Koulenti, Zhang & Fragkou (2020) described nosocomial pneumonia, commonly known as hospital-acquired pneumonia (HAP), as an infection of the lungs people contract while residing in a healthcare institution. The condition tremendously impacts the American healthcare system, with thousands of patients impacted annually. The Centres for Disease Control and Prevention (CDC) estimate around 157,500 HAP cases annually in the US (Gaffney, 2019). Patients with an increased risk of getting HAP are those already hospitalized, primarily those with conditions that require mechanical breathing. Also, additional risk factors include old age, immunosuppression, chronic respiratory conditions, and invasive medical treatments like intubation or central line insertion.
According to Poovieng, Sakboonyarat & Nasomsong (2022), hospital-acquired pneumonia patients may suffer severe consequences. Firstly, HAP prolongs hospital stays dramatically, which raises healthcare expenses and demands more resources. Patients with HAP may need more extensive diagnostic procedures, specialist therapies, and prolonged antibiotic regimens. The lengthy hospitalization affects the patient’s psychological and emotional wellness and physical well-being, which may result in anxiety, sadness, or post-traumatic stress disorder. HAP may also lead to consequences that add to the stress on individuals and the healthcare system. Respiratory failure, infection, lung infections, and effusions of the pleural cavity are some of these problems. Patients with HAP frequently require hospitalization in the intensive care unit (ICU), mechanical breathing, and surgical operations, which strains the financial capacity of healthcare facilities and increases the burden for healthcare professionals.
In addition to the individual clients, the entire US healthcare system is affected financially by pneumonia acquired in a healthcare facility. HAP is linked to significant healthcare expenses because of extended hospital stays, greater drug needs, and the demand for specialist therapies. According to research presented by Munro et al. (2021) in Infection Control & Hospital Epidemiology, the added economic cost of HAP is projected to be about $40,000 per case, amounting to billions of dollars every year in the United States. Because of these expenditures, healthcare facilities, insurers, and patients are under significant financial strain.
The overall healthcare system is heavily burdened by pneumonia acquired in hospitals. It makes it more difficult for healthcare professionals to oversee and manage patients necessitating hiring more employees and resources. As a result of the increase in HAP cases, healthcare facilities are under stress to put in place proactive measures like infection control strategies, surveillance initiatives, and staff training to lessen the likelihood of HAP incidence and spread in healthcare settings. Antimicrobial resistance is another issue brought up by the rise in HAP frequency. The misuse and abuse of antibiotics in the treatment of HAP can result in the emergence of bacterial strains that are resistant to them, resulting in more difficulty in properly treating infections. The problem restricts the options for therapy for various infectious illnesses, which worsens the control of HAPs and has larger consequences for care delivery.
Nursing theory
The Neuman Systems Model is a theory in nursing that closely connects to addressing the problem of hospital-acquired pneumonia (HAP). According to this nursing theory, the patient is an intricate system continuously interacting with its surroundings. A patient’s immune system is disrupted by HAP, which is a stressor (Lawson, 2021). Therefore, the nurse must assist the patient in coping with the stressor and preserving homeostasis. The Neuman Systems Model proposes a model principle for comprehending the elements, including a patient’s underlying health state, the medical facility, and the employed healthcare methods, that support the onset of HAP. The framework offers a platform for creating HAP control and preventative strategies. For instance, nurses utilize the Neuman Systems Model to identify admitted individuals more susceptible to HAP. Thus, they put treatments into place to lessen the patient’s exposure to health threats, like handwashing, using sterile equipment, and maintaining a sanitary atmosphere. Also, nurses can collaborate with other healthcare providers to create guidelines and processes that will aid in the prevention and management of HAP,
The Neuman Systems Model is a thorough and all-encompassing model used to comprehend and resolve the challenging problem of HAP. It is a useful tool for healthcare professionals to prevent and control this severe infection (Etchin et al., 2020). The examples of how the Neuman Systems Model addresses HAP include 1) Nurses can utilize the Neuman Systems Model to determine patients extremely susceptible to HAP. This may be achieved by evaluating the patient’s health status, the healthcare facility setting, and the healthcare delivery processes. For example, immunosuppressed patients, those with chronic lung illness, or receiving ventilatory support are more likely to develop HAP; 2) Nurses can put measures in place to lessen exposure to stresses that contribute to HAP development and 3) By offering emotional assistance, imparting coping mechanisms, and encouraging caring for oneself, nurses may assist patients in adjusting to the pressures of HAP. Nurses engaging their health facilities to minimize and manage HAP can benefit greatly from using the Neuman Systems Model. The theory is a thorough and all-encompassing idea that may be utilized to comprehend and deal with the difficult problem of this severe illness.
