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

Abstract

Aim RCT to evaluate the efficacy of multi-component interventions for prevention of hospital-acquired pneumonia in hospitalized older patients. Findings The multi-component interventions did not reduce hospital-acquired pneumonia but increased the mean time to next hospitalisation due to respiratory infection (11.5 months vs. 9.5 months; P = 0.049), and reduced the risk of hospitalisation in 1 year (18.6% vs. 34.4%; P = 0.049). This was likely due to the increased recognition of oropharyngeal dysphagia (35.6% vs. 20.3%; P < 0.001) and improved influenza (54.5% vs 17.2%; P < 0.001) and pneumococcal vaccination rates (52.5% vs. 20.3%; P < 0.001). Message A multi-component intervention for nosocomial pneumonia may not significantly reduce the incidence of hospitalacquired pneumonia but significantly increases the frequency of diagnosis of oropharyngeal dysphagia, improves vaccination rates and can reduce future hospitalisations for respiratory infections in older adults.

Decreased Hospital-Acquired Respiratory Infections among elder Inpatients in General Hospital during the COVID-19 Pandemic

“…In our study, the incidence of hospital acquired respiratory infections was similar to reports from other countries, which was ranging from 1-4.7%. The annual incidence rate of HAIs in a teaching hospital in the south of Iran was 1.46% [8,9] .A study to quantify the incidence and in uence of NV-HAP in the United States using a national dataset showed that the incidence of NV-HAP was 1.6% [9] .A randomized, parallelgroup, controlled trial about elder patients in a tertiary hospital geriatric unit in US showed the incidence of nosocomial pneumonia was4.7% [10] . A 3-year surveillance study on the epidemiological and clinical characteristics of healthcare associated-infections (HAIs) in elderly inpatients in a large tertiary hospital in China showed the incidence of the lower respiratory tract infection was 0.85% [11] .…”

“…However, this study had only 4 hospital acquired pneumonia patients, making the study under-powered. [10] Despite poor outcome caused by hospital acquired respiratory infection [9,14] , few studies paid special attention to non-ventilator-associated pneumonia in hospitalized patients. Some investigators have called for increased attention and resources for this underappreciated health care associated infection.…”

Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022 Update

“…One small randomized trial of usual care versus a bundle comprising dysphagia screening, oral care with chlorhexidine, placing the bed in the reverse Trendelenburg position, and vaccination against influenza and pneumococcus reported no difference in NV-HAP rates, length of stay, or mortality but did report a lower 1-year risk of readmission for respiratory infection. 316 in Vietnam found that semirecumbent position was associated with no difference in pneumonia rates but more frequent complications including the need for tracheostomy. 317 The generalizability of these findings to nontetanus patients in other settings is unknown.…”

Validation of the Hospital Frailty Risk Score in older adults hospitalized with community‐acquired pneumonia

“…16,23 The 109 ICD codes can be found in Supplementary Information 2. Patients were categorized into three frailty risk groups: high risk (>15), intermediate risk (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15), and low risk (<5) of frailty, as described by Gilbert et al 16 Hospitalization utilization included length of stay (LOS), where long LOS was defined as ≥7 days, and 30-day emergency hospital re-admissions. Mortality was reviewed during the hospital admission and at 30 days, 90 days and 1 year from the date of hospital admission.…”

“…11 Frail older adults have a poorly functioning immune system, reduced airway clearance, altered bronchial epithelium and multiple longterm conditions increasing their risk of pneumonia, and are more likely to have underlying dysphagia. 9 Early identification of dysphagia in older patients can be significantly improved with the use of a respiratory prevention bundle compared with standard care, 12 which suggests that early identification of frailty can highlight these "at-risk" patients and trigger further in-depth assessment of the patient, such as through a Comprehensive Geriatric Assessment (CGA).…”