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HOSPITAL ACQUIRED PNEUMONIA 1

HOSPITAL ACQUIRED PNEUMONIA 10

Review of Literature

Effective ways to prevent Hospital Acquired Pneumonia in an Acute Care Setting

Introduction.

The literature review aims to discuss the current knowledge regarding ways that can be used to prevent hospital-acquired pneumonia in an acute care setting. The discussion will enable individuals responsible for the control and surveillance of infections in hospitals in acute-care settings to understand better ways of reducing the incidences of hospital-acquired pneumonia. The review will address current and developing knowledge concerning the issue. Some of the topics discussed include patients who are more prone to contracting HAP (hospital-acquired pneumonia) while admitted in an acute-care set-up and effective means of preventing and reducing the infection following practice guidelines of nursing that are based on evidence.

The research question for this study is:

Hospital-acquired infections, what are the effective ways of preventing acquired pneumonia in an acute-care hospital setting?

The research study took place in 2020 during the summer period completed following the use of reliable sources via online sources. The references were mostly obtained from Regis College Library and Google Scholar, which offered various articles from NCBI, Nursing Management, and HCM website sources that provided factual information concerning the issue of discussion. Nine peer-reviewed research journals were used to offer reliable information for the literature matrix (Appendix B) and this review. Some of the terms used while searching for information concerning the issue in discussion includes hospital-acquired pneumonia, acute-care settings, infections in the acute-care setting, effective means of preventing infections, and theoretical framework supporting the prevention measures for infections that may be contracted in hospitals. The research study mostly used the current journal articles from 2015 to 2020 to ensure the most relevant literature was used. Only one article from 2008 was used. The article was used due to its relevance to the research question. In the course of acquiring information for the discussion, some gaps were identified, which revealed the necessity to further research on this issue of identifying the most effective means of preventing HAP.

The literature review will include empirical and theoretical parts. It will also include a short description of how the researcher arrived at this topic of interest. In the empirical literature art, the literature from the peer-reviewed journals will be reviewed and analyzed. Findings for the articles will be cited to give information about how to prevent hospital-acquired pneumonia in an acute care setting. This paper will be concluded with the gap in the literature and why there is a need for more research on this topic.

Empirical Literature

Overview

Hospital-acquired pneumonia is a controversial issue that has resulted in different researches developed to address ways of preventing infectious disease in an acute setting. The literature review matrix (Appendix B) several peer-reviewed sources that studied effective ways the acute-care settings can prevent HAP.

Hospital-acquired pneumonia (HAP) is an infection commonly acquired in hospital set-up that recording roughly 15% of all infections acquired in hospitals (Torres et al., 2017). It is the deadliest among all such infections with a mortality rate ranging between 205 and 30%; hence it is highly significant to implement strategies of preventing this infection.

Oral care

HAP commonly occurs resulting from a Staphylococcus aureus and gram-negative bacilli, which may flourish in a patient’s oral cavity while in the acute care environment. Additionally, the research has identified that standardized oral precautions reduce any bacteria in a patient’s mouth, and more studies have identified a substantial HAP decline when an effective oral program is used. Green et al. (2016), carried out a systematic review study to compare the association between oral health and pneumonia. There were 202 patients in the control group and 215 participants in the interventional group. The experts indicated that cariogenic and periodontal pathogens, dental decay, and poor oral hygiene are significantly connected to the increase of pneumonia cases. Thus, dental plaque may become the reservoir for respiratory pathogens in hospitalized patients in an acute care setting without sufficient dental hygiene. The results showed positive preventive effects of oral hygiene on pneumonia. To support this finding, Weitzel, Robinson, & Holmes (2020), did an experimental study where they observed patients for 100 consecutive days and found out that the rate of HAP had decreased from 0.49 to 0.3 after maintaining oral hygiene in patients.

This finding shows that maintaining oral hygiene may aid in minimizing the microbial development in the oral airway. Nurses should use a soft bristle toothbrush or an electric suction toothbrush to assist a patient to clean his or her mouth; use a toothpaste that has sodium bicarbonate; effectively assess the oral cavity for the patients that are receiving antibiotics and ensure that patient's dentures are cleaned after they take a meal (Green et al.,2016). Oral care is proven to impact in reducing infections on the respiratory tract, mortality, and HAP. However, evidence suggests that oral care among nursing staff is poorly documented (Warren et al., 2019), indicating the need to improve the provision and adherence of oral care by nursing staff.

