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This article is sponsored by Stryker Oral Care.
Hospital-acquired pneumonia remains one of the most common—and deadly—infections patients face during hospitalization. Yet, while significant progress has been made in reducing ventilator-associated pneumonia, its lesser-known counterpart, non-ventilator hospital-acquired pneumonia (NVHAP), continues to quietly harm patients, often escaping attention altogether.
Unlike ventilator-associated pneumonia, which occurs in intubated patients, NVHAP develops in non-ventilated, hospitalized patients. Studies suggest it accounts for 65 percent of all hospital-acquired pneumonia cases, yet many hospitals do not track it, and it remains unrecognized by most health care leadership as a preventable harm.
The absence of mandatory reporting has allowed NVHAP to remain hidden. Health care systems primarily focus on outcomes tied to required safety and quality metrics, such as central-line infections or catheter-associated urinary tract infections (CAUTIs). Unfortunately, NVHAP does not yet carry the same weight despite its substantial impact on patient outcomes, hospital length of stay, and overall costs.
To understand the scope of NVHAP, one must first examine its root causes. Pneumonia, whether ventilator-associated or not, often begins in the mouth. Hospitalized patients can develop an unhealthy oral microbiome within just 48 hours, allowing pathogens to thrive. These pathogens are then aspirated into the lungs—sometimes in microscopic amounts—and the body’s weakened immune defenses struggle to fight off infection.
While some populations face greater vulnerability, such as elderly patients, those with cancer, or individuals with comorbidities like heart failure and COPD, the reality is that all hospitalized patients are at risk. The very act of lying in a hospital bed increases susceptibility through immobility, reduced oral care, and compromised defenses.
The effects of NVHAP are staggering. Patients who develop NVHAP can see their hospital stay increase by up to 15 days, putting them at higher risk for other complications, including pressure injuries, falls, and antibiotic-resistant infections. Moreover, NVHAP is one of the leading causes of hospital-acquired sepsis, which carries an alarmingly high mortality rate. Even for those who survive, recovery is often grueling. A significant portion of patients require transfer to higher levels of care upon discharge, leaving families to cope with unexpected financial, physical, and emotional burdens.
Despite its profound impact, NVHAP prevention is surprisingly simple—and effective. Most prevention strategies require no physician orders and can be incorporated into nursing standards of care. Oral hygiene, for example, remains a cornerstone of NVHAP prevention. Good oral care helps to address the presence of harmful bacteria, helping to minimize the risk of that bacteria being aspirated into the lungs. Other straightforward measures include elevating the head of the bed, encouraging patient mobility, and performing bedside swallow screens for at-risk individuals.
However, challenges remain. Prevention programs rely heavily on frontline nursing staff and nursing assistants, who already shoulder enormous workloads. Without proper education, leadership support, and compliance monitoring, even simple preventive strategies can fall by the wayside. Oral care, for instance, is still viewed by many as a comfort measure rather than a critical intervention. Patients themselves often refuse it, unaware of the risks associated with poor oral hygiene during hospitalization.
To successfully address NVHAP, hospitals must embrace a cultural shift that prioritizes its prevention as much as other hospital-acquired conditions. This begins with leadership. Hospital executives must recognize NVHAP for what it is: a preventable harm occurring under their watch. NVHAP may not yet be a required reportable metric, but its connection to mortality, sepsis, and prolonged length of stay makes it impossible to ignore. For hospital systems focused on operational efficiency, the financial burden is also undeniable. NVHAP costs hospitals an estimated $28,000 to $40,000 per patient—expenses that could be avoided with preventive care.
Health care professionals, too, must play a central role in tackling NVHAP. Nurses, nursing assistants, and infection control teams are well-positioned to champion prevention protocols, provided they are given the tools and education to succeed. Compliance must be more than a checked box on a chart. Real-time monitoring, bedside checks, and patient engagement are key to ensuring preventive strategies are implemented consistently and effectively.
Patients and their families also deserve education. Many do not understand oral care’s role in addressing the risk factors of pneumonia. When patients refuse oral hygiene or resist getting out of bed, it often stems from a lack of awareness. By including them in the conversation and empowering them to participate in their care, hospitals can turn patients into active partners in prevention.
