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Modification of the risk of mortality

May Grossman, age 57, is admitted for elective surgery to reverse a colostomy from a previous surgical procedure. Her health has been good except for occasional diverticulitis bouts. She takes care of her three grandchildren several times a week.

Mrs. Grossman tolerates the surgery well until postop day 2, when she complains of shortness of breath. You measure her temperature at 101.4° F (38.5° C). A workup reveals an elevated white blood cell (WBC) count; a chest X-ray shows a left lower lobe in­filtrate.

The physician initiates antibiotics and respiratory treatments, but Mrs. Grossman continues to
deteriorate. She is transferred to the intensive care unit with a diagno­-sis of hospital-acquired pneumonia (HAP).

Nurses on medical-surgical and intensive care units (ICUs) are familiar with scenarios like this: A healthy person enters the hospital but deteriorates suddenly from HAP.

Since 2008, Medicare payment policy and the National Healthcare Safety Network (NHSN) have focused hospitals’ efforts on reducing HAP and other hospital-acquired infections (HAIs) by mandating prevention policies and monitoring of device-associated infections, such as central-line associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), and ventilator-associated pneumonia (VAP). Over the last 10 years, incidence of device-associated infections has dropped significantly.

But the three most common device-associated infections account for only about 25% of HAIs. What’s more, VAP represents only 38% of total HAP cases. Hospitals are striving to meet NHSN requirements; yet monitoring and interventions to prevent nonventilator HAP (NV-HAP) aren’t required. As a result, cases like Mrs. Grossman’s go unnoticed for their potential to inform basic nursing care and HAI prevention.

This article discusses the causes and impact of unaddressed NV-HAP and explains why we need to return to basic nursing and oral care to prevent this illness.