D219 Oral Care of a Hospitalized Patient and the Risk of Pneumonia

D219 Oral Care of a Hospitalized Patient and the Risk of Pneumonia

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Western Governors University

D218 Intrapersonal Leadership and Professional Growth

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Date

Impact of the Problem on the Patient

Hospital-acquired pneumonia (HAP) represents one of the most frequent yet preventable complications affecting patients in acute care environments. Hospitalization often disrupts patients’ daily hygiene practices, restricts mobility, and weakens the immune system, all of which heighten susceptibility to infections like pneumonia. Patients who contract HAP frequently require escalated levels of medical intervention due to complications such as sepsis, extended hospital stays, or readmission. Moreover, recovery often demands transfer to a skilled nursing facility rather than discharge to home, thereby diminishing overall quality of life and prolonging dependency on healthcare systems.

In addition to the physical impact, HAP contributes to psychological distress, including anxiety and reduced motivation toward recovery. The illness may also impede the rehabilitation process, particularly for postoperative or elderly patients. Preventive strategies such as consistent oral hygiene and early mobilization have therefore become critical in mitigating this risk.

 Impact of the Problem on the Organization

Hospital-acquired pneumonia has significant organizational implications. Financially, it imposes additional burdens on healthcare facilities because costs associated with preventable infections are typically not reimbursable by insurance providers. This loss affects hospital revenue and may also influence institutional performance metrics related to patient safety and quality of care.

HAP increases hospital length of stay, staff workload, and the need for advanced interventions such as antibiotics or respiratory therapy. Consequently, this results in higher operational costs and potential penalties under healthcare quality programs. Moreover, it affects hospital reputation, potentially lowering public trust and accreditation ratings. Institutions are therefore compelled to adopt evidence-based preventive measures, including standardized oral care protocols, to enhance patient outcomes and reduce avoidable expenses.

1. Identify the PICO Components

2. Evidence-Based Practice Question

Question:
For hospitalized patients, will implementing a protocol of scheduled oral care reduce hospital-acquired pneumonia compared to having no standardized oral care protocol?

This question seeks to evaluate whether structured oral hygiene practices can significantly decrease the occurrence of non-ventilator hospital-acquired pneumonia (NV-HAP) in inpatient populations.

 Research Article

Title

Impact of an Oral Care Intervention among Medical-Surgical Patients

1. Background Introduction

The selected research article investigates the effect of an oral care protocol on the prevalence of non-ventilator hospital-acquired pneumonia (NV-HAP) in a community hospital setting. The study emphasizes the importance of structured oral hygiene practices as a preventive measure against pneumonia in non-intubated patients.

2. Methodology

The research utilized a quantitative design, employing both baseline and post-implementation data. Data collection followed the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network surveillance protocol for identifying NV-HAP. An interdisciplinary oral care team conducted a gap analysis to identify deficiencies in current practices and introduced updated oral care tools and educational initiatives to improve outcomes.

3. Level of Evidence

The study was conducted over a two-year period at a 208-bed community hospital across five medical-surgical units. According to the Johns Hopkins Evidence-Based Practice Model, the study presents Level III evidence, reflecting a well-designed quasi-experimental approach. A nurse scientist led the project, ensuring methodological rigor.

4. Data Analysis

Data were gathered over a 28-month period, revealing a 58% reduction in NV-HAP cases. Researchers analyzed patients’ respiratory symptoms and chest radiograph results to confirm pneumonia diagnoses. The NV-HAP rate was computed as:

[
\text{NV-HAP Rate} = \left(\frac{\text{Number of NV-HAP Cases}}{\text{Patient Days}}\right) \times 1000
]

(Stepinski et al., 2022).

5. Ethical Considerations

The study was approved by the hospital’s Institutional Review Board (IRB) and renewed annually. Informed consent was not required since the intervention—oral care—was considered a standard nursing practice. Ethical concerns were minimal as the research did not alter patient risk levels.

6. Quality Rating

Using the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) appraisal tool, the study achieved a Level I (high-quality) rating due to its clear conclusions, consistent outcomes, and practical applicability across multiple units.

7. Analysis of the Results/Conclusions – Alignment to the EBP Question

The findings directly align with the EBP question. Increased frequency of oral care (four times daily) demonstrated a significant reduction in NV-HAP incidence, confirming that regular oral hygiene serves as a powerful preventive measure in acute care settings.

Non-Research Article

Title

Oral Health Status and the Etiology and Prevention of Non-Ventilator Hospital-Associated Pneumonia

1. Background Introduction

This article reviews the role of oral care in preventing non-ventilator hospital-acquired pneumonia (NVHAP). It discusses the epidemiology, microbiology, and pathogenesis of NVHAP and highlights how effective oral hygiene can disrupt bacterial colonization responsible for infection.

2. Type of Evidence

The article is a literature review and quality improvement summary, integrating evidence from multiple peer-reviewed studies on inpatients in acute care facilities.

3. Level of Evidence

According to the Johns Hopkins EBP Model, this literature review represents Level V evidence, as it synthesizes previously published data to develop clinical recommendations.

4. Quality Rating

The article is rated high quality under the JHEBPM framework. It presents clear evidence that structured oral care programs reduce NVHAP by 37%, saving approximately $1.72 million, 500 hospital days, and eight patient lives annually (Scannapieco et al., 2022).

5. Author’s Recommendations

Authors recommend implementing preventive strategies such as:

• Maintaining correct head-of-bed elevation

• Administering pneumococcal and influenza vaccinations

• Ensuring proper denture hygiene

• Establishing consistent oral care routines

They also advocate for randomized controlled trials (RCTs) to further confirm the effectiveness of oral hygiene interventions in diverse hospital settings.

Recommended Practice Change

Both articles advocate for a standardized oral care regimen performed four times daily—after meals and before bedtime. The Stepinski et al. (2022) study demonstrated a 58% NVHAP reduction, while Scannapieco et al. (2022) reported a 37% decrease with structured oral hygiene programs. These findings underscore the clinical and financial benefits of routine oral care as a preventive intervention.

1. Key Stakeholders

2. Barriers to Implementation

Primary barriers include:

• Limited nursing time due to workload and staffing shortages.

• Lack of awareness or adherence to new oral care protocols.

3. Strategies to Overcome Barriers

To mitigate these barriers:

• Incorporate electronic medical record (EMR) reminders prompting completion and documentation of oral care.

• Conduct training sessions emphasizing the link between oral hygiene and pneumonia prevention.

• Provide audit feedback to reinforce adherence.

4. Indicator to Measure the Outcome

The success of this intervention will be measured by a reduction in NVHAP rates per 1,000 patient days. A consistent decline in infection rates, combined with lower readmission and shorter hospital stays, would indicate successful implementation of the oral care protocol.

 References

Scannapieco, F. A., Giuliano, K. K., & Baker, D. (2022). Oral health status and the etiology and prevention of non-ventilator hospital-associated pneumonia. Periodontology 2000, 89(1), 51–58. https://doi.org/10.1111/prd.12423

Stepinski, J., Rowe, S., & Robertson, R. (2022). Impact of an oral care intervention among medical-surgical patients. MEDSURG Nursing, 31(2), 91–98.