Incidence and Predictors of Nonventilator Hospital–Acquired Pneumonia in a Community Hospital

Abstract

Background: Nonventilator hospital–acquired pneumonia (NV-HAP) is a common hospital-acquired condition that is amenable to basic nursing care interventions. Purpose: The purpose of this study was to determine the incidence of NV-HAP in a California community hospital and to identify the patient and nursing care factors including missed nursing care associated with its development. Methods: A retrospective study identified possible NV-HAP cases with ICD-10 (International Classification of Diseases, Tenth Revision) codes and then validated cases using Centers for Disease Control and Prevention confirmatory criteria. Results: The incidence of NV-HAP in our hospital was 0.64 cases per 1000 patient-days. Patient factors most strongly associated with NV-HAP were age (each year of increased age was associated with a 4% increased likelihood of developing NV-HAP) (OR = 1.04-1.07) and the presence of underlying disease, which reduced odds of developing NV-HAP by 36% (OR = 0.36; 95% CI, 0.12-0.98). Head-of-bed elevation reduced by 26% the odds of developing NV-HAP (OR = 0.26; 95% CI, 0.07-0.08). Conclusions: NV-HAP can be predicted and potentially prevented. Paradoxically, the presence of underlying disease was not positively associated with the development of NV-HAP in this study.

Risk Factors on Healthcare-Associated Infections Among Hospitalized Tuberculosis Patients in China From 2001- 2020: A Systematic Review and Meta-Analysis

“…Prolonged hospitalization stay extends the exposure to HAIs among TB hospitalized patients, which is con rmed in some studies (30,31). TB hospitalized patients who stay longer in hospital are more likely to have underlying disease or complications or invasive procedure and so on (32,33). As previously mentioned, they promote the probability of the exposure to HAIs for TB hospitalized patients.…”

The impact of “missed nursing care” or “care not done” on adults in health care: A rapid review for the Consensus Development Project

“…Their Average Length of Stay in hospital was 24 days and 25% were readmitted within 30 days. In a similar US study situated within a community hospital in California Patty et al., ( 2020 ) reported that elevated bed heads reduced NV‐HAP by 26%, but there was no association with mouth care, ambulation, deep breading exercises, use of spirometry or mouth care (Patty et al., 2020 ). The difficulty in establishing direct causation between missed care and adverse events is spelt out by Kalánková et al, who distinguish between the risk of adverse events and direct evidence/causation.…”

“…A more recent study conducted in California with patients with several comorbidities indicated that they were less likely to experience an adverse event. In this case the authors argued that nurses were less likely to miss care where they knew the patient was vulnerable (Patty et al., 2020 ).…”

“…This rapid review explored the question; what is the impact of “missed nursing care” for adult patients? Four outcomes were identified in the research literature, with three addressed here: patient mortality (Schubert et al., 2012 ), adverse events (Brooks‐Carthon et al., 2016 ; Liu et al., 2016 ; Patty et al., 2020 ) and failure to maintain (Bail & Grealish, 2016 ). The fourth factor, patient satisfaction is not addressed here.…”

Evaluation of multi-component interventions for prevention of nosocomial pneumonia in older adults: a randomized, controlled trial

“…Reverse Trendelenburg is a novel aspect of this study, and was well tolerated by patients. Patient positioning during hospitalisation is gaining momentum as a preventative strategy, with twice-daily elevation of the head of the bed shown to reduce pneumonia by 26% outside of an ICU setting [42]. The majority of studies and guidelines aimed at preventing hospital acquired pneumonia have utilized semi-recumbent positioning of 30°-45° [4,19,[42][43][44] but it is conceivable that intra-abdominal pressure and gastro-oesphageal aspiration would be reduced using reverse Trendelenburg positioning compared to elevation of the head of the bed.…”