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Purpose Nonventilator hospital‐acquired pneumonia (NV‐HAP) is an underreported and unstudied disease, with potential for measurable outcomes, fiscal savings, and improvement in quality of life. The purpose of our study was to (a) identify the incidence of NV‐HAP in a convenience sample of U.S. hospitals and (b) determine the effectiveness of reliably delivered basic oral nursing care in reducing NV‐HAP. Design A descriptive, quasi‐experimental study using retrospective comparative outcomes to determine (a) the incidence of NV‐HAP and (b) the effectiveness of enhanced basic oral nursing care versus usual care to prevent NV‐HAP after introduction of a basic oral nursing care initiative. Methods We used the International Statistical Classification of Diseases and Related Problems (ICD‐9) codes for pneumonia not present on admission and verified NV‐HAP diagnosis using the U.S. Centers for Disease Control and Prevention diagnostic criteria. We completed an evidence‐based gap analysis and designed a site‐specific oral care initiative designed to reduce NV‐HAP. The intervention process was guided by the Influencer Model™ (see Figure ) and participatory action research. Findings We found a substantial amount of unreported NV‐HAP. After we initiated our oral care protocols, the rate of NV‐HAP per 100 patient days decreased from 0.49 to 0.3 (38.8%). The overall number of cases of NV‐HAP was reduced by 37% during the 12‐month intervention period. The avoidance of NV‐HAP cases resulted in an estimated 8 lives saved,$1.72 million cost avoided, and 500 extra hospital days averted. The extra cost for therapeutic oral care equipment was $ 117,600 during the 12‐month intervention period. Cost savings resulting from avoided NV‐HAP was$1.72 million. Return on investment for the organization was $ 1.6 million in avoided costs. Conclusions NV‐HAP should be elevated to the same level of concern, attention, and effort as prevention of ventilator‐associated pneumonia in hospitals. Clinical Relevance Nursing needs to lead the way in the design and implementation of policies that allow for adequate time, proper oral care supplies, ease of access to supplies, clear procedures, and outcome monitoring ensuring that patients are protected from NV‐HAP.

Hospital-acquired pneumonia (HAP) is the most common and deadly healthcare-associated infection, and antibiotic prescribing for possible HAP is one of the most common drivers of broad-spectrum antibiotic use in hospitals.1,2 A point-prevalence study conducted by the US Centers for Disease Control and Prevention estimated that HAP affects ∼1 in 100 admissions.1 Crude mortality rates for HAP range from 15% to 30%.3 Far more than 1% of hospitalized patients receive antibiotics for possible pneumonia, however, because of the inherent difficulty accurately diagnosing pneumonia.4 The signs and symptoms of pneumonia are neither sensitive nor specific and a host of conditions common in hospitalized patients have overlapping clinical signs including heart failure, atelectasis, mucous plugging, obstructive lung disease, thromboembolic disease, hypersensitivity reactions, lung contusions, pulmonary hemorrhage, and more.5 The issue is further complicated by the challenge of differentiating colonization from infection. Cases were detected using a combination of discharge diagnosis codes, positive blood or respiratory cultures on hospital day ≥3, and treatment with ≥3 days of antibiotics starting on the day the blood or respiratory culture turned positive. Antibiotic resistance rates were also fairly similar across all 3 HAP types: about 40% of Staphylococcus aureus isolates were methicillin resistnat, 13%–15% of gram negative isolates were resistant to third-generation cephalosporins, 7%–9% were resistant to carbapenems, and 15%–16% were resistant to anti-pseudomonal β-lactams. Not every patient with possible HAP requires immediate antibiotics.16,17 In a subset of patients with less severe disease, short delays to gather more diagnostic data to help rule in or out bacterial pneumonia have not been associated with harm.18–20 Indeed, the 2021 version of the Surviving Sepsis Campaign guidelines explicitly guides clinicians to balance patients’ severity of illness against their likelihood of infection to determine antibiotic urgency.21 The new guidelines state that antibiotics should only be given immediately to patients with possible septic shock or clear evidence of infection.

Pneumonia is the leading hospital-acquired infection (HAI) among US hospitals, with nonventilator hospital-acquired pneumonia (NVHAP) now representing the majority of cases (65%).1 NVHAP affects ∼1 in 100 hospitalized patients across all risk factors and carries an associated crude mortality rate of 15%–30%.2 NVHAP is associated with increased antibiotic usage, high ICU utilization rates, and high readmission rates (20%) for survivors, and NHVAP is the most common pathway to sepsis.2,3 Despite the harm from NVHAP, with no current safety and reporting requirements, most hospitalized patients who acquire NVHAP do not receive therapeutic prevention interventions.4 In 2020, with the support of numerous healthcare leadership organization, the Department of Veterans’ Affairs formed the National Organization to Prevent Hospital-Acquired Pneumonia (NOHAP). [...]emphasized is the importance of describing pathways for prevention and implementation science related to NVHAP.2 The Association for Professionals in Infection Control and Epidemiology (APIC) published a published a position paper stating that hospitals should design local programs to address NVHAP, including surveillance and reporting requirements.5 To understand the current status of NVHAP prevention programs in US hospitals, we created a survey designed to identify current NVHAP policies and prevention practices. Based on these findings and the NOHAP Call to Action, hospitals may consider: (1) an in-depth review of current policies and practices related to NVHAP prevention, including patients with severe acute respiratory coronavirus virus 2 (SARS-CoV-2), (2) implementing robust staff training and professional development, (3) conducting a gap analysis to appraise type and quality of equipment and tools required to address NVHAP, (4) designing methods to capture NVHAP process measures and monitoring, and (5) providing patient and families with educational materials to help engage them in NVHAP prevention. Individual hospital systems can determine NVHAP prevention quality measures and outcomes based recommendations from Association for Professionals in Infection Control and Epidemiology (APIC),3 Johns Hopkins’ I-COUGH,8 and Kaiser Permanente’s ROUTE bundle9 programs to address NVHAP.

