The results of new research results published in the April issue of the Journal of the American College of Surgeons show that a pilot pneumonia-prevention program significantly reduced postoperative pneumonia in a hospital surgical ward.
Postoperative pneumonia is a common complication among surgical patients and is the third most common infectious complication after urinary tract and wound infections. According to the Institute for Healthcare Improvement, a facility that performed 10,000 noncardiac operations per year would be expected to have approximately 150 cases of postoperative pneumonia. In the intensive care unit (ICU), this complication can translate into additional healthcare costs of approximately $40,000 per patient, and an estimated mortality rate of 20 percent to 70 percent. National efforts have been focused on reduction of intensive care-acquired pneumonias, but there has been no program addressing hospital patients outside of the ICU.
"Postoperative pneumonia is a problem facilities face continually, but our research shows that simple steps in prevention can have such a substantial effect," according to Sherry Wren, MD, FACS, chief of general surgery, Veterans Affairs (VA) Palo Alto Health Care System and professor of surgery, Stanford University School of Medicine. "This program, if expanded to other VA or private hospitals, could help improve patient care and lower morbidity, mortality and overall healthcare costs."
The ward pneumonia-prevention quality improvement task force was formed in December 2006 and met during a three-month period to review evidence-based strategies. The group agreed on the following eight intervention strategies which were implemented in April 2007: (1) educating nursing staff about pneumonia prevention; (2) cough and deep-breathing exercises with incentive spirometer, a device that helps patients gauge lung function; (3) twice daily oral hygiene with chlorhexidine swabs; (4) ambulation with good pain control; (5) head of bed elevation to at least 30 degrees and sitting up for all meals; (6) quarterly discussion of the progress of the program and results for nursing staff; (7) pneumonia bundle documentation in the nursing documentation; and (8) computerized pneumonia-prevention order set in the physician order entry system.