Data collection and tracking remain critical. Hospitals that have implemented NVHAP prevention programs often begin with retrospective chart reviews or ICD-10 code analysis to measure baseline rates. More recently, electronic methods for NVHAP surveillance have been developed, allowing hospitals to identify cases in real time. Combining outcome metrics—like incidence rates of NVHAP and associated sepsis—with process metrics, such as oral care frequency and patient mobility, allows hospitals to measure the success of their programs and make necessary improvements.
The good news is that NVHAP prevention efforts work. Hospitals that have implemented oral care protocols alongside other preventive measures have reported significant reductions in NVHAP cases. The results extend beyond patient safety: fewer infections mean shorter hospital stays, lower readmission rates, and cost savings that benefit both patients and health care systems.
Addressing NVHAP requires a unified effort. Health care leadership must take the lead by acknowledging NVHAP as a serious threat and providing the resources needed to combat it. Frontline staff must see NVHAP prevention not as an added task, but as a critical part of patient care. Patients and families must be engaged and educated to play their part.
NVHAP may not yet have the spotlight, but its prevention is both achievable and necessary. By elevating its importance, hospitals can reduce harm, improve outcomes, and ensure safer stays for every patient. The solutions are within reach—it’s time to act.
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Transcript
Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. Subscribe at KevinMD.com/podcast. Today we have a special sponsored episode from Stryker Oral Care. We welcome Dr. Barbara Quinn, a board-certified adult clinical nursing specialist and fellow of the National Association of Clinical Nurse Specialists since 2020. She has 30 years of nursing experience and specializes in evidence-based practice to improve patient outcomes. We also welcome Elias Coury, the market director of quality and risk at two medical centers in Arizona. Today we’ll be discussing “Patient safety in focus: Helping to address risk factors associated with non-ventilator hospital-acquired pneumonia.” Find out more at KevinMD.com/Stryker. That’s Stryker with a Y, KevinMD.com/S-T-R-Y-K-E-R. The link will be in the show notes. Barbara and Elias, welcome to the show.
Barbara Quinn: Thank you very much.
Kevin Pho: Now, hospital-acquired pneumonia is the most common hospital-acquired infection. However, most of the attention has been on ventilator-associated pneumonia, even though 65 percent of hospital-acquired pneumonia cases occur in non-ventilated patients. Barbara, can you explain what ventilator-associated pneumonia is, and when did you first learn about non-ventilator hospital-acquired pneumonia?
Barbara Quinn: Well, that’s a good question. Ventilator-associated pneumonia, most people are quite familiar with. That’s a diagnosed pneumonia that occurs 48 hours after mechanical ventilation in the hospital, usually. On the other hand, non-ventilator hospital-acquired pneumonia is a diagnosed hospital-onset pneumonia in non-intubated patients, which is really the majority of the patients we see in the hospital, right?
My first awareness of non-ventilator hospital-acquired pneumonia, or NVHAP, as we like to call it, as a patient safety issue was back in 2010, which is a long time ago now. I was rounding on patients in one of our ICUs, and one of the RNs in the ICU, who was also on the rapid response team, asked how many non-intubated patients we were getting that had pneumonia in the hospital. As a new team member in our quality department, I wasn’t sure, so I asked around and found out that because we weren’t measuring it, nobody really knew. It was really quite an unknown, and nobody really knew how to answer me. So I went to the literature, and there was nothing there either besides ventilator-associated pneumonia.
So that’s what launched me into this program of research, really looking at this hidden pneumonia that was occurring in our hospital. In the very first one-year retrospective review, we found 115 cases of NVHAP in our hospital, with very few VAPs. So that showed us that it was really occurring much more often, but it had just hidden under the radar because we weren’t required to look at it.
Kevin Pho: So, Barbara, what kinds of factors have contributed to this lack of awareness or emphasis on non-ventilator hospital-acquired pneumonia compared to ventilator-associated pneumonia?
Barbara Quinn: Well, I think, again, we focus in our hospital systems, for better or for worse, on quality and safety metrics that are required to be reported. Unfortunately, to this date, NVHAP is still not a required reportable metric.
