Biography
Biography: Dian Baker
Abstract
Purpose: Non-ventilator hospital acquired pneumonia (NV-HAP) is an understudied disease, with substantial fiscal impacts and potential for reduction of morbidity and mortality. Because it is not required by regulatory agencies, most hospitals do not monitor NV-HAP. We sought to utilize transdisciplinary partnerships to determine the incidence and implement a basic oral care protocol to reduce NV-HAP. Background: The US Centers for Disease Control and Prevention’s 2014 study on hospital acquired infections indicated that NV-HAP (i.e., non-device related) is the leading cause of hospital-acquired infections. We mined the Healthcare Utilization Project data set and found a NV-HAP rate of 4.3% (284,601/6,567,271). In several hospital systems, we found unreported NV-HAP rates of 1.22–8.9 per 1,000 hospital days, mean excess stay of 14 or more days, and NV-HAP on all types of hospital units. Further analysis indicated than 50% of our NV-HAP occurred in post-surgical patients. Methods: Our transdisciplinary team implemented a universal (i.e., every patient) new oral care protocol at a 600-bed community hospital. In addition, we partnered with perioperative nurses to implement a basic oral care protocol prior to surgery for every patient and added oral care to the standard perioperative check list. We used a descriptive, retrospective comparative study to determine changes in oral care delivery and prevalence of NV-HAP. The Influencer Model™ was used to manage the complexity of the multi-levels of intervention required. Results: Implementation of a universal oral care protocol, both in the perioperative area and on the floors, resulted in an overall decrease of NV-HAP by 71%, with a 75% decrease in post-operative patients (p<0.0001: (OR=0.292, 95%CI = 0.199, 0.429), extra cost for new therapeutic oral care equipment was $120,000. Cost savings resulting from 80 avoided NV-HAP cases was $3.2 million. Thus, return on investment for the organization was $3.08 million in avoided costs and an estimated 15 lives saved. Importantly we have sustained these positive outcomes over a three-year period of time.