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Incidence and risk factors of non–device-associated pneumonia in an acute-care hospital

Published online by Cambridge University Press:  29 October 2019

Paula D. Strassle
Affiliation:
Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Emily E. Sickbert-Bennett
Affiliation:
Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Department of Hospital Epidemiology, University of North Carolina Medical Center, Chapel Hill, North Carolina
Michael Klompas
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
Jennifer L. Lund
Affiliation:
Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Paul W. Stewart
Affiliation:
Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Ashley H. Marx
Affiliation:
Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, North Carolina
Lauren M. DiBiase
Affiliation:
Department of Hospital Epidemiology, University of North Carolina Medical Center, Chapel Hill, North Carolina
David J. Weber
Affiliation:
Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Department of Hospital Epidemiology, University of North Carolina Medical Center, Chapel Hill, North Carolina
Corresponding

Abstract

Objective:

To update current estimates of non–device-associated pneumonia (ND pneumonia) rates and their frequency relative to ventilator associated pneumonia (VAP), and identify risk factors for ND pneumonia.

Design:

Cohort study.

Setting:

Academic teaching hospital.

Patients:

All adult hospitalizations between 2013 and 2017 were included. Pneumonia (device associated and non–device associated) were captured through comprehensive, hospital-wide active surveillance using CDC definitions and methodology.

Results:

From 2013 to 2017, there were 163,386 hospitalizations (97,485 unique patients) and 771 pneumonia cases (520 ND pneumonia and 191 VAP). The rate of ND pneumonia remained stable, with 4.15 and 4.54 ND pneumonia cases per 10,000 hospitalization days in 2013 and 2017 respectively (P = .65). In 2017, 74% of pneumonia cases were ND pneumonia. Male sex and increasing age we both associated with increased risk of ND pneumonia. Additionally, patients with chronic bronchitis or emphysema (hazard ratio [HR], 2.07; 95% confidence interval [CI], 1.40–3.06), congestive heart failure (HR, 1.48; 95% CI, 1.07–2.05), or paralysis (HR, 1.72; 95% CI, 1.09–2.73) were also at increased risk, as were those who were immunosuppressed (HR, 1.54; 95% CI, 1.18–2.00) or in the ICU (HR, 1.49; 95% CI, 1.06–2.09). We did not detect a change in ND pneumonia risk with use of chlorhexidine mouthwash, total parenteral nutrition, all medications of interest, and prior ventilation.

Conclusion:

The incidence rate of ND pneumonia did not change from 2013 to 2017, and 3 of 4 nosocomial pneumonia cases were non–device associated. Hospital infection prevention programs should consider expanding the scope of surveillance to include non-ventilated patients. Future research should continue to look for modifiable risk factors and should assess potential prevention strategies.

Type
Original Article
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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References

