Reducing The Incidence of Hospital Acquired Pneumonia (HPA)

Significance 

In a revelation of the prevalence of hospital acquired infections among individuals during the 21 st century, most individuals have been left in awe over the dominance of respiratory tract infections under this category of diseases and infections (Passaro et al., 2016). Research revealed that the most frequent forms of hospital acquired infections affected the respiratory tract, mainly pneumonia together with lower respiratory tract infections (Passaro et al., 2016). Additional research revealed that the prevalence of the condition was underreported and therefore leading to lack of vital information especially regarding the prevention and control of the condition (Munro et al., 2018). This is especially in view of the fact that the diagnosis of HAP in patients has been detected to significantly increase the chances of fatality for most patients. Findings revealed that 30% of the patients that were diagnosed with the condition succumbed to the illness during administration of treatment and care (Quinn et al., 2014). Scholarly findings have revealed that incidence of HAP is caused and spread in the respiratory tract by bacteria, with a high frequency of cases revealing the relationship between the disease causing pathogens and multi-drug resistant pathogens. 

Given the recent attention to HAP and respiratory diseases, prevention of the occurrence of HAP has become a priority aspect in the delivery of healthcare for most industry players. The significance of prevention is pinned on the fact that the avoidance of the condition has been revealed to save millions of dollars in treatment and care costs together with saving lives of innumerable patients in the long-run (Passaro et al., 2016). Critical to understanding prevention have been the risk factors that have been identified for the occurrence of HAP. Among the most dominant risk factors identified for the occurrence of HAP were advanced age of patients, sex of patients with males exhibiting high risk for diagnosis, structural lung disease together with poor state of and attention to oral care by individuals (Passaro et al., 2016). Poor oral hygiene results in the formation of a biofilm in the mouth which breeds pathogens and disease causing bacteria which increase the chances of the acquisition of and diagnosis with HAP (Quinn et al., 2014). 

Research has revealed that the observation of good oral hygiene together with consistent attention to oral health 2 to 4 times in a day significantly reduces the chances for occurrence of HAP by approximately 50% (Quinn et al., 2014). The brushing of teeth with plays an imperative role in the elimination of the biofilm, is revealed to prevent the occurrence of HAP and therefore additionally acting to prevent the occurrence of fatality as a result of diagnosis with HAP (Munro et al., 2018). The diagnosis and classification of poor oral care and hygiene as a modified risk factor lays emphasis on the need for focus on improved oral care (Passaro et al., 2016). This is especially due to the fact that brushing of teeth regularly is not only an achievable prevention measure, but also doubles up as a relatively affordable and efficient prevention measure (Quinn et al., 2014). Given the high cost of treatment of pneumonia together with social costs related with the deaths due to HAP, it is safe to say that oral care and hygiene observation is an ideal prevention measure for both patients and facilities. 

PICOT Question 

In medical-surgical adult non-ventilated patients, how do improved teeth brushing two times a day compared to no tooth brushing; to reduce the incidence of hospital-acquired pneumonia in medical-surgical adult non-ventilated patients over a twelve-month period. 

Search Strategy 

Collection of data for the research study was online based and an electronic search was conducted on various web based resources encompassing scholarly articles that dwelled on the subject matter of HAP, its prevention and the role of oral care in particular. The search conducted focused on systematic reviews together with meta-analysis, clinical practical guidelines, critically appraised studies, individual research studies together with electronic textbooks. The aforementioned scholarly material for the conduct of the research study was derived from the following databases: Cochrane, Joanna Briggs, ACP Journal Club, PubMed, DynaMed, AHRQ Evidence Reports. The sources which encompassed critical scholarly material contained elaborately and meticulously researched on and elaborated on concepts regarding the prevalence of the condition together with the most efficient prevention measures. 

