Probable Non-Ventilator-Associated Hospital-Acquired Pneumonia: A Case Report.
Kimberly Paige Rathbun, Annette M Bourgault, Mary Lou Sole
PMID 38555965WHAT IT FOUND
Probable non-ventilator hospital-acquired pneumonia developed in one hospitalized older adult after days without oral care, with oral Neisseria rising and oral health score worsening.
Daily oral care, accessible supplies, early mobility, and dysphagia screening are prevention points; this case cannot prove they worked.
Key findings
01The patient developed new respiratory symptoms and a chest radiograph opacity on hospital day 4, and empirical antibiotics were started after a probable non-ventilator hospital-acquired pneumonia diagnosis on hospital day 5.
02Oral care was performed on only 2 of the 7 hospital days, and there was no oral care on hospital days 2, 3, and 4 before the probable NV-HAP diagnosis.
03The patient's oral health score increased to 7 on hospital day 5, when Neisseria made up 21% of oral bacteria.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for SLPsWhat it means for RNs
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What it does not show
This is a single case report, so it cannot show that oral care, ambulation, or dysphagia screening caused or prevented NV-HAP. The diagnosis was probable, not definitive; some pneumonia criteria were missing, and a lower respiratory tract culture was ordered but not collected. The patient had many comorbidities and received several treatments at once, so the contribution of any single factor cannot be separated. Oral bacterial changes may have been influenced by diet, oral care, anxiety, depression, and other factors. No follow-up chest radiograph was obtained before discharge, and the cause of death was not documented.
The easy way to misread this
Do not conclude that missed oral care caused this probable non-ventilator hospital-acquired pneumonia. The diagnosis was not definitive, no lower respiratory tract culture was collected, and one case cannot separate oral care from other hospital factors.