Kevin Pho: Elias, tell us, what misconceptions about non-ventilator hospital-acquired pneumonia do you encounter among health care professionals or leadership?
Elias Coury: Good question. I really think the biggest misconception, particularly with NVHAP, is that it doesn’t carry as much weight or impact as some of the other hospital-acquired infections. Like Barb said, it’s not measured, right? That’s kind of apparent on all levels. For nursing, we’re so proactive on awareness of falls and the mitigation strategies, and sepsis, and our device utilization, and we proactively work on strategies to stop those from occurring. Quality and infection control focus on compliance with prevention, so they do audits on our fall strategies, we do C. diff testing protocols, and we have device days that we look at periodically, in morning briefs and afternoon briefs, to see when we can remove those. But we don’t typically do so much around pneumonia.
So we don’t always look at the oral care compliance or how often that’s happening. We might put the incentive spirometers in the rooms but don’t really look to see how often they’re being used, and you might overlook something like the head of the bed being at 30 degrees. So there’s just not enough focus, really, and I think that’s because NVHAP just isn’t as recognized. So when you start bringing up issues with it and are trying to develop strategies to reduce it, you face some resistance on the importance of what you’re doing and why that item might take priority over some of the other things that are already being measured and looked at by different agencies.
Kevin Pho: Barbara, are there specific patient populations who are more vulnerable to developing non-ventilator hospital-acquired pneumonia?
Barbara Quinn: There are definitely some patient populations who are at higher risk, but when I’m asked this question, I like to go back to why anybody is at risk for pneumonia. There are really three mechanisms, Kevin, and it just takes one risk in each of those categories for patients in the hospital to be susceptible to pneumonia.
The first one is oral pathogens. Most people don’t understand that the majority of hospital pathogens originate in the mouth, and it only takes one to two days in the hospital to disrupt our normal microbiome and make it susceptible to those pathogens in the mouth. Secondly, those pathogens are then aspirated, or micro-aspirated: Little bits of saliva slip into the lungs, and that happens with even healthy people. We normally micro-aspirate a little bit each day. So you put together those oral pathogens from the hospital that are aspirated, and our patients are at higher risk for aspiration. Then those patients also don’t have the same strong host defenses that normally would fight off an infection like that.
So there are some patients who fall into all three of those categories and are at higher risk than others, for example, cancer patients, elderly patients, and patients with common comorbidities like heart failure and COPD. But what we found in our research is that all people are at some risk, and that’s why we look at pneumonia prevention in the hospital as a standard of care for all patients, because all patients are at some risk.
Kevin Pho: Now, each of you has a different clinical perspective, so I’m going to ask the same question to both of you. Elias, can you walk us through what it looks like when a patient in the hospital develops non-ventilator hospital-acquired pneumonia, and how their stay is impacted by it?
Elias Coury: Yeah. In my role with quality and risk, we look at a lot of the risk associated with that from my perspective. So you have a patient that’s developing pneumonia, and their risk is right then increasing for other issues that could happen to them. You increase their length of stay, and some studies are suggesting that could be an increase of up to 15 days. A longer length of stay is also associated with higher risk for other hospital-acquired conditions and HACs. You’re putting them at a higher risk for pressure injuries because they’re in the bed longer, they’re sitting there longer, they’re in the hospital longer. There’s a higher potential for falls, and in that, they could get injured with a fall injury.
They’re going to be put on more antibiotics, and so then you look at C. diff coming into place, right? You’re having an increase in antibiotics, and you increase the antibiotic-resistant organisms that you’re putting them at risk for. Then there’s also a lot of association between sepsis and mortality. NVHAP is one of the most frequent causes of hospital-acquired sepsis, and so I think we need to look at that. It’s also associated with a higher mortality risk. So a patient that develops hospital-acquired pneumonia, or NVHAP, is really being placed in that high-risk, vulnerable situation.
Kevin Pho: All right, Barbara, same question. Walk us through what it looks like when a patient in a hospital develops NVHAP, non-ventilator hospital-acquired pneumonia, and how their stay is impacted by it.