Benchmark
Jones et al. (2023) reported that HAP is the most prevalent source of hospital-acquired infections in the US, with 5 to 10 per 1000 hospital admissions. Intubated patients and those receiving mechanical ventilation account for more than 90% of HAP Episodes in intensive care units. In addition, Giuliano et al. (2021) reported that HAP is the second-most typical illness in hospitalized patients and is a result of one-fourth of all outbreaks in intensive care settings. The overall mortality rates for hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) are comparable. However, numerous hospitals have VAP monitoring and preventive programs, not HAP.
The National Healthcare Safety Network (CDC-NHSN)5 of the US Centers for Disease Control and Prevention (CDC) has produced a set of surveillance criteria that are challenging to implement in an organized and straightforward way since they contain several arbitrary and confusing criteria. A few of the issues include variations in oxygen supply, the kind and volume of fluid from the lungs, and reading chest radiographs. The criteria frequently fail to align with histology pneumonia and are susceptible to human error and interobserver heterogeneity. In addition, discharge diagnostic codes’ weak specificity, sensitiveness, and variations in how they are utilized among and within hospitals make them similarly unreliable for surveillance (Ji et al., 2019). These obstacles prohibit hospitals from creating HAP monitoring and preventive initiatives, make it challenging to evaluate HAP prevention efforts, and make it challenging to calculate the total burden of HAP in the country.
AHRQ’s Healthcare-Associated Infections Program
The HAI initiative at AHRQ sponsors works to assist frontline physicians and other healthcare professionals in preventing HAIs, including HAP, through transforming care given to patients. The effort by AHRQ is carried out through a comprehensive inventory of funds and agreements focusing on applied research, which includes research that improves physicians’ abilities to address HAIs in the clinical setting. The applied research it funds helps doctors and staff comprehend more effectively how to use proven techniques to render treatment safer, bringing information to the point lines of care faster. AHRQ finances research and implementation initiatives with the main objectives of; improving HAI prevention science, creating more effective methods for minimizing HAI, and assisting physicians in using tried-and-true techniques to avoid HAIs. AHRQ’s HAI program adheres to the guidelines developed by the US Department of Health and Human Services (HHS), “National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination” and the “Combating Antibiotic-Resistant Bacteria Action Plan.” (Caballero et al., 2022)
One of the most effective tool kits used under this program is the Comprehensive Unit-based Safety Program (CUSP) Tool Kit. The CUSP integrates approaches for improving the safety culture, cooperation, and communication with an inventory of tried-and-true procedures. The Core CUSP Toolkit was created according to the observations of over 1,000 intensive care units, which decreased central line-associated bloodstream illnesses by 41 percent. Evidence of the CUSP in the prevention of HAP is documented by Davila (2020).
Hospital-Acquired Condition Reduction Program
The HAC Reduction Program promotes healthcare facilities to enhance the safety of patients and minimize the prevalence of conditions associated with hospitalization, like HAP and pressure sores following surgery. The program does this by promoting hospitals to enhance patient safety and apply standards of excellence to prevent healthcare-associated infections. The initiative is well-defined in Section 1886(p) of the Social Security Act of the United States. It extends to all subsection (d) hospitals, including general acute care healthcare facilities.
The benchmark shows that hospital-acquired pneumonia is thought to impact one out of every 100 people admitted to hospitals. HAP is a severe safety for patients and a standard of care issue. However, HAP is yet to be acknowledged as one of the variables for which healthcare facilities remain culpable by the National Database of Nursing Quality. The Centers for Medicare & Medicaid Services (CMS) also ignores the infection, which mandates that healthcare facilities disclose to the Centers for Disease Control & Prevention (CDC) National Healthcare Safety Network. HAP is not included in the CMS’s up-to-date pay-for-reporting initiative. As a result, HAP becomes an illness acquired through healthcare that is neither tracked nationally nor held accountable and is not addressed by healthcare institutions or governing bodies (Sheetz et al., 2019).
Impact on Patients
Patients suffering from hospital-acquired pneumonia must deal with serious consequences. Hospital-Acquired pneumonia patients are significantly affected in several ways. HAP puts a heavy load on patients and harms their general well-being since it can lead to serious problems, extended hospital stays, and mental discomfort.
Hospital stays being prolonged is among the primary outcome of HAP. Patients with HAP frequently need specialist care, advanced diagnostic procedures, and prolonged antibiotic medication. The additional healthcare procedures extend the length of hospital stays, raising expenditures and using resources for healthcare. Also, long-term hospital stays are mentally and physically taxing on patients as they might feel uncomfortable and lonely or have their daily routines disturbed. In addition to their physical and financial well-being, HAP may harm patients’ psychological and emotional health (Lacerna et al., 2020). Getting a lung infection while hospitalized is upsetting and frightening for any patient. Patients might feel anxious, hesitant, and helpless whenever they choose to manage their health. Loneliness and mental anguish might worsen if one cannot partake in common activities like conversing with their carers. The extended implications of these emotional impacts may necessitate further financial assistance.