Increased mobility

Mitchell et al. (2019) conducted a systematic review to identify how increased mobility can reduce the incidence of pneumonia among patients in an acute care setting. The literature involved 1551 articles from which 15 articles met the inclusion criteria, most of the studies were conducted in hospital settings. The study identified that increased mobility, which involves physical activity, is one of the main ways of preventing hospital-acquired pneumonia incidences. This intervention includes preoperative patient training, early ambulation and individually controlled breathing exercise, and preoperative physiotherapy.

A randomized controlled study by Boden et al. (2018) assessed preoperative physiotherapy sessions' effectiveness to reduce postoperative pulmonary complications. Four hundred forty-one adults within six weeks of an elective were randomly assigned to receive either an information package (n=219; control) or preoperative physiotherapy (n=222; intervention) and followed for 12 months. Preoperatively, the controlled participants received an information booklet whiles the interventional group received education on early ambulation and breathing exercise training session. Postoperatively, all participants were engaged in standardized early ambulation. The result showed that early and complex mobility approaches minimize HAP's occurrence and the impacts of deconditioning that is a result of too much stay in bed. There are several barriers to mobility: insufficient time, issues about the safety of the patients, physiological instability, and faulty equipment to transfer patients (Boden et al., 2018). Therefore, imperative for health care providers to keep these gaps in mind.

Additionally, a pilot study conducted by Turner (2015), which involved two respiratory and two elderly care wards with each ward receiving early mobility programs showed that nurses have a significant role in evaluating the safe patient transfers to minimize the risk of falling. Besides, getting the patient out of bed at least two times a day, significantly reducing the incidence of hospital-acquired pneumonia. Administering an individualized analgesics schedule and avoiding over-sedation before getting off bed may assist patients in meeting their mobility goals. The nurses involved in helping the patients asserted that they required physical therapists to maintain safe interventions.

Hands-On Interventions for Nursing

Tesoro, Peyser & Villarente (2018) used a descriptive, observational, retrospective chart to review that HAP and its negative impact on cost and patient outcomes may decrease through improved primary nursing care. The study emphasized on hand hygiene being a practical approach for preventing hospital-acquired pneumonia. The researchers concluded that access to bedside antiseptic hand-washing to maximize hand hygiene helps reduce the incidence for hospital-acquired pneumonia. Additionally, facemasks can be essential in minimizing the transmission of pathogens, like influenza.

In another study conducted by Kleinpell et al., (2008), hand hygiene is an effective strategy for hospital-acquired pneumonia prevention. The literature showed that the use of alcohol-based sanitizers helps minimize the transmission of probable pathogens from the health care provider's hands to patients. According to the study, nurses should adopt gloves when taking care of respiratory secretions or other items that handle respiratory secretions. One should also consider putting on a gown if one anticipates that they will be soiling from the secretion. Decontaminating the hands and changing gloves are needed when handling different patients.

Head of Bed Elevation

Similarly, the head of the bed elevation is another approach that can be used to reduce hospital-acquired pneumonia incidences. Several kinds of research have proved that raising the bead of the bed is a simple approach that can aid in minimizing the aspiration risks—elevating the head of the bed to 45 degrees as a deterrent to micro-aspiration in patients (Najafi et al.,2019). Nursing staff needs to conduct aspiration risk assessments continuously, especially in vulnerable patients like the elderly. If the evaluation shows that the patient has a risk of aspiration, raising the head of the bed to at least 45 degree should be added to the patient's care plan (Najafi et sl., 2019).

Passoro and his associates (2016), conducted a literature review using the Medline for guidelines of the current standards for preventing HAP. The researchers assessed a study that involved 45 patients, where the effect of bed elevation was evaluated when resting when taking meals and taking medications. The study included patients in an acute care setting. The researchers found that aspiration can be prevented by raising the head of the bed to a higher position when eating and taking medicine. Also, when taking care of patients with a nasogastric tube, it was vital to maintain the head of the bed at 30 degrees or high to prevent aspiration, which would eventually result in HAP.

