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Nonventilator hospital-acquired pneumonia: A call to action

Recommendations from the National Organization to Prevent Hospital-Acquired Pneumonia (NOHAP) among nonventilated patients

Published online by Cambridge University Press:  09 June 2021

Shannon C. Munro Open the ORCID record for Shannon C. Munro [Opens in a new window] ,
Dian Baker Open the ORCID record for Dian Baker [Opens in a new window] ,
Karen K. Giuliano ,
Sheila C. Sullivan Open the ORCID record for Sheila C. Sullivan [Opens in a new window] ,
Judith Haber ,
Barbara E. Jones Open the ORCID record for Barbara E. Jones [Opens in a new window] ,
Matthew B. Crist ,
Richard E. Nelson ,
Evan Carey Open the ORCID record for Evan Carey [Opens in a new window]  and
Olivia Lounsbury
...Show all authors
Shannon C. Munro
Affiliation:
Research and Development, Salem Veterans’ Affairs Medical Center, Salem
Dian Baker
Affiliation:
School of Nursing, California State University, Sacramento, California
Karen K. Giuliano
Affiliation:
College of Nursing & Institute for Applied Life Sciences, University of Massachusetts–Amherst, Amherst, Massachusetts
Sheila C. Sullivan
Affiliation:
Research, Evidence Based Practice and Analytics, Office of Nursing Services, Department of Veterans’ Affairs, Washington, DC
Judith Haber
Affiliation:
Oral Health Nursing Education and Practice, Rory Meyers College of Nursing, New York University, New York, New York
Barbara E. Jones
Affiliation:
Pulmonary & Critical Care Medicine, University of Utah, Salt Lake City, Utah Salt Lake City Veterans’ Affairs Healthcare System, Salt Lake City, Utah
Matthew B. Crist
Affiliation:
Division of Health Care Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Richard E. Nelson
Affiliation:
Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah George E. Wahlen Department of Veterans’ Affairs Medical Center, Salt Lake City, Utah
Evan Carey
Affiliation:
Research and Development, Rocky Mountain Regional Veterans’ Affairs Medical Center, Aurora, Colorado
Olivia Lounsbury
Affiliation:
Patient Safety Movement Foundation, Irvine, California
Michelle Lucatorto
Affiliation:
Office of Nursing Services, Department of Veterans’ Affairs, Washington, DC
Ryan Miller
Affiliation:
Office of Nursing Services, Department of Veterans’ Affairs, Washington, DC
Brian Pauley
Affiliation:
Geriatrics & Extended Care, Veterans’ Affairs Pacific Islands Healthcare System, Honolulu, Hawaii
Michael Klompas*
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston Department of Medicine, Brigham and Women’s Hospital, Boston
*
Author for correspondence: Michael Klompas, E-mail: [email protected]
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Executive summary

In 2020 a group of U.S. healthcare leaders formed the National Organization to Prevent Hospital-Acquired Pneumonia (NOHAP) to issue a call to action to address non–ventilator-associated hospital-acquired pneumonia (NVHAP). NVHAP is one of the most common and morbid healthcare-associated infections, but it is not tracked, reported, or actively prevented by most hospitals. This national call to action includes (1) launching a national healthcare conversation about NVHAP prevention; (2) adding NVHAP prevention measures to education for patients, healthcare professionals, and students; (3) challenging healthcare systems and insurers to implement and support NVHAP prevention; and (4) encouraging researchers to develop new strategies for NVHAP surveillance and prevention. The purpose of this document is to outline research needs to support the NVHAP call to action. Primary needs include the development of better models to estimate the economic cost of NVHAP, to elucidate the pathophysiology of NVHAP and identify the most promising pathways for prevention, to develop objective and efficient surveillance methods to track NVHAP, to rigorously test the impact of prevention strategies proposed to prevent NVHAP, and to identify the policy levers that will best engage hospitals in NVHAP surveillance and prevention. A joint task force developed this document including stakeholders from the Veterans’ Health Administration (VHA), the U.S. Centers for Disease Control and Prevention (CDC), The Joint Commission, the American Dental Association, the Patient Safety Movement Foundation, Oral Health Nursing Education and Practice (OHNEP), Teaching Oral-Systemic Health (TOSH), industry partners and academia.