Barbara Quinn: You know, all the things that Elias spoke of are 100 percent validated in the literature. There’s a study, specifically a large study of Medicare patients, where they found that when they acquired non-ventilator hospital-acquired pneumonia, 36 percent of them went on to develop sepsis. Like Elias said, those sepsis patients, especially with hospital-onset sepsis, have much worse outcomes, much higher mortality, and other complications. So all those things that he said are absolutely true.
I think one thing that hasn’t been mentioned yet is what happens to patients if they survive their hospitalization and are then discharged. Forty percent or more are discharged to a higher level of care than they came to us with. So that’s a cost and a price and an impact that we haven’t even started to look into, but that takes a real toll on our patients. Think of their families, changing all the ways that they deal with functional decline after a severe hospitalization. So all of those things take a big toll on our patients and their families.
Kevin Pho: You’re listening to a special sponsored episode of The Podcast by KevinMD, “Patient safety in focus: Helping to address risk factors associated with non-ventilator hospital-acquired pneumonia.” Find out more at KevinMD.com/Stryker. That’s Stryker with a Y, KevinMD.com/S-T-R-Y-K-E-R. The link will be in the show notes. Barbara, what are some ways hospitals can implement prevention strategies to address the risk factors of non-ventilator hospital-acquired pneumonia?
Barbara Quinn: Well, I think, like any prevention program, a hospital needs to apply implementation science and that change management strategy to achieve and sustain a change in practice. This includes education, which is very important; leadership support, visible leadership support; and then that ongoing feedback and engagement of the bedside staff.
The examples of strategies for this particular topic address all three of those mechanisms that we talked about that can lead to pneumonia. We want to reduce oral pathogens with oral hygiene and oral care. We want to reduce the aspiration risk by elevating the head of the bed or performing bedside swallow screens. And one way to strengthen the normal physiologic response is to do things like get the patients up and out of bed.
Kevin Pho: So again, I’m interested in hearing both of your clinical perspectives. Elias, let me ask this to you, and I’ll ask the same question to you, Barbara. Elias, in what ways do health care professionals like nurses, nursing assistants, and other clinical staff support the prevention of NVHAP outside of infection control programs?
Elias Coury: I think it starts with the frontline staff, right? In quality and infection control, we can put together all the processes and programs, but if you don’t have the nurses and the front line bought in and understanding the purpose, the problem, and what we’re trying to do with the solution, then you’re really not going to get anywhere. You can make plans all day, but it’s truly the people that are enacting those plans that are going to make it successful.
So I think that you create champions on your nursing floor. You create people that are really bought in. Once nurses and those clinical teams start understanding what’s going on, and you’ve done a good job of painting that picture for them and they’re bought into it, then that’s where you’re going to truly see better outcomes, an increased awareness of something like NVHAP, and actually a reduction in what you’re trying to achieve there.
Kevin Pho: And Barbara, same question. Tell us, from your perspective, how can health care professionals support the prevention of NVHAP outside of infection control programs?
Barbara Quinn: Well, really, most prevention strategies for pneumonia don’t require a provider order, so it really comes back, like Elias says, to the bedside staff and really that nursing standard of care. So nurses, based on evidence, can update their policies and their standards to align with pneumonia prevention activities.
I want to call out the nursing assistants, the CNAs, who provide a lot of the basic care. They take care of ambulation, oral hygiene, and those types of things. They have to be included in the education and included in the ongoing process improvement. Some of our CNAs were the strongest champions for oral care. They became a very passionate part of the health care team.
Kevin Pho: Barbara, you implemented some of these prevention strategies at your hospitals, and your research and reduction in non-ventilator hospital-acquired pneumonia was published in the Journal of Nursing Scholarship and the American Journal of Infection Control. Can you briefly walk us through the oral care protocol that you implemented and the impact it had?
Barbara Quinn: Yeah, I’d love to. We started because the majority of NVHAP that we found in our hospital occurred in adult patients, so we really started our focus there, with that population. We began on one unit, and then we quickly spread to all the adult units in the hospital. We developed a standard oral care protocol that was based on the literature and then was eventually approved by the board of the American Dental Association in 2017. We made sure we included all patients, from self-care to dependent, and ventilated patients, of course.