Prevention of aspiration and dysphagia

The retrospective chart review by Baker and Quinn (2018) explored how preventing aspiration and dysphagia can reduce hospital-acquired pneumonia incidences. The study was conducted in 24 United States'Hospitals. The study found that dysphagia is an essential risk factor for aspiration pneumonia, mostly in the elderly patient. Approximately 43 to 54 percent of the patients with dysphagia aspirate and 37 percent may develop pneumonia. Additionally,

Passaro, Harbath, & Landelle (2016), studied a dysphagia program analysis and pneumonia prevention amid post-stroke patients, mostly focusing on dysphagia diagnosis methodology, analyzed some of the diagnostic methods They included evaluation of bedside programs, video fluoroscopic swallowing study, swallowing difficulty reports among patients, and fiber optic endoscopic swallowing examination. The study identified that diagnosis and dysphagia treatment, systematic program implementation among patients with acute stroke appeared to lower rates of pneumonia significantly. The study also determined that general programs for swallowing were associated with reducing the risk of acquiring pneumonia among patients with acute stroke while in the acute setting of the hospital. Nurses should provide a detailed evaluation involving measuring residual feeding and talking to the physical on the pro-kinetic agent, which can minimize aspiration in patients. (Passaro, Harbath & Landelle, 2016).

Coughing, Deep breathing and Incentive Spirometry

According to the literature review carried out by Meehan and McKenna (2020), coughing, deep breathing, and incentive spirometry are significant components of preventing hospital-acquired pneumonia among patients in an acute care setting. Baker and Quinn's (2018) retrospective chart review, which was carried out in hospital in the United States, found out that coughing and deep breathtaking enhance the expectoration od the secretions and enhance chest wall expansion to aid in minimizing HAP. Besides, their results showed that managed inspiration using incentive spirometry could improve oxygenation and reduce pulmonary complications. Nevertheless, they also found there are insufficient guidelines for the routine use of incentive spirometry in preventing hospital-acquired pneumonia. The incentive spirometer was used to remind the patients of the effectiveness of coughing and deep breathing to prevent pulmonary infections. However, the nurses informed the researchers that guidelines for utilizing the incentive spirometers differ among nurses and respiratory therapists, thus resulting in patient confusion (Meehan and McKenna, 2020).

Summary

The sources used in the discussion supports and the study research and addresses the discussion question. It provides insights on some of the effective ways that hospitals and health caregivers can incorporate to prevent HAP in an acute-care setting. There are various recommendations stipulated by numerous professional individuals and societies which may have different guidelines on the pneumonia prevention in the acute-care environment but agree on the above discussed preventive measures: Hands-on interventions for nursing, prevention of dysphagia and aspiration, bed position, increased mobility and teaching patients. Some of the theoretically measures included oral care, early mobilization, hand hygiene, bed elevation, and aspiration prevention.

Therefore, it is safe to conclude that HAP is understudied and underreported hospitalization complications with significant mortality and the patients' morbidity. It increases healthcare costs, time spent in hospitals, and long-term healthcare facilities discharges. Several critical interventions for nursing have been correlated with a decline in the possibility of contracting HAP. However, there are no consistent protocols available for sufficient documentation and monitoring. The fundamental skills including the best infection prevention practices, head of the hospital bed elevation, early mobility, deep breath and coughing, and oral care. All may improve health outcomes, particularly among patients with a higher risk of contracting pneumonia. Therefore, hospitals responsibility in the acute-care setting to improve healthcare provision and provision of protocols for the healthcare givers in preventing the pneumonia infection in the acute-care environment.

Gaps in Literature

HAP has remained a significant cause of patients' morbidity in acute hospitalization, especially among older patients. Data concerning HAP prevention in an acute-care setting is of poor quality and scarcely available. Therefore, evidence-based guidelines and some formal recommendations are unavailable, offering a gap to further studies. There is a need to identify the gaps between the clinical practices applied with evidence-based guidelines stipulated for nursing interventions, medical treatment, and diagnostic procedures for all patients, including those with special needs such as the older adults. The study further recommends some measures in the acute care setting to improve the effectiveness of pneumonia prevention measures. They include, use of antiseptics in providing daily oral care, respect, hand hygiene practices, implement treatment, and systematic diagnosis, program of post-stroke patients with dysphagia and support early patient mobilization by taking into account the possibility of risks a such as falls.

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