Practices to prevent non-ventilator hospital-acquired pneumonia: a narrative review

Nosocomial infection has significant consequences in health care, both at the individual level due to increased morbidity and mortality, and at the organizational level due to increased costs. Hospital-acquired pneumonia (HAP) is the most common nosocomial infection, and is associated with high excess mortality, frequent use of broad-spectrum antimicrobials and increased length of stay. This review explores the preventative strategies that have been examined in non-ventilator HAP (NV-HAP). The management of aspiration risk, interventions for oral hygiene, role of mobilization and physiotherapy, modification of environmental factors, and vaccination are discussed. Many of these interventions are low risk, acceptable to patients and have good cost-benefit ratios. However, the evidence base for prevention of NV-HAP is weak. This review identifies the lack of a unified research definition, under-recruitment to studies, and variation in intervention and outcome measures as limitations in the existing literature. Given that the core risk factors for acquisition of NV-HAP are increasing, there is an urgent need for research to address the prevention of NV-HAP. This review calls for a unified definition of NV-HAP, and identification of a core outcome set for studies in NV-HAP, and suggests future directions for research in NV-HAP. Improving care for people with NV-HAP will reduce morbidity, mortality and healthcare costs significantly.