Type
Commentary
Information
Infection Control & Hospital Epidemiology , Volume 42 , Issue 8 , August 2021 , pp. 991 - 996
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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References

See, I, Chang, J, Gualand, N, et al. Clinical correlates of surveillance events detected by National Healthcare Safety Network pneumonia and lower respiratory tract definitions— Pennsylvania, 2011–2012. Infect Control Hosp Epidemiol 2016;37:818–824.CrossRefGoogle Scholar
Davis, J, Finley, E. A second breadth: hospital-acquired pneumonia in Pennsylvania, nonventilated versus ventilated patients. PA Patient Saf Advis 2018;15:48–59.Google Scholar
Giuliano, KK, Baker, D, Quinn, B. The epidemiology of nonventilator hospital-acquired pneumonia in the United States. Am J Infect Control 2017. doi: 10.1016/j.ajic.2017.09.005.CrossRefGoogle Scholar
Micek, ST, Chew, B, Hampton, N, Kollef, MH. A case–control study assessing the impact of nonventilated hospital-acquired pneumonia on patient outcomes. Chest 2016;150:1008–1014.CrossRefGoogle ScholarPubMed
Ji, W, McKenna, C, Ochoa, A, et al. Development and assessment of objective surveillance definitions for nonventilator hospital-acquired pneumonia. JAMA Netw Open 2019;2:e1913674.CrossRefGoogle ScholarPubMed
Strassle, PD, Sickbert-Bennett, EE, Klompas, M, et al. Incidence and risk factors of non-device-associated pneumonia in an acute-care hospital. Infect Control Hosp Epidemiol 2020;41:73–79.CrossRefGoogle Scholar
Magill, SS, O’Leary, E, Janelle, SJ, et al. Changes in prevalence of health care-associated infections in US hospitals. N Engl J Med 2018;379:1732–1744.CrossRefGoogle Scholar
Zimlichman, E, Henderson, D, Tamir, O, et al. Healthcare-associated infections: a meta-analysis of costs and financial impact on the US healthcare system. JAMA Intern Med 2013;173:2039–2046.CrossRefGoogle Scholar
Hsu, JL, Siroka, AM, Smith, MW, Holodniy, M, Meduri, GU. One-year outcomes of community-acquired and healthcare-associated pneumonia in the Veterans’ Affairs healthcare system. Int J Infect Dis 2011;15:e382–e387.CrossRefGoogle Scholar
Nelson, RE, Samore, MH, Jones, M, et al. Reducing time-dependent bias in estimates of the attributable cost of health care-associated methicillin-resistant Staphylococcus aureus infections: a comparison of three estimation strategies. Med Care 2015;53:827–834.CrossRefGoogle ScholarPubMed
Nelson, RE, Jones, M, Liu, CF, et al. The impact of healthcare-associated methicillin-resistant Staphylococcus aureus infections on postdischarge healthcare costs and utilization across multiple healthcare systems. Health Serv Res 2018;53 suppl 3:5419–5437.CrossRefGoogle Scholar
Arefian, H, Vogel, M, Kwetkat, A, Hartmann, M. Economic evaluation of interventions for prevention of hospital-acquired infections: a systematic review. PLoS One 2016;11:e0146381.CrossRefGoogle ScholarPubMed
Rennert-May, E, Conly, J, Leal, J, Smith, S, Manns, B. Economic evaluations and their use in infection prevention and control: a narrative review. Antimicrob Resist Infect Control 2018;7:31.CrossRefGoogle ScholarPubMed
Dickson, RP, Erb-Downward, JR, Huffnagle, GB. Towards an ecology of the lung: new conceptual models of pulmonary microbiology and pneumonia pathogenesis. Lancet Respir Med 2014;2:238–246.CrossRefGoogle ScholarPubMed
Fine, LS. Nonventilator healthcare-associated pneumonia (NV-HAP): pathogenesis and microbiology of NV-HAP. Am J Infect Control 2020;48:A7–A9.CrossRefGoogle ScholarPubMed
Pettigrew, MM, Tanner, W, Harris, AD. The lung microbiome and pneumonia. J Infect Dis 2020.CrossRefGoogle Scholar
