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It's Pneumonia & Flu Season... Are you HAP & VAP Battle Ready?

Nurses Article   (590 Views 1 Comments 864 Words)
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Advanced suctioning techniques to help prevent HAP & VAP. This article also details the huge financial impact of HAP & VAP on hospitals!

It's Pneumonia & Flu Season... Are you HAP & VAP Battle Ready?

Hospital Acquired Pneumonia (HAP) is a severe and sometimes fatal infection. HAP is dangerous because patients already hospitalized have weakened immune systems. Research shows that the suctioning of oral & subglottic secretions in intubated and non-intubated patients decreases the risks of HAP and Ventilator Associated Pneumonia (VAP). This is why there is so much focus on not only oral suctioning, but also pharyngeal/subglottic suctioning.

Oral Cleaning and Oral Suctioning should be easy but when the patient bites down it can be very difficult and unsafe for the patient and the caregiver. The process of suctioning these pneumonia causing secretions is commonly stopped when patients bite down. We have all heard countless stories of patients biting so hard that they broke green suction swabs in half. In these situations, some clinicians are very hesitant to attempt oral care again, which is NOT A GOOD IDEA!

Pharyngeal Suctioning is also very important in both non-intubated and intubated patients. Yankauers work great for oral suctioning, but clinicians are missing an additional 3 inches of pharyngeal space. This area is usually where the pooling secretions hide out, drip down and further cause aspiration pneumonia. An easy way to reach those secretions, is with a suction catheter introducer for the oral airway. Insert a suction catheter into an introducer and extend your suction an extra 3 inches down into the pharyngeal / subglottic area.

How can you help battle HAP & VAP?

A suction catheter introducer can decrease the risks of HAP and VAP by making it safer and easier for caregivers to perform oral & pharyngeal suctioning. Introducer devices are made of bite-proof plastic. Therefore it is no problem if your patient bites down on the device, clinicians can easily continue with oral & pharyngeal suctioning. Effective secretion clearance gives weakened patients the upper hand in trying to fight off aspiration pneumonias.

Patient Population

Think of that little old lady who cannot quite cough out those gurgling secretions caught in the back of her throat... Or that extubated patient that you want to keep extubated, but isn't quite strong enough yet to give a big cough.

  • Pneumonia patients
  • Elderly, generalized weakness
  • History of aspiration pneumonia 
  • Dysphagia patients
  • ALS
  • CF
  • CVA
  • Spinal Cord Injury
  • MND-Motor Neuron Disease

The Financial Impact of HAP & VAP

In 2008, Centers for Medicaid Services’(CMS) no longer reimburse hospitals at the higher rate for complications unless these conditions were present on admission(POA) [1]. In addition, the hospitals cannot bill patients for hospital-acquired complications (nosocomial infections) [1]. In March 2009, the CDC estimated the overall annual direct medical cost of Hospital Acquired Infections to U.S. hospitals ranges from $35.7 billion to $45 billion [2]. Nosocomial Pneumonia is the second most common hospital acquired infection and leads to an increased risk of mortality [3,4]. VAP is the most common ICU-acquired infection among patients requiring mechanical ventilation and the incidence is estimated at 15% with a mortality of 50% [5,6]. Research has shown that Nosocomial Pneumonia can be reduced with suctioning of subglottic secretions and improved oral hygiene in both ventilated and non-ventilated patients [7,8]. Unfortunately patients can resist oral care or tracheal suction catheters can coil in the patient’s mouth, making oral hygiene and tracheal suctioning difficult, therefore increasing the risk that these patients develop Nosocomial Pneumonia and/or VAP. 

Financial Impact Averages

  • Hospital Acquired Pneumonia (HAP) costs a hospital an average of $17,677 per infected patient [3,4.]
  • Ventilator Associated Pneumonia (VAP) costs the hospital an average of $48,948 per infected patient [5,6].

With hospitals now bearing these costs, they are aggressively seeking suctioning solutions to help battle these Hospital Acquired Infections.

Learn about suction catheter introducers and implement them on your at-risk patients.


References

Steefel L, RN, MSN, CTN, "CMS changes alert nurses to caring's business side" Nursing Spectrum. 5 Nov.2007:1-2

Scott II RD, Economist, Division of Healthcare Quality Promotion National Center for Preparedness, Detection, and Control of Infectious Diseases, Coordinating Center for Infectious Diseases Centers for Disease Control and Prevention; Mar.2009:7

Patra PK, Jayashree M, Singhi S, Ray P, Saxena AK, "Nosocomial Pneumonia in PICU" Indian Pediatr. 2007: Jul:44(7):511-8.

Gomez J, Esquinas A, Agudo MD, Sanchez Nieto JM, Nunez ML, Banos V, Canteras M, Valdes M, "Retrospective analysis of risk factors and prognosis in non-ventilated patients with nosocomial pneumonia" Eur J Clin Microbiol Infect Dis. 1995: Mar;14(3):176-81.

Hyllienmark P, Gardlund B, Persson JO, Ekdahl K, "Nosocomial pneumonia in the ICU: a prospective cohort study" Scand J Infect Dis. 2007;39(8):676-82.

Efferen Linda S.,MD, "Impact of Nosocomial Infections in the ICU" Medscape coverage of: 96th International Conference of the American Thoracic Society 2000:1-6.

O'Neal PV, Munro CL, Grap MJ, Raush SM, "Subglottic secretion viscosity and evacuation efficiency", Biol Res Nurs. 2007: Jan;8(3):202-9.

Paju S, Scannapieco FA, "Oral biofilms, periodontis, and pulmonary infections" Oral Dis. 2007: Nov;13(6):508-12.

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ICU RN for 18 years and Suctioning Guru

5 Likes, 1 Follower, 3 Articles, 1,834 Visitors, and 10 Posts.

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