Reducing the incidence of stroke-associated pneumonia: an evidence-based practice

Abstract

Background Pulmonary infection is a frequent complication among stroke patients and adversely affects clinical outcomes, increases the length of hospitalization stay and costs, and aggravates the financial burden of the national medical health system. Early identification and management of high-risk patients are necessary and imperative to reduce the incidence of stroke-associated pneumonia (SAP). Aim The evidence-based practice project evaluated the effectiveness of a standard care bundle intervention in preventing the occurrence of SAP. Methods The project was conducted in a neurology department of a teaching hospital. Given the variation in assessment and management standards, evidence-based practice (EBP) methodology was used to establish a process for quality improvement. A thorough literature search was conducted to identify evidence-based interventions to manage and prevent SAP. Thorough critiques of the literature and synthesis of the evidence were completed. A systematic management flow and care bundle interventions were established. The care bundle included interventions, such as the utilization of tools for SAP risk screening; dysphagia screening and rehabilitation; feeding modification, oral care, airway management, position management, and the nursing techniques of traditional Chinese medicine. Results A significant improvement was observed in preventing SAP in patients in the postimplementation group compared with those in the preimplementation group (14.0% vs. 37.2%, p = 0.025). In addition, significantly lower duration of hospitalization, lower rate of aspiration, and improvements in albumin and oral hygiene were found after the implementation of the care bundle. Conclusions Evidence-based care bundles successfully empower nurses to reduce the incidence of SAP. The management flow of SAP prevention could be promoted to other units of the neurology department in the future. The results of the project reflect positively on the capacity to implement EBP in an acute care setting for stroke. The EBP methodology can be utilized to solve other clinical problems.

Pneumonia, Aspiration Pneumonia, or Frailty-Associated Pneumonia?

“…Higher oral bacterial counts are found [ 35 , 36 ], gram negative and anaerobic organisms are increasingly present in the microbiome, and the nature of any infection may change [ 37 ]. Studies have shown that, for those most at risk, effective proactive mouth care can mitigate any risk [ 38 , 39 ]. Poor oral health and oral frailty are associated with an increased mortality and morbidity [ 40 ].…”

Comparison of six risk scores for stroke-associated pneumonia in patients with acute ischemic stroke: A systematic review and Bayesian network meta-analysis

“…In addition, except preventive antibiotics, lots of other intervention could prevent SAP in patients with stroke of high risk. For instance, dysphagia assessment and management ( 52 ), modes of nutritional support ( 53 , 54 ) and care programme ( 55 ) also play important parts in the prevention of SAP.…”

Patient's care bundle benefits to prevent stroke associated pneumonia: A meta-analysis with trial sequential analysis

“…To our knowledge, this is the first meta-analysis with trial sequential analysis to investigate the preventive effect of the patient's care bundle on SAP in stroke patients. Pooled (22). Evidence-based protocol initiated by nurses for syndrome management is scientific, effective, targeted, safe, and systematic in stroke units (53).…”

“…In addition, Turner et al ( 21 ) discovered that achieving a care bundle for ischemic stroke could significantly reduce the occurrence of SAP. It should be noted that the majority of currently available care strategies are single or multiple preventive interventions that are not evidence-based ( 22 ). Evidence-based protocol initiated by nurses for syndrome management is scientific, effective, targeted, safe, and systematic in stroke units ( 53 ).…”

“…Currently, the components of the care bundles for SAP preventions varied in literatures; however, four major aspects were consistently involved in the currently available bundles, including feeding management, body position management, oral care, and respiratory tract management (22). Nevertheless, several randomized controlled trials (RCTs) (23)(24)(25)(26) with limited sample sizes have been conducted to investigate the interventional effect of care bundle on the prevention of SAP in stroke patients; however, these studies have reported conflicting results.…”