Appraisal of Evidence 

Passaro et al (2016) expounded though a narrated review on the best practices for the prevention of both the occurrence and subsequent spread of Hospital Acquired Pneumonia among admitted non-ventilated patients. The research conducted a literature search for guidelines published by professional medical societies where a myriad of systemic reviews were performed to determine the correlation between increased attention to oral care and HAP reduction (Passaro et al., 2016). Furthermore, the research article conducted a meta-analysis which investigated the impact of improved oral hygiene on the prevalence of HAP and its impact upon patients. The results of the study revealed that increased oral hygiene not only reduced the risk of acquisition of pneumonia, but also had an effect on the prevention and therefore reduction of the cases of fatality that result from pneumonia (Passaro et al., 2016). The scholars however warn over the predominance of the emphasis on oral hygiene highlighting other practices which would be deemed ideal for the successful prevention of the occurrence of HAP in addition to prevention of fatality among diagnosed patients. 

Adding to the existing body of research on the condition of HAP, its prevalence and prevention of the condition, Quinn et al (2014) elaborate on the basis nursing care practices that aid in the prevention and subsequent reduction of the occurrence of HAP. The study applied a quasi-experimental descriptive study which focused on the use of retrospective comparative outcomes (Quinn et al., 2014). The study reveals the fact that the occurrence and prevalence of HAP in non-ventilated patients is a case that is underreported and equally unstudied by the relevant parties (Quinn et al., 2014). In the analysis of the prevention measures for the occurrence of HAP, re-education of the staff on the causality coupled with the prevention of HAP was found to significantly reduced the occurrence of the condition (Quinn et al., 2014). Furthermore, inclusion of nursing staff in decision making pertaining the condition also reduced the rate of patient diagnosis with the condition. 

Further research conducted by Munro et al (2018) revealed the impact of the comprehension of oral care in the prevention of the prevalence of non-ventilator associated HAP among veterans. The pilot study was conducted on two medical facilities owned by the Veterans Affairs Medical Center (VAMC) to investigate the impact of oral care on the incidence of NV-HAP (Munro et al., 2018) The research conducted encompassed inquest into the impact of brushing of teeth twice by patients on the occurrence of the condition though the use of a single arm intervention study (Munro et al., 2018). The study results revealed that the prevalence of the condition had reduced mainly due to evidence based interventions encompassing the administration of good oral care (Munro et al., 2018). Additionally, the findings pointed to the fact that a majority of patients, up to 70%, did not adhere to standard oral hygiene practices (Munro et al., 2018). The study acknowledges the prevalence and depth of the impact of the condition and therefore recommends that special attention should be paid to prevention and treatment of NV-HAP. 

Summary and Conclusion 

Non-ventilator associated HAP has become a prevalent cause of fatality and disease in hospitals with the condition accounting for a significant portion of the Hospital Associated Infections (HAI) (Passaro et al., 2016). The research findings expounded upon in the above discussion not only point to the prevalence of the condition but also point to the most dominant causal factors of the condition. The studies reveal that oral care and hygiene significantly reduces the incidence of HAP together with preventing fatality as a result of HAP. Given the conclusions drawn by the research findings it is safe to conclude that commitment to thorough oral hygiene is key for both health facilities and patients to ensure that the incidence of the condition and its impact are curbed. 

References 

Munro, S., & Baker, D. (2018, December). Reducing missed oral care opportunities to prevent non-ventilator associated hospital pneumonia at the department of veterans’ affairs. Applied Nursing Research , 44 , 48-53. https://doi.org/10.1016/j.apnr.2018.09.004 

Passaro, L., Harbarth, S., & Landelle, C. (2016, November). Prevention of hospital-acquired pneumonia in non-ventilated adult patients: a narrative review. Open Access: Antimicrobial Resistance and Infection Control 

Quinn, B., Baker, D. L., Cohen, S., Stewart, J. L., & Lima, C. A. (2014). Basic nursing care to prevent nonventilator hospital-acquired pneumonia. Journal of Nursing Scholarship , 46 , 11-19. https://doi.org/10.1111/jnu12050