We had to purchase new oral care supplies, because what we had was of such poor quality it was really embarrassing. We had toothbrushes that the bristles fell out of. We had blue water to rinse with as an oral rinse. I don’t know if Elias had the same experience, but these were things that weren’t even therapeutic that we were offering to our patients to take care of their oral care. So getting some good products was important, and I’ll mention here that we did choose the Sage Stryker oral care products. We laid out all of the different products that were available to our hospital, and they were voted in by the staff and leadership because they met the evidence-based requirements from the American Dental Association. So we did use that.
We also had to do quite a bit of education. It’s surprising how many people, including nurses, nursing assistants, patients, and family members, really have no idea that the germs that cause pneumonia start in the mouth and how important it is to keep that mouth clean. So putting that into place, we did see a dramatic increase in oral care frequency and then a decrease in hospital-acquired pneumonia. That first year, we estimated we saved eight lives, prevented 500 extra hospital days, and saved $1.72 million, and that’s after subtracting the cost of the oral care equipment. So we felt like that was great, and as we continued to measure that for four years, we found that we actually increased prevention and continued to see the same results sustained.
Kevin Pho: Now, Elias, similarly, you implemented an oral care protocol at your hospital, including the Stryker Sage self oral care product, and presented a poster on it at the Society for Healthcare Epidemiology of America conference. What was your approach to implementing a new protocol?
Elias Coury: Yeah, so we really wanted to understand the problem fully, and so we started exploring different ways that we could link. We were already measuring our NVHAP, and we wanted to link our different areas to that. So we looked at sepsis that was coming from NVHAP, we looked at mortality that was coming from NVHAP, and then we started to paint the picture as a whole for the different parties that we were trying to get involved in our project.
So we did start with the frontline staff. We actually did toothbrush testing to show them the bacteria that was present on our current oral care devices. We did forums with our staff to figure out what some of the problems were that they were experiencing with our current process and with completing oral care appropriately. We did baseline measures of our compliance with oral care and different prevention strategies to figure out, you know, where are we currently, why are we falling through, and what are the numbers that we’re currently seeing? With that, we then put together this whole package and presented it to our staff, to our managers, to our directors, and to an admin team: “Here’s the problem that we’re having.”
We explored solutions, and so we ended up on the Sage Stryker oral care device. The reason we went with that was a few things. One, it helped with workflow; there was a lot of conversation about workflow. The bristles, as Barb mentioned, were a huge dissatisfier for staff and patients, if you brushed your teeth and you had the bristles all over, which is an increased risk for aspiration too. We actually ended up bringing our current toothbrushes, and then the products that we were looking at replacing them with, to one of our board meetings, and all of our governing board brushed their teeth with all the different products. They quickly saw the quality, so that was just kind of a fun thing to do to get them bought in on the project.
Then we rolled it out. We put together our bundle and what our process was going to look like. We put in ways to measure the outcomes and to measure compliance with that. We had the frontline staff bought in from day one, and so they were really pushing it forward. We did a lot of education on each floor and re-education, and answered any questions as they came up.
And we monitored it. We wanted to make sure that the outcome was actually tied to the bundle use, and so we had goals set on compliance, which we were able to hit. We did see a fantastic decrease in the areas that we were measuring, which, as I said, are NVHAP, then NVHAP-associated sepsis, and also mortality related to NVHAP. Our mortality actually came down by 50 percent in that year’s study, and so that was one of the things that we got to present at SHEA, which was fantastic. More than anything, it was great for our patients, right? We’re keeping our patients safer.
Kevin Pho: Now, both of you helped implement successful programs. I’m going to ask each of you, what challenges did you encounter when establishing a non-ventilator hospital-acquired pneumonia prevention program? Elias, talk about your challenges.
Elias Coury: Well, we needed to get buy-in, right? What we were proposing to do is more expensive, so we needed the C-suite to really get connected with that and buy into that. So that came back to painting that picture and connecting the dots to the areas of impact, and that looked a little different depending on who we were speaking to at the time for our project.
With our clinical leadership, like our chief medical officer and our CNO, we were really heavily focused on the patient outcomes. We were looking at, you know, “Here is the data for sepsis internally. Here is our data for mortalities and the patients that are passing away once they’ve developed NVHAP.” We really wanted to show them the true morbidity and mortality related to NVHAP in our facility.
