Implementation of an Oral Care Protocol on an Acute Geriatric Inpatient Unit

Abstract

Background: Hospital acquired pneumonia is the second most common hospital acquired infection, and is responsible for 20-33% of mortality rates from infection. Patients with HAP also have higher 30-day hospital readmission rates compared to patients without a hospital acquired infection. Nationwide, hospital acquired pneumonia accounts for 32.5-35.4 million discharges annually. According to the Centers for Disease Control, 5-7% of hospitalizations due to pneumonia end in death. The oral cavity is a high reservoir for infection, and evidence-based practice suggests oral hygiene interventions to prevent hospital acquired pneumonia. Hospital acquired pneumonia is more common in at risk individuals, and there are four routes of transmission: (1) through aspiration of oral contents (food, oropharyngeal secretions, or gastrointestinal contents), (2) from infectious sites, (3), from inhalation of aerosols that are infected, and (4) from extra-pulmonary sites. Aspiration of infectious organisms remains the number one way to acquire hospital acquired pneumonia, so reducing oral bacteria is critical in hospital acquired pneumonia prevention.

Local Problem: The focus site had no oral care protocols in place. Oral care supplies that were used were not ones recommended by evidence-based practice.

Interventions: This project was implemented over a 12-week time span beginning in September of 2018. Education sessions were provided to staff to ensure appropriate use of oral care equipment. A five-question pre and post education test was administered to measure retention of information. Staff documented each time oral care was performed in addition to documenting all of the supplies that were used. Oral care compliance was measured through point prevalence, and hospital acquired pneumonia incidences was tracked through manual extraction of infection data. Hospital acquired pneumonia percentages was calculated using the number of hospital acquired pneumonia incidences divided by the number of patient visits.

Results: Pre-implementation oral care compliance rates were (May-Aug) 36%. Postimplementation rates were (Sep-Dec) 52%. The average pre-pneumonia rate (May-Aug) was 25.8 and average post pneumonia rate (Sep-Dec) was 29.6. In addition, the average pre implementation aspiration pneumonia rate (May-Aug) was 7.3, and the average post aspiration pneumonia (Sep-Dec) was 5.5. The average grade on the pre-test was 77.8% and 82.5% on the post-test.

Conclusion: There was a 16% increase in oral care compliance with implementation of this quality improvement project. In addition, there was an appreciative decrease in aspiration pneumonia rates with the increase in oral care compliance. However, there was a surge in nonaspiration pneumonia rates in October in November. From the results of this quality improvement project, one can conclude there is a potential decrease in hospital acquired pneumonia from oral care compliance. The mixed results of this project suggest more research is needed to determine if comorbid conditions (i.e. influenza) affect hospital acquired pneumonia rates.