hygiene to brush their teeth twice daily, besides using mouth rinses comprising sodium bicarbonate. Therefore, nurses can prevent HAP development in senior residents in nursing homes by inculcating oral care and hand hygiene in their care protocols for the patient populations above.
Furthermore, nurses in older adults’ inpatient facilities can prevent convalescents from contracting HAP by using protocols that eliminate dysphagia and aspiration, common risk factors for the disease above. Nurses should first diagnose the presence of dysphagia in senior residents by conducting a bedside evaluation of patients who report swallowing difficulty. Additionally, nurses may request the senior resident facility to performing a videoflouroscopic examination of a patient’s swallowing to determine the presence of dysphagia. If an older adult reports swallowing problems and dysphagia is established, the nurse can prevent the convalescent’s development of healthcare-acquired pneumonia by prescribing non-oral feeding, faucial pillars’ stimulation, aromatherapy to ease swallowing and use of pharmacological interventions, such as nifedipine. Finally, nurses in older adult clinical centers should elevate patient beds as a strategy to prevent the development of HAP. For instance, after every meal, convalescent beds should be elevated in a semi-recumbent manner, a technique that has been proven to eliminate chances of older adults acquiring HAP. Therefore, healthcare-associated pneumonia in nursing homes can be prevented by bedside elevation and treatment of dysphagia.
The Importance of Quality Improvement Program Involvement
Nursing homes should incorporate quality improvement (QI) programs in their HAP prevention strategies for better patient outcomes. QI techniques that nurses can undertake in the clinical setup above include requesting audits, service evaluation, and research to reduce HAP if they spike suddenly. For instance, a nursing home may hire external auditors to check if nurses inculcate oral care and hygiene in their daily intervention routines. The auditor may also check if the patient’s beds are elevated every two hours after meals mandated by the nursing home. Nurses and nurse-leaders could then analyze audit results in senior resident facilities to determine areas where standards of care offered are below expectations. Nurse leaders should then emphasize the need for quality improvement by strictly adhering to preset care standards by nurses for positive patient outcomes and reduced mortality rates.
Furthermore, nurses in an older adult nursing facility could request the nurse leader to allocate resources to fund intensive research on other ways to end nosocomial infection incidences. For instance, perhaps even after observing hand hygiene and oral care, a senior residential facility still records a high rate of HAP from non-intubated and intubated patients. The nurses could conduct an inpatient survey to check for other ways in which older adult residents create enabling environments to develop HAP pathogens. Nurses could take patient blood cultures to sophisticated laboratories outside the nursing facilities or request specialists from high-end hospitals to visit the care center. The results of extensive research to check why nursing facilities have a spike in nosocomial infections after hospitalization could be implemented as a quality improvement measure ( Backhouse, 2020) . In the end, the nursing home that conducts research and implements recommended results from the study will achieve a reduction in its nosocomial infection rates.
Moreover, nursing homes could conduct service evaluations as a quality improvement strategy to end the prevalence of nosocomial infections. For instance, patients could evaluate their satisfaction rates with offered nursing care to check for under-serviced areas, which promote the thriving of HAP. If a convalescent reports they are dissatisfied because they reported a swallowing difficulty that is still untreated two days after, the nursing home should mandate that nurses offer immediate intervention for such cases. Patients’ families should also undertake service evaluations to help senior resident facilities improve their care quality and increase positive patient outcomes ( Backhouse, 2020) . For instance, a patient’s family member may insist they are unhappy because facility bedsides do not have hand washes, which could be a risk factor for nosocomial infection spread. The nursing home could then use the service assessment result to order antiseptic hand washes and conduct patient education to enlighten convalescents on the frequency of using the intervention strategy above.
Finally, the clinic could mandate nurses to undertake a service evaluation test to determine their satisfaction with the intervention strategies provided. For instance, a nurse could indicate they are unhappy because they request oral care resources every time the nursing home rejects their offer. If a nursing home leadership is keen, it will allocate funds to purchase mouth rinses to reduce the incidences of nosocomial infections in the clinical facility. In the end, the senior resident facility will encounter a reduction of nosocomial cases from remedying the problems highlighted by conducting a service evaluation. The incorporation of quality improvement strategies in clinical care is important because it reduces patients’ length of stay in nursing homes, mortality rates and increases recovery incidences. Therefore, senior resident facilities should emphasize the need to incorporate QI in care for positive patient outcomes.
The Importance of Nursing Values in Improving Patient Safety
Nursing facilities can improve older adults’ safety by mandating that nurses have values, such as altruism, integrity, honesty, human dignity, and social justice. Nurses who have the values above are keener when delivering care and are less likely to engage in medication errors with fatal outcomes in affected patients. When a nurse is honest, they will not allow patients illegal substances, such as marijuana or opium for pain control or to please the convalescent. Instead, the nurse will ensure the patient’s safety by using the appropriate channels to secure safe pain control medication for a convalescent. Moreover, if a nurse values human dignity, they will not mistreat an older adult or expose confidential information to non-authorized persons. The nursing home nurse understands that mistreatment of a patient could propel mental health problems in the victim.
Furthermore, if a nurse is altruistic, they listen to the patient keenly to identify undiagnosed causes of a disease or ways in which the convalescent encourages the development of nosocomial infections. By implementing listening skills, the nurse ensures patient safety because identified problems could be remedied to recover the convalescent ( Poorchangizi et al., 2019) . Finally, a nurse who values social justice will not promote discrimination in the nursing home, resulting in the patient’s development of stress, depression, or anxiety. Instead, the nurse will ensure patient safety by treating all senior residents equally and ensuring every patient receives high-quality care standards. Therefore, nurse values in the nursing home environment ensure patient safety, as discussed above.
References
Backhouse, A. (2020). Quality improvement into practice. British Medical Journal , 368 . https://dx.doi.org/10.1136%2Fbmj.m865
Poorchangizi, B., Borhani, F., Abbaszadeh, A., Mirzaee, M., & Farokhzadian, J. (2019). The importance of professional values from nursing students’ perspective. BMC Nursing , 18 (1). https://doi.org/10.1186/s12912-019-0351-1
Pássaro, L., Harbarth, S., & Landelle, C. (2016). Prevention of hospital-acquired pneumonia in non-ventilated adult patients: A narrative review. Antimicrobial Resistance & Infection Control , 5 (1). https://doi.org/10.1186/s13756-016-0150-3
Russell, C., Koch, O., Laurenson, I., O'Shea, D., Sutherland, R., & Mackintosh, C. (2016). Diagnosis and features of hospital-acquired pneumonia: A retrospective cohort study. Journal of Hospital Infection , 92 (3), 273-279. https://doi.org/10.1016/j.jhin.2015.11.013
