Abstract
Background: Hospital-acquired pneumonia (HAP) is one of the most common infections acquired in hospital settings throughout the United States. Surgical patients are at risk of developing HAP, which is associated with lengthened hospital stays, additional expenses of greater than $40,000 per patient, and increased morbidity. A midwestern Veterans Affairs Medical Center (VAMC) experienced seven cases of postoperative pneumonia over the 2018 fiscal year, which amounts to an estimated $280,000 in preventable costs. During this timeframe, no formal pneumonia prevention measures were in place for non-ventilated postoperative patients. Existing research identifies the importance of including oral hygiene in pneumonia prevention efforts for ventilated patients, though recommendations for non-ventilated (NV) postoperative patients remains scarce Further knowledge regarding oral care practices for pneumonia prevention in this population has the potential to improve patient outcomes across the nation.|Purpose: The purpose of this project was to implement an evidence-based pneumonia prevention bundle for adult postoperative patients on an inpatient surgical unit at a midwestern hospital.|Methods: This quality improvement study was inspired by the Palo Alto V.A. Medical Center (VAMC) which significantly decreased postoperative pneumonia rates through the implementation of a postoperative pneumonia prevention bundle. The bundle used in this study differed in that alcohol-free mouthwash replaced chlorhexidine oral rinse, given non-prescription mouthwash has been proven to elicit equivalent outcomes when combined with tooth brushing. The following evidence-based pneumonia prevention measures were included and documented on by nursing staff: hourly turn/cough/deep breathe exercises and incentive spirometry use, ambulation three to four times a day, head-of-bed elevation maintained at a minimum of thirty degrees, and oral cares twice a day including mechanical tooth brushing and mouthwash use. Pneumonia incidences were monitored through the V.A. National Surgical Quality Improvement Program.|Results: No incidences of postoperative pneumonia were reported on the inpatient surgical unit during this pilot. Nurse and patient compliance rates with ordered oral hygiene cares were low at twenty-nine percent, though close to the reported national inpatient average of thirty percent.|Conclusion: The incorporation of an evidence-based postoperative pneumonia prevention bundle successfully decreased NV-HAP incidence amongst postoperative adults admitted to a medical-surgical unit at a midwestern hospital. It is imperative for acute care facilities to have formal pneumonia preventions measures in place for this population. Future research should expand beyond the postoperative sample to evaluate the effectiveness of these measures in non-surgical, non-ventilated adults requiring hospitalization.