Pneumonia: Nursing Practice Gaps

Description of professional practice gaps

1. There is a practice gap for nurses related to a lack of good hand hygiene and glove-use practices and the use of contaminated respiratory equipment leading to hospital-acquired pneumonia (HAP), (Ellison & Donowitz, 2015).
2. There is a practice gap between current clinical practice and recommendations in evidence-based guidelines for prevention, diagnostic procedures, medical treatment, and nursing interventions for patients with pneumonia, especially hospital-acquired pneumonia (Eekholm, et al 2020).
3. There is an emerging body of evidence associating the use of comprehensive oral care and mobility to reduce the incidence of non-ventilator hospital acquired pneumonia (NV-HAP) (Giuliano K. 2022).

Evidence that validates professional practice gap

• Several studies have identified the development of nosocomial pneumonia as a category of patient-related, infection control-related, or intervention-related (particularly ventilators), hospital acquired infection (HAI).
• According to Nair and Niederman (2021), the American Thoracic Society and Infectious Diseases Society of America have updated CAP guidelines to help streamline disease management. The common theme is the use of timely, appropriate, and adequate antibiotic coverage to decrease mortality and avoid drug resistance.
• The Joint Commission has issued "Quick Safety 61: Preventing non-ventilator hospital acquired pneumonia" to challenge health care systems to implement and support NVHAP prevention, and to add NVHAP prevention measures to education for patients, health care professionals and students. NVHAP requires a complex interaction of events that includes aspiration of microorganisms present in the oral cavity and a vulnerable host, most prevention measures target primary source control, and may include:
  • Maintaining regular oral care
  • Maintaining patient mobility
  • Elevating the head of the patient’s bed
  • Reducing the use of acid-suppressing medications
  • Minimizing sedation
  • Performing dysphagia screening in high-risk patients
  • Using modified diets and feeding strategies for patients with abnormal swallowing
  • Following standardized processes to place and manage feeding tubes
  • Breathing exercises
  • Using chest physiotherapy
  • Using incentive spirometry
  • Educating the patient and family about NVHAP prevention

Educational needs that underlie the professional practice gap (Knowledge, skill, or practice)

The learner needs to know the following:

• The pathogens associated with community-acquired and hospital-acquired pneumonia.
• The risk factors associated with CAP and HAP.
• Proper hand washing, appropriate glove use to prevent the transmission of pathogens to patients.
• The Joint Commission associates comprehensive oral care with a reduction in HAP.
• The most common signs and symptoms of pneumonia.
• To be able to carry out a pneumonia assessment.
• Need to be able to educate patients and family members on prevention strategies for CAP.
• Need to know when to seek help due to changes in the patient’s condition.
  

Reference

Baker, D. L., & Giuliano, K. K. (2022). Prevention practices for nonventilator hospital-acquired pneumonia: A survey of the Society for Healthcare Epidemiology of America (SHEA) Research Network (SRN). Infection control and hospital epidemiology, 43(3), 379–380. https://doi.org/10.1017/ice.2021.427

Eekholm, S., Ahlström, G., Kristensson, J., & Lindhardt, T. (2020). Gaps between current clinical practice and evidence-based guidelines for treatment and care of older patients with Community Acquired Pneumonia: a descriptive cross-sectional study. BMC infectious diseases, 20(1), 73. https://doi.org/10.1186/s12879-019-4742-4

Giuliano, K. K., Baker, D., Thakkar-Samtani, M., Glick, M., Restrepo, M. I., Scannapieco, F. A., Heaton, L. J., & Frantsve-Hawley, J. (2022). Incidence, mortality, and cost trends in nonventilator hospital-acquired pneumonia in medicaid beneficiaries, 2015-2019. American journal of infection control, 51(2), 227–230. https://doi.org/10.1016/j.ajic.2022.06.016

Nair, G. B., & Niederman, M. S. (2021). Updates on community acquired pneumonia management in the ICU. Pharmacology & therapeutics, 217, 107663. https://doi.org/10.1016/j.pharmthera.2020.107663

Sattar, S. B. A., Sharma, S., & Headley, A. (2022). Bacterial Pneumonia (Nursing). In StatPearls. StatPearls Publishing.