Techniques dramatically preventing hospital-acquired pneumonia

Being admitted to a hospital has some risks involved and one of them is contracting pneumonia.  Pneumonia is often associated with only very sick, elderly individuals acquiring it.  However, this is not the case. Much younger people in their 40s and 50s (or younger) are also vulnerable to developing a case of pneumonia if certain hospital practices are not in place.

This news is according to a 2017 study in the American Journal of Infection Control which focused on the rate of common pneumonia infections or what is referred to as hospital-acquired pneumonia (HAP) or non-ventilator HAP compared to ventilator-associated pneumonia (VAP).  

Non-ventilator HAP is emerging as a major patient safety concern equally as dangerous as someone contracting pneumonia who is in critical care or in the ICU on a ventilator.  Each year there are 35-38 million total annual U.S. hospital discharges and the vast majority (83%) is from medical surgical units and not admitted to critical care.  Of patients admitted to critical care units, only 39.5% of them are on mechanical ventilation.  When using these figures, 32.6-35.4 million U.S. patients are at risk for non-ventilator HAP annually whereas only 3.6-3.9 million are at risk for VAP.

A 2016 review found that patients who developed non-ventilator HAP had an 8.4 times greater odds  of dying during hospitalization, more likely to require intensive care, 8.0 times more likely to require mechanical ventilation, and had a longer median hospital stay of 15.9 vs 4.4 days than patients who did not develop non-ventilator HAP. 

How to prevent the incidence of HAP

The number one hospital-acquired infection in America is pneumonia according to the Centers for Disease Control (CDC).  It typically is transferred from germs that enter the body through the mouth.  Patients who are on ventilators can catch the bacteria in their breathing tubes while those non-ventilated can acquire it in other ways. 

The reality of HAP is that it can be lethal to any patient is who admitted to a hospital.  Research has found that around 15% to 20% of patients who acquire HAP will die. One study conducted by the CDC and the Pennsylvania Department of Health found that about 31% of adult patients with HAP died. 

Over the years there have always been attempts at reducing a patient’s risk of contracting HAP.  Keeping hospital rooms and equipment clean and sanitized, judiciously controlling the use of antibiotics, and strategically placing hand sanitizers in patient rooms for both patients, hospital staff and visitors to use frequently.  All of these can be important factors in keeping patients safe from acquiring HAP. 

However, the 2017 study is recommending further steps need to be taken to significantly reduce the risk of HAP. Some of the steps experts are advocating in addition to the above stated are the following:

·      Keeping patients elevated in their beds as frequently as possible rather than lying down as much.

·      Getting patients up and out of bed more frequently to move and walk about.  This step provides the opportunity for deeper breathing allowing more air to move through their lungs preventing germs from settling there.

·      Patients should sit up at meal times and stay upright for 30 minutes after eating.  If a patient is unable to sit up in a chair, their bed should be tilted to an upright position for meals.

·      The head of a patient’s bed should be elevated to 30 degrees all of the time especially after surgery.  This allows for improved breathing helping to prevent pneumonia. 

·      Respiratory therapists can work with patients to practice on breathing deeply with a spirometer, a device to help expand the lungs helping to keep respiratory tracts clear. 

One of the more interesting and unusual takeaways from the study was using the technique of tooth brushing as a viable means of protecting against pneumonia.  A program at Sutter Medical Center in Sacramento, California, had every patient in the hospital brush their teeth several times a day.  Using 2010-2011 as a baseline, researchers found that from May 2012 through December 2014, HAP cases were reduced by 70%. 

Another campaign launched at the Department of Veterans Affairs Medical Center in Salem, Virginia, had patients brush their teeth twice a day.  Between October 2016 and December 2017, the number of non-ventilated HAP cases fell 92%. 

Why would brushing one’s teeth several times a day while in the hospital have such a distinct defense against HAP?  The reason is a strong link between the level of oral contaminants and pneumonia.  When there are elevated levels of bacteria in the mouth, it is more likely for bacteria to be aspirated into the patient’s lungs, which can then cause pneumonia.  Hospitalized patients with neurological conditions or who have difficulty swallowing are at an even higher risk. 

Keeping the mouth clean by frequent brushing of the teeth reduces the amount of bacteria in the oral cavity.  Normally, the teeth and oral cavity in a healthy mouth maintain a colony of otherwise harmless bacteria.  Infection takes root when a breathing tube allows free passage of the “good” bacteria into the lower parts of the lung.  This bacterium travels in small water droplets through the tube and can colonize the lung.  Once there, the bacteria takes advantage of a patient’s weakened immune system and multiply.  This is why regular tooth brushing kills the growth and subsequent spread of the bacterium that leads to HAP. 

Even in patients who are not ventilated, there is a risk of this bacteria spreading to the lungs if they are not maintaining a regular routine of brushing their teeth while in the hospital. 

Although nurses across America already practice tooth brushing on ventilated patients, more resources and energy needs to be invested in this routine practice on non-ventilated patients to decrease the incidence of HAP and possible death.