Younger patients constitute half of hospital-acquired pneumonia cases, most of which originate outside of the ICU, study finds

Research suggests gaps in pneumonia preventive measures could be cause behind the heightened risk


Arlington, VA, January 9, 2018

Hospital-acquired pneumonia has long been associated with the elderly and intensive care units (ICU). But according to a new multicenter nationwide study, nonventilator hospital-acquired pneumonia (NV-HAP) occurs across all units in all types and sizes of US hospitals, putting every patient—the young included—at higher risk for developing the infection.

The findings, published in the January issue of theAmerican Journal of Infection Control(AJIC), the journal of the Association for Professionals in Infection Control and Epidemiology (APIC), reviewed patient data across 21 US hospitals, retroactively pulling charts from January 1, 2014 through December 31, 2014 to identify NV-HAP cases, in addition to assessing demographic data, outcomes, and documented preventive interventions applied.

The research team flagged 1,300 patients who acquired NV-HAP, recording a NV-HAP incidence rate of 0.12-2.28 cases per 1,000 patient days. The study is one of the first to debunk the association that NV-HAP predominantly impacts the elderly, and reverses previously held notions that patients in the ICU are at greatest risk for contracting pneumonia.

Here’s what the researchers found:

  • Patients 65-years and younger constitute half of NV-HAP cases, both in and outside of hospitals’ surgical departments.
  • Roughly seven in 10 (70.8%) NV-HAP cases were acquired outside of the ICU. Of these cases, 43.1% were acquired in medical-surgical departments; 8.5% in telemetry; 7.2% in progress care units; 4.9% in oncology; and 2.8% in orthopedic.
  • Almost six in 10 patients (57.7%) recorded hospital stays that ranged upwards of 15 days. Of the patients transferred to the ICU, four in 10 (40.8%) stayed in the hospital more than 20 days. Of the 1300 cases, 19.3% were readmitted to the hospital within 30 days. Patients in the ICU typically stay in the hospital for more extended periods of time and are at greater risk for mortality.
  • 27.3% of patients acquired NV-HAP in the ICU, indicating that patients in the ICU continue to acquire HAP despite preventive efforts in place to counter ventilator-associated pneumonia.
  • Pneumonia risk can be minimized through preventive measures. But as researchers found, basic pneumonia preventive measures are often missing in patient care provided during a hospital stay. 58.6% of patients diagnosed with NV-HAP did not receive oral care; 81.8% did not receive incentive spirometry; 67.4% did not undergo cough and deep breathing exercises; and only 28.7% of patients stepped out of bed two or more times in the 24-hours prior to their pneumonia diagnosis.
  • Standardizing protocols for preventive care can help reduce rates of NV-HAP. In a 2012 trial conducted in one hospital, evidence-based oral care protocols aimed at NV-HAP prevention for acute care patients decreased the rate of NV-HAP from 0.5 to 0.3. This saved an estimated eight lives, $1.72 million in costs, and 500 days in extra hospital stays during the study period. By 2014, the initiative reduced NV-HAP cases by 70%, saving $5.9 million in NV-HAP related costs.

“NV-HAP does not discriminate; all patients across all hospital floors face a risk for acquiring pneumonia,” said Dian Baker, PhD, RN, the study’s lead author and a school nurse program coordinator at the California State University School of Nursing. “But from standardizing oral care protocols to tracking hospital-wide NV-HAP rates, providers can address gaps to identify new or reinforce existing preventive measures. We predict that with the right interventions to cut NV-HAP rates in half, hospitals could save roughly 10 thousand lives, 490,000 hospital days and $2.43 billion in costs per year.”

Up to 35.4 million US patients are at risk for NV-HAP annually—as compared to 3.9 million patients at risk for ventilator-associated pneumonia (VAP). And while both healthcare-associated infections (HAI) have a roughly 19% mortality rate, NV-HAP costs health systems some $156 million, in contrast to the $86 million attributed to VAP costs. Patients with NV-HAP are 8.4 times more likely to require intensive care and/or die during hospitalization; 8.0 times more likely to require mechanical ventilation and, on average, have a readmission rate of 19.3%.

“Healthcare-acquired pneumonia is an under-appreciated HAI, causing patient harm, deaths, and excess healthcare costs,” said 2018 APIC President Janet Haas, PhD, RN, CIC, FSHEA, FAPIC. “However, since this infection is often preventable through nursing care activities aimed at preventing aspiration, once we recognize this problem, we can improve. This study underscores the need to implement evidence-based practices known to prevent pneumonia throughout the hospital.”

Visit www.apic.org to learn more information about preventing infections in healthcare facilities.

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Notes for editors
The article is “Hospital Acquired Pneumonia Prevention Initiative-2: Incidence of nonventilator hospital-acquired pneumonia in the United States,” by Dian Baker, PhD, RN and Barbara Quinn, MS, RN (https://doi.org/10.1016/j.ajic.2017.08.036). It appears in the American Journal of Infection Control, volume 46, Issue 1 (January 2018).

Authors
Dian Baker, PhD, RN
School of Nursing
California State University

Barbara Quinn, MS, RN
Integrated Quality Services
Sutter Medical Center

About AJIC:American Journal of Infection Control
AJIC: American Journal of Infection Control covers key topics and issues in infection control and epidemiology. Infection preventionists, including physicians, nurses, and epidemiologists, rely on AJIC for peer-reviewed articles covering clinical topics as well as original research. As the official publication of APIC, AJIC is the foremost resource on infection control, epidemiology, infectious diseases, quality management, occupational health, and disease prevention. AJIC also publishes infection control guidelines from APIC and the CDC. Published by Elsevier, AJIC is included in MEDLINE and CINAHL. www.ajicjournal.org

About APIC
APIC’s mission is to create a safer world through prevention of infection. The association’s more than 15,000 members direct infection prevention programs that save lives and improve the bottom line for hospitals and other healthcare facilities. APIC advances its mission through patient safety, implementation science, competencies, and certification, advocacy, and data standardization. Visit APIC online at www.apic.org. Follow APIC on Twitter: www.twitter.com/apic and Facebook: www.facebook.com/APICInfectionPreventionandYou. For information on what patients and families can do, visit APIC’s Infection Prevention and You website at www.apic.org/infectionpreventionandyou.

About Elsevier
Elsevier is a global information analytics business that helps institutions and professionals progress science, advance healthcare and improve performance for the benefit of humanity. Elsevier provides digital solutions and tools in the areas of strategic research management, R&D performance, clinical decision support, and professional education; including ScienceDirect, Scopus, SciVal, ClinicalKey and Sherpath. Elsevier publishes over 2,500 digitized journals, including The Lancet and Cell, more than 35,000 e-book titles and many iconic reference works, including Gray's Anatomy. Elsevier is part of RELX Group, a global provider of information and analytics for professionals and business customers across industries. www.elsevier.com

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