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Prevention of Aspiration and the Development of Pneumonia
By Diane Baranowsky, RN, BSN, MS, CIC
Pneumonia is a serious infection occurring in hospitalized patients and isusually the second most common nosocomial infection after urinary tractinfections. Mortality from pneumonia is also very high; it is the fifth leadingcause of death in elderly patients.
Many cases of nosocomial pneumonia are aspiration related.
Aspiration pneumonia is a type of pneumonia that can occur when a personinhales a foreign item such as saliva and oral secretions, refluxed gastriccontents, food and/or liquid. It can happen during or after swallowing. Commonrisk factors for patients with potential for aspiration are altered mentalstatus, post anesthetic recovery, weakness or frailty, sedation, tracheostomyand recumbent position.
Dysphagia, which is difficulty with chewing and swallowing, can also causethe devastating consequences of choking and aspiration. Frequently, dysphagia isa clinical manifestation resulting from neurologic disorders such ascerebrovascular accident, traumatic brain injury, Parkinson's disease,Alzheimer's disease and Guillain-BarrÃ© syndrome.
Nursing staff members play an integral role in the prevention of aspirationand the development of pneumonia. They must be knowledgeable not only aboutpatient populations at risk but also aware of early signs and symptomsindicating dysphagia. Patients should be observed for and or questioned aboutthe following factors, for example:
Relevant history taking and physical assessment skills should include thefollowing:
An individualized patient care plan should then be developed which addresses:
Lastly, the patient's care should also include patient/family education inapproaches to prevent aspiration such as:
In order to have better clinical outcomes, being aware of who is at risk ofaspiration and the potential development of pneumonia, implementing timely andindividualized interventions is crucial.
Diane Baranowsky, RN, BSN, MS, CIC, is nurse epidemiologist at TheStamford Hospital in Stamford, Conn.