Roulson, J, Benbow, EW, Hasleton, PS. Discrepancies between clinical and autopsy diagnosis and the value of post mortem histology; a meta-analysis and review. Histopathology 2005;47:551–559.CrossRefGoogle ScholarPubMed
Wolfensberger, A, Meier, AH, Kuster, SP, Mehra, T, Meier, MT, Should, Sax H. International Classification of Diseases codes be used to survey hospital-acquired pneumonia? J Hosp Infect 2018;99:81–84.CrossRefGoogle ScholarPubMed
van Mourik, MS, van Duijn, PJ, Moons, KG, Bonten, MJ, Lee, GM. Accuracy of administrative data for surveillance of healthcare-associated infections: a systematic review. BMJ Open 2015;5:e008424.CrossRefGoogle ScholarPubMed
Baker, D, Quinn, B. Hospital-Acquired Pneumonia Prevention Initiative-2: incidence of nonventilator hospital-acquired pneumonia in the United States. Am J Infect Control 2018;46:2–7.CrossRefGoogle ScholarPubMed
Wolfensberger, A, Jakob, W, Faes Hesse, M, et al. Development and validation of a semi-automated surveillance system-lowering the fruit for non–ventilator-associated hospital-acquired pneumonia (nvHAP) prevention. Clin Microbiol Infect 2019;25:1428.e7–1428.e13.CrossRefGoogle ScholarPubMed
Roberts, IS, Benamore, RE, Benbow, EW, et al. Post-mortem imaging as an alternative to autopsy in the diagnosis of adult deaths: a validation study. Lancet 2012;379:136–142.CrossRefGoogle Scholar
Ramirez Batlle, H, Klompas, M. Accuracy and reliability of electronic versus CDC surveillance criteria for nonventilator hospital-acquired pneumonia. Infect Control Hosp Epidemiol 2020;41:219–221.Google Scholar
Klompas, M, Branson, R, Eichenwald, EC, et al. Strategies to prevent ventilator-associated pneumonia in acute-care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014;35:915–936.CrossRefGoogle ScholarPubMed
Quinn, B, Baker, DL, Cohen, S, Stewart, JL, Lima, CA, Parise, C. Basic nursing care to prevent nonventilator hospital-acquired pneumonia. J Nurs Scholarsh 2014;46:11–19.CrossRefGoogle ScholarPubMed
Cassidy, MR, Rosenkranz, P, Macht, RD, Talutis, S, McAneny, D. The I COUGH multidisciplinary perioperative pulmonary care program: one decade of experience. J Qual Patient Saf 2020;46:241–249.CrossRefGoogle ScholarPubMed
Sopena, N, Sabria, M. Multicenter study of hospital-acquired pneumonia in non-ICU patients. Chest 2005;127:213–219.CrossRefGoogle ScholarPubMed
Brogan, E, Langdon, C, Brookes, K, Budgeon, C, Blacker, D. Dysphagia and factors associated with respiratory infections in the first week post stroke. Neuroepidemiology 2014;43:140–144.CrossRefGoogle ScholarPubMed
Lacerna, CC, Patey, D, Block, L, et al. A successful program preventing nonventilator hospital-acquired pneumonia in a large hospital system. Infect Control Hosp Epidemiol 2020;41:547–552.CrossRefGoogle Scholar
Kaneoka, A, Pisegna, JM, Miloro, KV, et al. Prevention of healthcare-associated pneumonia with oral care in individuals without mechanical ventilation: a systematic review and meta-analysis of randomized controlled trials. Infect Control Hosp Epidemiol 2015;36:899–906.CrossRefGoogle ScholarPubMed
Brogan, E, Langdon, C, Brookes, K, Budgeon, C, Blacker, D. Respiratory infections in acute stroke: nasogastric tubes and immobility are stronger predictors than dysphagia. Dysphagia 2014;29:340–345.CrossRefGoogle ScholarPubMed
Heo, SM, Haase, EM, Lesse, AJ, Gill, SR, Scannapieco, FA. Genetic relationships between respiratory pathogens isolated from dental plaque and bronchoalveolar lavage fluid from patients in the intensive care unit undergoing mechanical ventilation. Clin Infect Dis 2008;47:1562–1570.CrossRefGoogle ScholarPubMed
Hamuro, A, Kawaguchi, H, Yamazoe, K, Honda, M, Tanaka, R. Oral care and prevention of pneumonia in hospitalized patients with psychiatric disorders in Japan. Jpn Clin Med 2017;8:1179670717720407.CrossRefGoogle ScholarPubMed
