Background: Aspiration pneumonia is one of the leading causes of post stroke morbidity. It increases length of stay, rehabilitation period, readmission rates and mortality. Retrospective chart review at Kaiser Permanente, Woodland Hills indicated that hospital-acquired infections were the leading cause of harm in patient deaths. Of these deaths, hospital-acquired pneumonia (HAP) was the leading contributor. HAPs account for 5% of our hospital’s total pneumonia admissions.
Objective: We aimed to implement a simple, multidisciplinary Hospital-Acquired Pneumonia Prevention (HAPP) program in one of our stroke units, which had the highest incidence of HAPs, thus improving our stroke recovery and outcome.
Method: We analyzed data in a 15-month period, from January 2015 - April 2016, and determined our baseline data for HAP incidence. Data were separated based on nursing units. The stroke units had the highest incidences of HAPs, accounting for 50% of cases (53 out of 102 cases) in the hospital. We selected the stroke unit with the highest incidence to implement the HAPP program. Patients who were at risk for HAPs were identified using the following: Age ≥ 65, history of or actual aspiration, malnutrition, parenteral tube presence, chronic obstructive pulmonary disease, smoking, ventilator use and post-surgery. Once the patient had been identified as at risk for HAP, the HAPP bundle was implemented. The HAPP bundle included head of bed > 30° at all times, up and out of bed for all meals, oral care using chlorhexidine rinse, ambulate at least twice per day, bedside incentive spirometry use and patient/family education.
Results: After 3 months of HAPP program implementation there was a significant reduction of HAPs when compared to the same time period the previous year. In 4thQtr 2015, we had 8 HAPs, in 4thQtr 2016 after HAPP program implementation, we had 0 HAP on our targeted stroke unit.
Conclusion: Based on our 3 month data, the HAPP program is effective in preventing HAPs. However, we would need to further look at data over a longer period to determine the success of the bundle in preventing HAPs. We also would be spreading this practice throughout all the nursing units within our hospital and eventually to the rest of our hospital system within the Southern California Region.