A postoperative pneumonia prevention program for patients in the surgical ward nearly halved the incidence of the condition, California researchers have found.
The program, at the VA Palo Alto Health Care System, emphasized ongoing education for nurses, pneumonia prevention, coughing and deep-breathing exercises with an incentive spirometer, twice-daily oral hygiene with chlorhexidine, walking and sitting up to eat.
The study included patients who were not on a mechanical ventilator from 2008 to 2012. During this time, there were 18 cases of postoperative pneumonia among 4,099 at-risk patients, for a case rate of 0.44%. That marked a 44% decrease from the hospital’s preintervention rate of 0.78%, according to the researchers. Pneumonia rates in all years were lower than the preintervention rate (0.25%, 0.50%, 0.58%, 0.68% and 0.13% in 2008 to 2012, respectively).
“The standardized pneumonia prevention program achieved substantial and sustained reduction in postoperative pneumonia incidence on our surgical ward; its wider adoption could improve postoperative outcomes and reduce overall health care costs,” wrote the authors, who published their findings in JAMA Surgery (2014 Jul 23).
Although encouraging, these findings should be interpreted with caution, said Catherine Lewis, MD, a specialist in surgical critical care at the University of California, Los Angeles.
“Although the number of ward cases decreased from 13 to three, the number of non–ventilator-associated pneumonia ICU cases increased from four to 17, and therefore, the reported decrease could be due to redistribution in the location of patients,” Dr. Lewis wrote in an invited commentary to the paper. “[Another] concern is that the authors did not evaluate changes in patient care or surgical technique that could have altered the incidence of postoperative pneumonia.”
However, despite these concerns, she added, “The authors should be commended for the development and implementation of a quality improvement measure aimed at decreasing the rate of postoperative pneumonia in a Veterans Affairs population.”