Presentation Number 08 - Electronic Hand Hygiene Monitoring with a Complementary Improvement Program Significantly Increases Hand Hygiene Rates

Abstract

BACKGROUND: Non-ventilator (i.e., non-device related) hospital acquired pneumonia (NV-HAP) is an understudied disease, with substantial fiscal impacts and potential for reduction of morbidity andmortality. Because it is not required by regulatory agencies, most hospitals do notmonitor NV-HAP. In 2014, the US Centers for Disease Control and Prevention’s reported that NV-HAP now represents 60% of the HAP with mortality similar to VAP. Due to the association between the oral microbiome and pneumonia, we sought to utilize transdisciplinary partnerships to determine the incidence and implement a standardized oral care protocol to reduce NV-HAP. METHODS:We used a descriptive, retrospective comparative study to determine changes in oral care delivery and incidence of NV-HAP. We implemented a universal (all adult units and all perioperative patients) standardized oral care protocol from May 1, 2012 to December 31, 2014 at a 550 bed urban hospital. We computed percent of oral care delivered, NV-HAP cases/total discharges, and odds ratio of NV-HAP during the intervention period compared to the reference period. RESULTS: Implementation of a universal oral care protocol resulted in a 70% decrease in NV-HAP in the year 2014, with a 75% decrease in post-operative patients (P < .0001:OR = 0.51; 95% CI = 0.38, 0.70). Since 2012, we avoided 170 cases of NV-HAP and prevented 32 patient deaths. In addition, we saved $6.8M in costs, minus $320K for therapeutic equipment and supplies, which resulted in a return on investment of $6.48M. CONCLUSIONS: Comprehensive oral care is correlated with prevention of NV-HAP in the acute care setting. NV-HAP should be elevated to the same level of concern, attention, and effort as prevention of VAP. Infection Preventionists using a team-based, transdisciplinary approach, can take the lead in their hospital system to monitor and implement effective programs to protect their patients from NV-HAP, saving lives and dollars.