So it was a little different when we went and talked to our finance and operations teams. We really stuck to length of stay; obviously, that’s a huge ticket item for them. We pulled information surrounding lost revenue that comes from that increase in length of stay, and then we talked through some of the logistics of how it was impacting workflow and how it was impacting throughput from an operational standpoint.
Kevin Pho: Barbara, talk about some of the challenges you encountered when implementing your program.
Barbara Quinn: I think the lack of knowledge was really striking. Most nursing programs back in my day didn’t even talk about oral care as a preventive measure. It was just sort of a nice-to-do, and when something’s just nice to do and not understood to be as important as it is, those are the things that fall to a lower priority for staff. So lack of knowledge was a big one.
I think there was the perception by staff of, “Oh, you’re just asking us to do one more thing.” So again, that education helped overcome that. The data and the chart review, where you’re trying to measure outcomes, can be very labor-intensive and laced with a little bit of subjectivity, and that has been difficult for some of us to overcome also.
And then one surprising thing that ended up being a challenge was patients refusing to do oral care, because they truly did not understand why, when they didn’t feel good and didn’t feel like doing anything, we were asking them to brush their teeth. They just didn’t feel like it was important. So those are a few of them, besides what Elias talked about.
Kevin Pho: You’re listening to a special sponsored episode of The Podcast by KevinMD, “Patient safety in focus: Helping to address risk factors associated with non-ventilator hospital-acquired pneumonia.” Find out more at KevinMD.com/Stryker. That’s Stryker with a Y, KevinMD.com/S-T-R-Y-K-E-R. The link will be in the show notes. Again, we’ll ask both of you the same next question. Barbara, what data or outcomes would you recommend tracking to measure the success of a non-ventilator hospital-acquired pneumonia prevention program?
Barbara Quinn: Well, I think, as Elias already spoke about, you need process and outcome metrics. You need to know that the nursing practice, the preventive strategies that you’re putting in place, are actually being done. So those are things like the oral care frequency: Are you using the oral care supplies? Those types of things.
Then for the outcome, you want to know what the NVHAP incidence is, and this is where we have some of the most struggles. I used the ICD-10 codes; I started with those, so that’s the coded data, the administrative data. Then I reviewed the charts and overlaid the NHSN definition to make sure that this was valid data. This can be time-consuming.
I’m happy to say that there is a newer electronic option that’s available now. It was published in JAMA by Dr. Barbara Jones and Dr. Michael Klompas, where they identified the electronic pieces of the NHSN definition and were able to run it in real time without the subjectivity of how we were doing it before. So that’s great. I’m hoping that will make it easier for people and reduce the challenge of this part of measuring the outcome of NVHAP.
Kevin Pho: Elias, tell us about the data or outcomes that you would recommend tracking to measure the success of your NVHAP prevention program.
Elias Coury: I think a good starting point for outcomes is, as Barb mentioned, the ICD-10 codes. It’s probably the simplest way, especially if you don’t have a really big pool of resources and you’re trying to start gathering data. So that will give you your outcomes, or your prevalence. But, as Barb said, most important is the compliance. We need to figure out: Is there a true association between what your practice is and what you’re doing for the pneumonia?
So don’t just look at charting, is what I always say. I’ve moved away from just asking, “Are they charting and documenting that it was completed?” Do real in-person review, where we even go up and ask the patient, “Hey, how many times have you had your teeth brushed?” You go and you physically look and see: Is the oral care device available in the room? How many of them have been used? Is it dated? So have a little bit more structure to the compliance, and don’t rely too heavily on the charting of it, is what I would recommend.
Kevin Pho: And the next question, again, I’m going to ask both of you. Elias, we’ll start with you. If you could change one thing about how hospitals address non-ventilator hospital-acquired pneumonia today, what would that one thing be?
Elias Coury: I would just love to see it monitored more. I know that at my facilities, it’s one of the top things we look at, and we’ve made it a priority, but I would just like to see more hospitals putting data out there and having it available to them. I think that they’ll see a lot more impact on their patient care in different areas, like we said, like sepsis and mortality and length of stay, and things that maybe they aren’t associating with it yet, that they would anticipate. So that would be my big thing: just getting hospitals more bought in on the impact they can really have when you reduce NVHAP.
