David Witt, MD

Infectious Diseases, KP Oakland

Preventing Hospital-Acquired Pneumonia

“This is the first significant, well-documented report of a health care organization launching a prevention program for hospital-acquired pneumonia. We succeeded thanks to our integrated system, and our physicians and nurses working toward the same goal—patient safety.”

Hospital-acquired pneumonia (HAP) has been a leading cause of mortality among hospitalized patients in the United States for decades, and is the most common cause of mortality from hospital-acquired infection. Yet when Dr. Witt searched in 2008 for diagnostic and prevention guidelines in the medical literature to help reduce HAP in Kaiser Permanente Northern California, he came up nearly empty-handed.

“Very little research existed because the condition is hard to define and diagnose, and often occurs in elderly patients who already have serious underlying health conditions,” says Dr. Witt. “But it’s uniformly caused by aspiration of microorganisms, usually bacteria, which can be prevented.”

So Dr. Witt set out with a team of infection preventionists and patient safety staff. He investigated the limited literature available and the practices of the best-performing inpatient units in KP Northern California, and created a set of prevention guidelines known as ROUTE, which stands for Respiration and reduced sedation, Oral care, Up, Tube care, and Education. ROUTE components include regular toothbrushing with antibacterial mouthwash, incentive spirometer use, twicedaily ambulation, and sitting up when eating.

To support consistent implementation, Dr. Witt worked with colleagues across disciplines to develop guidelines to identify at-risk patients, standardize physician orders for prevention strategies, and streamline documentation. After several successful pilots, the evidence-based HAP prevention program was rolled out to all KP Northern California hospitals in early 2013.

The results have been extraordinary. Incidence of HAP declined 66% between 2011 and 2016, and today it averages 2.4 per 1,000 hospital admissions, one of the lowest rates in the country. An estimated 1,648 cases of HAP have been avoided, 308 deaths prevented, and 22,944 patient days saved since 2013.

“Dr. Witt is an incredible human being, who cares deeply about his patients and is always looking for ways to make things better,” says Naveen Kumar, physician-in-chief at KP San Rafael. “His pioneering efforts have saved atients’ lives across Northern California.”