There are increasing numbers of children with special health care needs (CSHCN) who require various levels of care each school day. The purpose of this study was to examine the role of public schools in supporting CSHCN through in-depth key informant interviews. For this qualitative study, the authors interviewed 17 key informants to identify key themes, provide recommendations, and generate hypotheses for further statewide survey of school nurse services. Key informants identified successful strategies and challenges that public schools face in meeting the needs of all CSHCN. Although schools are well intentioned, there is wide variation in the ability of schools to meet the needs of CSHCN. Increased funding, monitoring of school health services, integration of services, and interagency collaboration are strategies that could improve the delivery of health services to CSHCN in schools.

Patient safety organizations and researchers describe hospital-acquired pneumonia (HAP) as a largely preventable hospital-acquired infection that affects patient safety and quality of care. We provide evidence regarding the consequences of HAP among 2019 Medicare beneficiaries. Retrospective case-control study. Calendar year 2019 Medicare beneficiaries with HAP during an initial hospitalization, defined by (ICD-10-CM) coding on inpatient claims (n = 2,457). Beneficiaries with HAP were matched using diagnosis-related group (DRG) codes with beneficiaries who did not experience HAP (n = 2,457). The 2019 calendar year Medicare 5% Standard Analytic Files (SAF), for inpatient, outpatient, physician, and all postacute hospital settings. The case group (HAP) and control group (non-HAP) were matched on disease severity, age, sex, and race and were compared for hospital length of stay, costs, and mortality during the initial hospitalization and across settings for 30, 60, and 90 days after discharge. The 2019 fiscal year MedPAR Claims data were used to determine Medicare costs. Medicare beneficiaries with HAP were 2.8 times more likely to die within 90 days compared with matched beneficiaries who did not develop HAP. Among those who survived, beneficiaries with HAP spent 6.6 more days in the hospital (69%) and cost the Medicare program an average of $14,487 (24%) more per episode of care across initial inpatient and postdischarge services. The findings of higher mortality and cost among Medicare beneficiaries who develop HAP suggest that HAP prevention should be prioritized as a patient safety and quality initiative for the Medicare program.

This qualitative study explored the barriers and facilitators of cancer screening among women of Hmong origin. Using a community-based participatory research approach, we conducted focus groups (n=44) with Hmong women who represented four distinct demographic groups among the Hmong community. The participants described sociocultural barriers to screening, which included a lack of accurate knowledge about the causes of cervical cancer, language barriers, stigma, fear, lack of time, and embarrassment. Structural barriers included attitudes and practices of health care providers, lack of insurance, and negative perceptions of services at clinics for the uninsured. Health care providers may require additional training and increased time per visit to provide culturally sensitive care for refugee groups such as the Hmong. Health-related social marketing efforts aimed at improving health literacy may also help to reduce health inequities related to cancer screening among the Hmong.

Objectives. We explored factors associated with perception of barriers to immunization among parents of Hmong origin in California, whose children experience persistent immunization inequities even with health insurance. Methods. A partnership of academic researchers and members of the Hmong community conducted a community-based participatory research project. We collected data in naturalistic settings with a standardized instrument. We analyzed responses from 417 parents and caregivers and created a structural equation model to determine factors that contributed to perceived barriers. Results. Of 3 potential contributing factors to perceived barriers—nativity, socioeconomic position, and use of traditional Hmong health care (i.e., consulting shamans and herbalists)—the latter 2 significantly predicted higher perceived barriers to immunization. Nativity, indicated by years in the United States, age of arrival in the United States, and English language fluency, did not predict perceived barriers. Conclusions. Interventions aimed at reducing immunization inequities should consider distinct sociocultural factors that affect immunization rates among different refugee and immigrant groups.

Children with special health care needs (CSHCN) are at risk for school failure when their health needs are not met. Current studies have identified a strong connection between school success and health. This study attempted to determine (a) how schools meet the direct service health needs of children and (b) who provides those services. The study used the following two methods: (a) analysis of administrative data from the California Basic Educational Data System and (b) a cross-sectional online survey of 446 practicing California school nurses. Only 43% of California’s school districts employ school nurses. Unlicensed school personnel with a variety of unregulated training provide school health services. There is a lack of identification of CSHCN, and communication barriers impair the ability to deliver care. Study results indicate that California invests minimally in school health services.

Purpose: The purpose of this study was to determine the effectiveness of a process‐based translation method for a health survey instrument, Searching for Hardships and Obstacles to Shots (SHOTS), using a community‐based participatory approach with the Hmong community. Design: The study was based on a cross‐sectional survey to assess the reliability and validity of the SHOTS immunization survey, an instrument used in the Hmong community, who are refugees originally from Laos living in the United States. Method: Process‐based universalistic health survey translation methods were used in a six‐step procedure to translate the instrument. Mixed methods were used to analyze results, including cognitive interviewing, content validity indexing, Cronbach's α, t tests, and the Kolmogorov‐Smirnov test. Findings: Participants were able to accurately complete the SHOTS survey in either Hmong or English, depending on participant preference. Conclusions: Universalistic, process‐based, mixed methods used to analyze language translation, in combination with the principles of community‐based participatory research, provide effective methods to translate health surveys. Involvement of the community strengthens the quality of translation and improves reliability and validity of survey results. Clinical Relevance: Healthcare providers require accurate and reliable information from evidence‐based health surveys to plan for culturally responsive care. Cross‐cultural research often relies on language translation. Translation of a health survey instrument may be improved with universalistic, process‐based methodology.