Abstract
Background
Non-Ventilator Hospital-acquired Pneumonia (HAP) is a prevalent healthcare-associated infection with mortality of 21%. HAP prevention literature is scant. We developed a definition enabling accurate surveillance to support this effort and implemented a prevention bundle based on available literature and characteristics of our high-performing centers.
Methods
Kaiser Permanente Northern California is an integrated healthcare system providing care for 4.4 million patients at 21 medical centers. Discharge diagnoses of HAP cases were reviewed for accuracy and factors permitting programmatic confirmation. A natural language extraction program identified new and persisting imaging findings, providing specificity. No other surveillance factors added specificity. Surgery, altered mental status, sedation, albumin <3 g/dl and tube feedings were identified as predictive risks. Seven interventions became part of a new pneumonia prevention order set for automatically identified high-risk patients: aggressive mobilization, upright posture for meals, swallowing evaluation before feeding, sedation restriction, elevated head of bed, oral care and feeding tube care. The project was fully implemented in 2015.
Results
Results were reported by 1,000 admissions and by 100,000 members served, to address a rapidly growing population. HAP decreased from 5.92 to 1.79/1000 admissions and 24.57 to 6.49/100,000 members and HAP case mortality remained stable (18–19%) while overall HAP mortality decreased from 1.05 to 0.34/1000 admissions (4.37 to 1.24 /100,000 members) (Figure 1 and 2). Carbapenem, quinolone, aminoglycoside and vancomycin use all decreased significantly (Figure 3). Benzodiazepine use decreased from 10.4% of all inpatient-days in 2014 to 8.8% of inpatient-days in 2016.
Conclusion
HAP rates, mortality and broad-spectrum antibiotic use were all reduced significantly, despite the absence of clinical practice guidelines or strong supportive literature for guidance. Some interventions had limited support, but most augmented basic nursing care. None had risks of adverse consequences. This supports the need to examine practices to improve care despite absent literature and even more so supports a need to study these difficult nebulous areas of care.
Disclosures
All authors: No reported disclosures.
Session: 143. HAI: Respiratory Infections (incl VAP, HAP)
Friday, October 4, 2019: 12:15 PM