Akutsu, Y, Matsubara, H, Okazumi, S, et al. Impact of preoperative dental plaque culture for predicting postoperative pneumonia in esophageal cancer patients. Dig Surg 2008;25:93–97.CrossRefGoogle ScholarPubMed
Fox, J, Frush, K, Chamness, C, Malloy, J, Hyde, S. Preventing hospital-acquired pneumonia (HAP) outside of the ventilator-associated pneumonia bundle. Prevent Strateg 2015;Fall:45–48.Google Scholar
Warren, C, Medei, MK, Wood, B, Schutte, D. A nurse-driven oral care protocol to reduce hospital-acquired pneumonia. Am J Nurs 2019;119:44–51.CrossRefGoogle ScholarPubMed
Juthani-Mehta, M, Van Ness, PH, McGloin, J, et al. A cluster-randomized controlled trial of a multicomponent intervention protocol for pneumonia prevention among nursing home elders. Clin Infect Dis 2015;60:849–857.CrossRefGoogle ScholarPubMed
Klompas, M, Speck, K, Howell, MD, Greene, LR, Berenholtz, SM. Reappraisal of routine oral care with chlorhexidine gluconate for patients receiving mechanical ventilation: systematic review and meta-analysis. JAMA Intern Med 2014;174:751–761.CrossRefGoogle ScholarPubMed
Price, R, MacLennan, G, Glen, J. Selective digestive or oropharyngeal decontamination and topical oropharyngeal chlorhexidine for prevention of death in general intensive care: systematic review and network meta-analysis. BMJ 2014;348:g2197.CrossRefGoogle ScholarPubMed
Stenlund, M, Sjodahl, R, Pia Yngman-Uhlin, RN. Incidence and potential risk factors for hospital-acquired pneumonia in an emergency department of surgery. Int J Qual Health Care 2017;29:290–294.CrossRefGoogle Scholar
Teodoro, CR, Breault, K, Garvey, C, et al. STEP-UP: study of the effectiveness of a patient ambulation protocol. Medsurg Nurs 2016;25:111–116.Google ScholarPubMed
Fan, E, Dowdy, DW, Colantuoni, E, et al. Physical complications in acute lung injury survivors: a two-year longitudinal prospective study. Crit Care Med 2014;42:849–859.CrossRefGoogle ScholarPubMed
Hopkins, RO, Miller, RR, 3rd, Rodriguez, L, Spuhler, V, Thomsen, GE. Physical therapy on the wards after early physical activity and mobility in the intensive care unit. Phys Ther 2012;92:1518–1523.CrossRefGoogle ScholarPubMed
Stolbrink, M, McGowan, L, Saman, H, et al. The early mobility bundle: a simple enhancement of therapy which may reduce incidence of hospital-acquired pneumonia and length of hospital stay. J Hosp Infect 2014;88:34–39.CrossRefGoogle ScholarPubMed
Herzig, SJ, Howell, MD, Ngo, LH, Marcantonio, ER. Acid-suppressive medication use and the risk for hospital-acquired pneumonia. JAMA 2009;301:2120–2128.CrossRefGoogle ScholarPubMed
Krag, M, Marker, S, Perner, A, et al. Pantoprazole in patients at risk for gastrointestinal bleeding in the ICU. N Engl J Med 2018;379:2199–2208.CrossRefGoogle ScholarPubMed
Wren, SM, Martin, M, Yoon, JK, Bech, F. Postoperative pneumonia-prevention program for the inpatient surgical ward. J Am Coll Surg 2010;210:491–495.CrossRefGoogle ScholarPubMed
Kane, RL, Shamliyan, TA, Mueller, C, Duval, S, Wilt, TJ. The association of registered nurse staffing levels and patient outcomes: systematic review and meta-analysis. Med Care 2007;45:1195–1204.CrossRefGoogle ScholarPubMed
Munro, S, Haile-Mariam, A, Greenwell, C, Demirci, S, Farooqi, O, Vasudeva, S. Implementation and dissemination of a Department of Veterans’ Affairs oral care initiative to prevent hospital-acquired pneumonia among nonventilated patients. Nurs Adm Qtrly 2018;42:363–372.CrossRefGoogle Scholar
Wood, W, Tschannen, D, Trotsky, A, et al. A mobility program for an inpatient acute-care medical unit. Am J Nursing 2014;114:7.CrossRefGoogle ScholarPubMed