Preventing Pneumonia

[Sally Furniss]

PREVENTING PNEUMONIA

http://www.reproline.jhu.edu/English/4morerh/4ip/IP_manual/27_Pneumonia.pdf

[mixin]

Re: Preventing Pneumonia

Thanks Sally! Good information for anyone anticipating surgery.

Nosocomial pneumonia is the infection most likely to be fatal, with mortality rates exceeding 30%, and is the most expensive to treat. Patients on mechanical ventilators develop pneumonia more frequently and are more likely to have a fatal outcome than those not requiring assisted respiration. Half of all nosocomial pneumonias occur after surgery, especially if mechanical ventilation is needed postoperatively.

Most nosocomial pneumonias occur by aspiration of bacteria growing in the back of the throat (oropharynx) or stomach. Intubation and mechanical ventilation greatly increase the risk of infection because they:
# block the normal body defense mechanisms?coughing, sneezing and
the gag reflex;
# prevent the washing action of the hair (cilia) and mucus-secreting cells
lining the upper respiratory system; and
# provide a direct pathway for microorganisms to get into the lungs.
Other procedures that may increase the risk of infection include oxygen
therapy, intermittent positive pressure breathing (IPPB) treatment and
endotracheal suctioning.

Most reported nosocomial pneumonias are due to bacteria. Early onset
pneumonia is likely to involve the patient?s own flora, especially
streptococcus and haemophilus species. When pneumonia occurs later on
during the hospitalization, it is more likely to be due to gram-negative organisms from the hospital environment. The combination of severe illness, presence of multiple invasive devices (IVs, urinary catheters and mechanical ventilators) and frequent contact with the hands of personnel often leads to cross-contamination. For example, in one study by Weinstein, 20?40% of nosocomial pneumonias were due to crosscontamination of organisms from one patient to another, most likely from the hands of hospital staff.

Numerous studies have shown that preoperatively teaching patients about
how to prevent postoperative pulmonary problems (e.g., deep breathing,
moving in bed, frequent coughing) combined with early movement (sitting
up and walking) and limited use of narcotic analgesics for a short duration
can reduce the risk of nosocomial pneumonia.