The Impact of an Oral Hygiene Bundle on Hospital Acquired Pneumonias

Background: Hospital acquired infections (HAIs) have a significant impact on patient outcomes with hospital acquired pneumonias (HAPs) accounting for a large part of the cost and care burden. At Henry Ford Hospital, the HAP rate over the last 3 years has increased from 1181 (June 2020) to 1869 (June 2021) to 1078 (June 2022), in large part due to the COVID 19 pandemic. Review of the literature shows that implementation of a nursing protocol with clearly defined steps helped to increase the number of patients receiving oral care and reduced the incidence of hospital acquired pneumonias (Warren, 2019). In addition, oral care as part of the VAP bundle significantly reduced the incidence of pneumonia when compared to oral care alone. Study Purpose: The primary purpose of this evidence based practice project is to evaluate the effectiveness of a standardized oral care regimen on HAPs for all patients in the hospital over a 6 month period following focused education for the nursing staff. Methodology: A site specific oral hygiene protocol was developed and replicated the protocol used by Warren (2019). Nursing staff were educated on the protocol via cornerstone module. Units were encouraged to have unit champions identified to support the implementation of the bundle. HAP rates, LOS and mortality rates were compared 3 months prior to bundle implementation to 3 months post-implementation. Data was abstracted from the EMR and included frequency and type of oral care performed. Data analysis: Data was extracted from the EMR collected in a 3-month period prior to bundle implementation and in a 3-month period post implementation. In each period HAP rates, LOS and mortality rates were computed. The two rates, HAP and mortality were compared using a Chi-squared test. and LOS using a Student’s t-test. Discussion: At Henry Ford Hospital, the HAP rate over the last 3 years has increased significantly, in large part to the COVID 19 pandemic. Research shows that implementation of a nursing oral care protocol with clearly defined steps helps to increase the number of patients receiving oral care and reduces the incidence of hospital acquired pneumonias Data from this project shows that as the number of oral care interventions increased there was a concomitant decrease in VAP. The education intervention resulted in increased adherence to the protocol as well as increase in documentation of care provided. In addition, length of stay decreased while discharge to home remain unchanged. Mortality rate and discharge to SAR both decreased slightly. Clinical Implications: The project is low risk with high benefit, and is a standard of care that all patients receive. This may influence how patients manage their own oral care after discharge. Study Limitations: The impact from Covid-19 is still present in the hospital, and may impact outcomes as related to available resources and manpower. Data retrieval was from the EMR and will only be as good as the data entered. Conclusion: Providing oral care is a simple and minimal cost intervention that can have significant impact on patient outcomes related to HAP. Educating staff on the value of oral care can help improve adherence to oral care protocols.https://scholarlycommons.henryford.com/nursresconf2023/1005/thumbnail.jp

Performance-based financing as a health system reform : mapping the key dimensions for monitoring and evaluation

Peer reviewedPublisher PD

Laparoscopic Removal of Angelchik Prosthesis Followed by Interval Sleeve Gastrectomy

Introduction. The Angelchik prosthesis (AP) is a historic antireflux device which consists of a C-shaped silicone ring placed around the gastroesophageal junction (GEJ) and secured by Dacron tape. We present a rare experience with an AP and its impact on bariatric surgical outcomes. Case. Our patient is a 66-year-old woman who had an open antireflux procedure with an AP in 1987. She presented to a bariatric clinic for consideration of bariatric surgery for the treatment of morbid obesity and associated comorbidities. She also reported significant problems with reflux and dysphagia. After an appropriate work-up, an AP was identified at her GEJ. She was taken to the operating room for laparoscopic removal with planned interval laparoscopic sleeve gastrectomy. Intraoperatively, the AP was identified around the GEJ; after extensive adhesiolysis, the prosthesis was removed. Postoperatively, in order to determine if the AP had caused any lasting esophageal motility problems, the patient underwent a high-resolution esophageal manometry which demonstrated normal esophageal motility. Interval laparoscopic sleeve gastrectomy was performed safely 9 weeks later. Conclusion. Although rarely used, it is still possible to encounter an Angelchik prosthesis in practice. General and bariatric surgeons need to be aware of this rare device and understand how to manage its related complications

A major locus controls a biologically active pheromone component in Heliconius melpomene

Understanding the production, response, and genetics of signals used in mate choice can inform our understanding of the evolution of both intraspecific mate choice and reproductive isolation. Sex pheromones are important for courtship and mate choice in many insects, but we know relatively little of their role in butterflies. The butterfly Heliconius melpomene uses a complex blend of wing androconial compounds during courtship. Electroantennography in H. melpomene and its close relative Heliconius cydno showed that responses to androconial extracts were not species specific. Females of both species responded equally strongly to extracts of both species, suggesting conservation of peripheral nervous system elements across the two species. Individual blend components provoked little to no response, with the exception of octadecanal, a major component of the H. melpomene blend. Supplementing octadecanal on the wings of octadecanal-rich H. melpomene males led to an increase in the time until mating, demonstrating the bioactivity of octadecanal in Heliconius. Using quantitative trait locus (QTL) mapping, we identified a single locus on chromosome 20 responsible for 41% of the parental species' difference in octadecanal production. This QTL does not overlap with any of the major wing color or mate choice loci, nor does it overlap with known regions of elevated or reduced F-ST. A set of 16 candidate fatty acid biosynthesis genes lies underneath the QTL. Pheromones in Heliconius carry information relevant for mate choice and are under simple genetic control, suggesting they could be important during speciation.Peer reviewe

Consequences of anastomotic leaks after minimally invasive esophagectomy: A single-center experience

Background: Anastomotic leak (AL) after minimally invasive esophagectomy (MIE) is a well-described source of morbidity for patients undergoing surgical treatment of esophageal neoplasm. With improved early recognition and endoscopic management techniques, the long-term impact remains unclear. Methods: A retrospective review was conducted of patients who underwent MIE for esophageal neoplasm between January 2015 and June 2021 at a single institution. Cohorts were stratified by development of AL and subsequent management. Baseline demographics, perioperative data, and post-operative outcomes were examined. Results: During this period, 172 MIEs were performed, with 35 of 172 (20.3%) complicated by an AL. Perioperative factors independently associated with AL were post-operative blood transfusion (leak rate 52.9% versus 16.8%; p = 0.0017), incompleteness of anastomotic rings (75.0% vs 19.1%; p = 0.027), and receiving neoadjuvant therapy (18.5% vs 30.8%; p < 0.0001). Inferior short-term outcomes associated with AL included number of esophageal dilations in the first post-operative year (1.40 vs 0.46, p = 0.0397), discharge disposition to a location other than home (22.9% vs 8.8%, p = 0.012), length of hospital stay (17.7 days vs 9.6 days; p = 0.002), and time until jejunostomy tube removal (134 days vs 79 days; p = 0.0023). There was no significant difference in overall survival between patients with or without an AL at 1 year (79% vs 83%) or 5 years (50% vs 47%) (overall log rank p = 0.758). Conclusions: In this large single-center series of MIEs, AL was associated with inferior short-term outcomes including hospital length of stay, discharge disposition other than to home, and need for additional endoscopic procedures, without an accompanying impact on 1-year or 5-year survival. Key message: In this large, single-center series of minimally invasive esophagectomies, anastomotic leak was associated with worse short-term outcomes including hospital length of stay, discharge disposition other than to home, and need for additional endoscopic procedures, but was not associated with worse long-term survival. The significant association between neoadjuvant therapy and decreased leak rates is difficult to interpret, given the potential for confounding factors, thus careful attention to modifiable pre- and peri-operative patient factors associated with anastomotic leak is warranted