Non-ventilator Hospital-acquired Pneumonia: An Emerging Threat

Non-ventilator hospital-acquired pneumonia (NV-HAP) has long been associated with mostly elderly patients in intensive care units (ICU), but now, a new study has found that half of the patients with these infections are under the age of 65 and most acquire these infections outside of the ICU.

Pneumonia is an infection of the lungs that can occur due to bacterial, viral, or fungal pathogens, and is typically marked by symptoms such as a cough, fever, and difficulty breathing. Worldwide, pneumonia is the leading infectious cause of death in children under the age of 5. The Centers for Disease Control and Prevention (CDC) notes that Streptococcus pneumoniae is a common cause of bacterial pneumonia, and recommends the pneumococcal conjugate vaccine to prevent these infections for all children younger than 2 years old, all adults 65 years or older, and individuals 2 through 64 years old who have certain medical conditions. Vaccines for pertussis (whooping cough), varicella (chickenpox), measles, and influenza can also prevent pneumonia caused by those illnesses.

According to the CDC, there were an estimated 157,000 hospital-associated pneumonia cases in 2011. In hospitals, patients on a ventilator can develop ventilator-associated pneumonia (VAP) if germs in the breathing tube get into a patient’s lungs. Now, in a new study recently published in the American Journal of Infection Control, researchers looked at the incidence and overall burden of NV-HAP in the United States. The authors say that these infections — often associated with elderly patients in the ICU – are understudied and are emerging as a major concern when it comes to patient safety. In fact, the authors note that 32.6 to 35.4 million US patients are at risk for NV-HAP each year, while only 3.6 to 3.9 million are at risk for VAP.

After reviewing patient data to identify NV-HAP cases from 21 US hospitals from January 1, 2014, through December 31 of the same year, the study authors found that half of those pneumonia cases occurred in patients 65 years old and younger, including healthy patients. In addition, only 27.3% of patients acquired NV-HAP in the ICU, contradicting the association that is often made between them. Instead, patients acquire about 7 in 10 cases of NV-HAP outside of the ICU, catching these infections in medical-surgical departments, telemetry, progress care units, oncology, and orthopedic care. The findings suggest that while older patients and those with preexisting health conditions are at higher risk for developing NV-HAP, all patients in all types of hospital units are at some risk.

While pneumonia prevention is emphasized for ICU patients on a ventilator, the authors emphasize that patients in the ICU who are not on a ventilator and those in other units would also benefit from pneumonia prevention programs; too often, these patients don’t receive the therapeutic interventions needed to prevent NV-HAP. Interventions to prevent NV-HAP include oral care, head of the bed evaluation, patient mobility, as well as deep breathing and coughing exercises.

“NV-HAP does not discriminate; all patients across all hospital floors face a risk for acquiring pneumonia,” said the study’s lead author Dian Baker, PhD, RN, in a recent press release. “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.”