Magill, SS, Edwards, JR, Bamberg, W, et al. Multistate point-prevalence survey of health care-associated infections. N Engl J Med 2014;370:11981208.CrossRefGoogle ScholarPubMed
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;379:17321744.CrossRefGoogle Scholar
Klevens, RM, Edwards, JR, Richards, CL Jr., et al. Estimating health care-associated infections and deaths in U.S. Hospitals, 2002. Public Health Rep 2007;122:160166.CrossRefGoogle Scholar
Zimlichman, E, Henderson, D, Tamir, O, et al. Health care-associated infections: a meta-analysis of costs and financial impact on the us health care system. JAMA Intern Med 2013;173:20392046.CrossRefGoogle ScholarPubMed
Calfee, DP, Farr, BM. Infection control and cost control in the era of managed care. Infect Control Hosp Epidemiol 2002;23:407410.CrossRefGoogle ScholarPubMed
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;35:915936.CrossRefGoogle ScholarPubMed
Weber, DJ, Sickbert-Bennett, EE, Brown, V, Rutala, WA. Completeness of surveillance data reported by the national healthcare safety network: an analysis of healthcare-associated infections ascertained in a tertiary care hospital, 2010. Infect Control Hosp Epidemiol 2012;33:9496.CrossRefGoogle Scholar
DiBiase, LM, Weber, DJ, Sickbert-Bennett, EE, Anderson, DJ, Rutala, WA. The growing importance of non–device-associated healthcare-associated infections: a relative proportion and incidence study at an academic medical center, 2008–2012. Infect Control Hosp Epidemiol 2014;35:200202.CrossRefGoogle ScholarPubMed
Davis, J, Finley, D. The breadth of hospital-acquired pneumonia: nonventilated versus ventilated patients in Pennsylvania. Penn Patient Safety Advisory 2012;9:99105.Google Scholar
Giuliano, KK, Baker, D, Quinn, B. The epidemiology of nonventilator hospital-acquired pneumonia in the United States. Am J Infect Control 2018;46:322327.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;46:27.CrossRefGoogle ScholarPubMed
See, I, Chang, J, Gualandi, N, et al. Clinical correlates of surveillance events detected by national healthcare safety network pneumonia and lower respiratory infection definitions-Pennsylvania, 2011–2012. Infect Control Hosp Epidemiol 2016;37:818824.CrossRefGoogle ScholarPubMed
Klompas, M. Hospital-acquired pneumonia in nonventilated patients: the next frontier. Infect Control Hosp Epidemiol 2016;37:825826.CrossRefGoogle ScholarPubMed
Passaro, L, Harbarth, S, Landelle, C. Prevention of hospital-acquired pneumonia in non-ventilated adult patients: a narrative review. Antimicrob Resist Infect Control 2016;5:43.CrossRefGoogle ScholarPubMed
Kanamori, H, Weber, DJ, DiBiase, LM, et al. Longitudinal trends in all healthcare-associated infections through comprehensive hospital-wide surveillance and infection control measures over the past 12 years: substantial burden of healthcare-associated infections outside of intensive care units and “other” types of infection. Infect Control Hosp Epidemiol 2015;36:11391147.CrossRefGoogle Scholar
Klompas, M. Complications of mechanical ventilation—the CDC’s new surveillance paradigm. N Engl J Med 2013;368:14721475.CrossRefGoogle Scholar
Deyo, RA, Cherkin, DC, Ciol, MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 1992;45:613619.CrossRefGoogle ScholarPubMed
Quan, H, Sundararajan, V, Halfon, P, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 2005;43:11301139.CrossRefGoogle ScholarPubMed
Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine for adults with immunocompromising conditions: recommendations of the Advisory Committee on Immunization Practices (ACIP). Morb Mortal Wkly Rep 2012;61:816819.Google Scholar
Greenberg, JA, Hohmann, SF, Hall, JB, Kress, JP, David, MZ. Validation of a method to identify immunocompromised patients with severe sepsis in administrative databases. Ann Am Thorac Soc 2016;13:253258.Google ScholarPubMed
Subbe, CP, Kruger, M, Rutherford, P, Gemmel, L. Validation of a modified early warning score in medical admissions. QJM 2001;94:521526.CrossRefGoogle ScholarPubMed
Morse, JM, Morse, RM, Tylko, SJ. Development of a scale to identify the fall-prone patient. Can J Aging 1989;8:366377.CrossRefGoogle Scholar
Morse, JM, Black, C, Oberle, K, Donahue, P. A prospective study to identify the fall-prone patient. Soc Sci Med 1989;28:8186.CrossRefGoogle ScholarPubMed
Lee, EW, Wei, LJ, Amato, DA, Leurgans, S. Cox-type regression analysis for large numbers of small groups of correlated failure time observations. In: Klein, JP, Goel, PK, eds. Survival Analysis: State of the Art. Dordrecht: Springer Netherlands; 1992: 237247.CrossRefGoogle Scholar
Fine, JP, Gray, RJ. A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc 1999;94:496509.CrossRefGoogle Scholar
Seaman, SR, White, IR. Review of inverse probability weighting for dealing with missing data. Stat Methods Med Res 2013;22:278295.CrossRefGoogle ScholarPubMed
Howe, CJ, Cole, SR, Westreich, DJ, Greenland, S, Napravnik, S, Eron, JJ Jr. Splines for trend analysis and continuous confounder control. Epidemiology 2011;22:874875.CrossRefGoogle ScholarPubMed
Wasserstein, RL, Lazar, NA. The ASA’s statement on p-values: context, process, and purpose. Am Stat 2016;70:129133.CrossRefGoogle Scholar
Wasserstein, RL, Schirm, AL, Lazar, NA. Moving to a world beyond “p < 0.05.” Am Stat 2019;73:119.CrossRefGoogle Scholar
Chastre, J, Fagon, JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med 2002;165:867903.CrossRefGoogle ScholarPubMed
Rello, J, Ollendorf, DA, Oster, G, et al. Epidemiology and outcomes of ventilator-associated pneumonia in a large US database. Chest 2002;122:21152121.CrossRefGoogle Scholar
Jackson, ML, Neuzil, KM, Thompson, WW, et al. The burden of community-acquired pneumonia in seniors: results of a population-based study. Clin Infect Dis 2004;39:16421650.CrossRefGoogle ScholarPubMed
Herzig, SJ, LaSalvia, MT, Naidus, E, et al. Antipsychotics and the risk of aspiration pneumonia in individuals hospitalized for nonpsychiatric conditions: a cohort study. J Am Geriatr Soc 2017;65:25802586.CrossRefGoogle ScholarPubMed
Dzahini, O, Singh, N, Taylor, D, Haddad, PM. Antipsychotic drug use and pneumonia: systematic review and meta-analysis. J Psychopharmacol 2018;32:11671181.CrossRefGoogle ScholarPubMed
Warren, C, Medei, MK, Wood, B, Schutte, D. A nurse-driven oral care protocol to reduce hospital-acquired pneumonia. Am J Nurs 2019;119:4451.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;46:1119.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 Q 2018;42:363372.CrossRefGoogle Scholar
Deschepper, M, Waegeman, W, Eeckloo, K, Vogelaers, D, Blot, S. Effects of chlorhexidine gluconate oral care on hospital mortality: a hospital-wide, observational cohort study. Intensive Care Med 2018;44:10171026.CrossRefGoogle ScholarPubMed

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