HAP complications may severely impact the health of patients. Lung failure, infection, and other potentially fatal complications might develop because of HAP. Patients with HAP must be transferred to ICUs (intensive care units) and receive ventilatory therapy or other invasive operations to sustain their respiratory function; such measures prolong the patient’s recuperation time and raise the chance of secondary issues, increasing the patient’s discomfort.
HAP has a wider financial impact beyond its patients. Higher healthcare costs are because of longer hospital stays, more therapies, and greater medication needs caused by HAP. Insurance firms and medical professionals are affected by bearing the cost burden, in addition to those receiving treatment. The cumulative impact of HAP-related expenditures burdens hospital finances, thus, difficulty in providing other patients with the best treatment possible (Carey et al., 2022). Lastly, the global fear regarding antibiotic resistance is exacerbated by HAP. Drug-resistant bacterial strains emerge because of the improper or incorrect consumption of antibiotics in HAP treatment, which restricts the possibilities for treating various infectious disorders in addition to making HAP management more difficult. Patients with HAP need more intensive antibiotic medication, which raises the possibility of adverse reactions and intensifies antibiotic resistance (Munro et al., 2021).
Implementing effective preventative measures, quick diagnoses, suitable treatments, and compassionate care is crucial to lessen the effects of HAP on patients to assist their rehabilitation and well-being. A multidisciplinary group of experts in infectious disorders, lung disorders, emergency care, anesthesia professionals, and any medical professionals and healthcare professionals, including nurses and pharmacy technicians, are needed to manage hospital-acquired pneumonia (HAP) (Carey et al., 2022). The mortality and morbidity rates from HAP are significant without adequate care.
Methodology
Wolfensberger et al. (2020) recommend that The bundle strategy is a particularly successful clinical practice for reducing hospital-acquired pneumonia (HAP). This strategy entails putting into practice several measures that have been proven successful in avoiding HAP. The nvHAP bundle comprises five main preventive strategies: oral hygiene, dysphagia aspiration control and management, movement, discontinuing needless proton pump medications, and respiratory treatment. However, the following actions are most frequently recommended when applying the bundle approach to achieve effective results including.
The most crucial strategy for avoiding HAP is hand washing. The surfaces of the hands of nurses should be properly cleaned regularly, particularly before and following interaction with patients. Secondly, any equipment used on an individual’s ventilatory system must be sterile, including ventilator tubs, suction catheters, and endotracheal tubes. The area surrounding the patient must be maintained sanitary and germ-free. Tasks like sanitizing the patient’s room and correctly discarding rubbish must be done routinely. Lastly, the appropriate use of antibiotics. Antibiotics are a pharmaceutical therapy in managing HAP but can also encourage the growth of resistant bacteria. Thus, antibiotics must only be used when required. The IDSA advises treating individuals with HAP following the microbiological findings from regular blood cultures and non-invasively acquired samples from the respiratory tract (Muno et al., 2021). It is crucial to determine the prescription antibiotics and reduce them as necessary accurately. Noteworthy non-invasive respiratory collection methods include sputum induction and organic expectoration.
Unresponsive patients to prior antibiotic treatment may be evaluated for bronchoalveolar drainage if no secretions from the respiratory tract are collected, and blood test results are inconclusive. Inpatient treatment in a unit with less than 20 percent MRSA, no known MRSA incidence, or a significant mortality threat is advised to have empiric coverage of MRSA in patients treated directly for HAP and possess an elevated risk of contracting methicillin-resistant Staphylococcus aureus (MRSA), including prior IV antibiotic administration within 90 days. MRSA must be covered empirically if the individual with HAP has no MRSA risk indicators. Given the extremely low quality of the documentation, dual therapy for Pseudomonas aeruginosa and other powerful gram-negative bacilli is only advised for individuals with an elevated risk of death who have already received IV antibiotics within 90 days (Suaya et al., 2021). Although it is highly advised against employing an aminoglycoside as the primary antipseudomonal treatment, one drug is frequently sufficient.
Conclusion
HAP is a serious issue for the US healthcare system. Its’ widespread prevalence, the link to serious problems, increased financial burden, and influence on healthcare personnel’s workload underlines the necessity for preventative measures to prevent and manage HAP successfully. It is essential to identify and solve the issues posed by HAP to improve patient outcomes, lessen the financial burden on people and healthcare organizations, and improve the overall standard of care given to patients. The prevalence of HAP and its effects can be decreased by improving procedures for controlling infections, strengthening antibiotic prescription tactics, and implementing comprehensive monitoring programs. The healthcare system may enhance patient outcomes, lessen financial burdens, and guarantee the delivery of safe and efficient treatment for all people by addressing this crucial issue.
The call to action for HAP is to involve stakeholders, including student nurses and national groups, such as The Joint Commission. A healthcare dialogue regarding HAP prevention must be started. Nursing students and researchers are urged to develop fresh ideas for HAP monitoring and control. The current issue of patient safety and quality of life must focus on the need for healthcare systems to promote and execute HAP mitigation and integrate NVHAP preventive strategies into the patient, healthcare worker, and student education.
References
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