Kevin Pho: And Barbara, what would be one thing that you would change about how hospitals address non-ventilator hospital-acquired pneumonia?
Barbara Quinn: I think I would change their perception, if I had a magic wand to do that, so that they would perceive NVHAP as a preventable harm that’s occurring on our watch, and take it as seriously as they do sepsis and CAUTI and CLABSI. There was a study that just came out from AHRQ recently that showed that HAP occurs 16 times more frequently than CAUTI. And yet where is our leadership focusing? They’re focusing on something that doesn’t happen nearly as often and doesn’t harm nearly as many patients. So I would say, if I could, change their perception, so they see that this is happening, it is happening to patients under their care, and it is a preventable harm.
Kevin Pho: Elias, how can we increase the importance of NVHAP in the eyes of hospital leadership, staff, patients, and their loved ones?
Elias Coury: Well, with leadership, right now, until we get ties to some of the different measures through either CMS or, you know, NHSN or one of those regulatory bodies, we really just have to show the correlations to what they’re currently focusing on. So that length of stay is a big one, the 15 days, and what that looks like from a financial standpoint. It’s estimated that an NVHAP probably costs facilities anywhere from $28,000 to $40,000 per patient, and if you start looking at that by occurrence, you know, that can add up very, very quickly. I think that’s something that the leadership would be really big on.
From a nursing standpoint, most of the prevention strategies for NVHAP are simple, right? If you’re looking at all the things that can go wrong when a patient gets NVHAP that we talked about earlier, hey, the prevention for this is, let’s brush their teeth. When you look at some of the other hospital-acquired conditions, it’s not that easy, right? The mitigation strategies can be a lot, and intensive. So for this one, I always say it’s one of the simplest hospital-acquired infections to prevent: good oral care practice. And so that’s what I really push with them.
For the families and the patients and the loved ones, it’s increasing the knowledge, so it’s giving that education. I still go up on the floors, and I’ll talk to a patient who doesn’t want to brush his teeth, or just won’t participate in that. So it’s just, you know, explaining the importance of that oral care to them as well, and getting them bought in on their recovery and their care. I think that will go a long way.
Kevin Pho: And Elias, speaking of knowledge, where should viewers start if they want to grasp the scope of NVHAP at their hospital?
Elias Coury: The easiest thing, if you don’t have a measuring mechanism already, is going to be the ICD-10 codes to start with. Start looking at that. Contact your data team, your CDI team, or maybe your HIM team, and see if there are any sort of queries you can run. Depending on what EHR system you have, it might be easier than others, but just try and look at the outcomes first.
And then I think you try and correlate those patients to some of the other things you’re looking at. Look and see: Did those patients have a higher frequency of readmissions? What was their average length of stay? Did they end up developing anything else, like a hospital-acquired sepsis? So see if you can start. You start with the ICD-10 codes, figure out that patient population, and you can dig deeper.
Kevin Pho: All right, and now we’re going to end with some take-home messages. I’m going to ask both of you to leave with the KevinMD audience. Barbara, why don’t you go first?
Barbara Quinn: I would say my take-home message is to make the effort. Look at your own data. Don’t assume this only affects other hospitals and not yours. It really takes courage to look for hidden harm, with all the other requirements that we have in health care right now, but our patients are counting on us to do the right thing.
Kevin Pho: And Elias, what are some of your take-home messages?
Elias Coury: Just that we’re all advocates for our patients, and if you see a problem, even if it isn’t something that’s at the top of the list, escalate it, and don’t be afraid to voice your opinions on it and work on it. That’s our job as clinicians. That’s our job in quality, to raise awareness. And so just continue to do that.
Kevin Pho: Thank you for listening to a special sponsored episode of The Podcast by KevinMD, “Patient safety in focus: Helping to address risk factors associated with non-ventilator hospital-acquired pneumonia.” Find out more at KevinMD.com/Stryker. That’s Stryker with a Y, KevinMD.com/S-T-R-Y-K-E-R. The link will be in the show notes. Barbara and Elias, thank you so much for sharing your perspective and insight. Thanks again for coming on the show.
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