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Simple steps to prevent hospital-acquired pneumonia in non-intubated patients: a quality improvement project

28 January 2021
Volume 30 · Issue 2



Hospital-acquired pneumonia (HAP) affects approximately 1.5% of UK inpatients. As well as leading to significant morbidity and mortality, HAP increases burden on hospitals by lengthening hospital stay. At a district general hospital in Kent, a quality improvement project (QIP) was designed that introduced simple preventive measures that could be implemented by ward nurses and allied health professionals.


Three audit cycles studying a total of 222 inpatients on elderly care wards were undertaken over a 6-month period to assess staff compliance at various stages of the project, with interventions between each cycle. Actions included raising bedheads to 30°, sitting patients out of bed for meals, discouraging use of drinking straws, and regular mouth care.


Overall, improvements were seen in three of the measures. Considering the percentage of patients, there was a 23% increase in patients with bedheads >30°, 21% increase in use of adult feeding cups rather than straws, and 26% rise in patients sitting out of bed for meals.


The main objective of this QIP was to show that these simple yet potentially life-saving interventions are easy to implement on a busy ward, and the results have shown this to be true.

Hospital-acquired pneumonia (HAP) is defined as a pneumonia that develops more than 48 hours after hospital admission. It affects approximately 1.5% of inpatients (National Institute for Health and Care Excellence (NICE), 2012). It is one of the most common healthcare-associated infections contributing to death and is estimated to increase hospital stay by up to 11 days (De Angelis et al, 2010). As well as increasing economic burden on hospitals (De Angelis et al, 2010), HAP carries significant morbidity and can increase mortality by 30-70% (NICE, 2012), especially among the elderly and frail. Immobilised patients and those with pre-existing lung conditions are at particular risk (Sopena et al, 2014). As guidelines for recognition and management of sepsis have been revolutionised in recent years, the early prevention of HAP becomes increasingly relevant. Preventing sepsis in the early stages by avoiding the development of primary infection has the potential to save numerous lives (Guiliano and Baker, 2020).

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