Becker's Clinical Quality & Infection Control

18 Executive Briefing: Non-ventilator hospital-acquired pneumonia Sponsored by E ach year, approximately 1.7 million healthcare-associated infections occur in U.S. hospitals, affecting 5 to 10 percent of the nation's hospitalized patients annually, according to the Centers for Disease Control and Prevention. HAIs can take the form of surgical site infections, hospital-acquired pneumonia, ventilator-associated pneumonia, catheter-associated urinary tract infections and central-line associated bloodstream infec- tions, among others. The rising cost of healthcare, the growing concern of resistant strains of infection and quality of life issues have all prompted increased scrutiny on the acquisition of healthcare-associated infections. Organizations that monitor hospital quality, accredita- tion and reimbursement have implemented programs specifically designed to prevent and reduce the incidence of HAIs, therefore, HAIs have become a high-priority issue for healthcare executives. Hospitals are now required to not only monitor and report certain HAIs, their reimbursement may be reduced or withheld if the re- ported rates do not improve. In recent years, there have been decreases in many device-relat- ed infections such as VAP, due in part to the newfound focus on HAIs. While hospitals were focused on prevention, early recogni- tion and treatment of VAP, overall hospital-acquired pneumonia rates were a less significant focus, but were increasing. A 2012 study in The New England Journal of Medicine led by Shelley Magill, MD, PhD, demonstrated that more than 60 percent of hos- pital-acquired pneumonia occurs in non-ventilated patients. This rate represents a significant opportunity for hospitals to improve healthcare quality, lower the cost of care and avoid reimburse- ment penalties. Key opinion leaders are taking notice. "For years now, hospitals have focused heavily on ventilator-associated pneumonia," says Joyce Ryan, DNP, RN, director of the Department of Clinical Af- fairs for Sage Products. "It was the only term you would ever hear, and people make the assumption that only patients on vents were getting pneumonia." It is true that being on a ventilator dramatically increases the risk of a patient getting pneumonia. In fact, being on a ventilator is the "primary risk factor for the development of hospital-associated bacterial pneumonia," according to 2003 Guidelines for Prevent- ing Health-Care-Associated Pneumonia from the CDC. While it has long been known that mechanical ventilation is a significant risk factor for hospital-acquired pneumonia, several studies have recently found that the incidence of non-ventilator HAP has been largely unmonitored and under-recognized. A 2012 study published in the American Journal of Infection Con- trol, "Clinical Attributes of Non-Ventilator-Associated Hospital-Ac- quired Pneumonia," called the condition "underreported and un- studied" and found the illness is "an emerging factor in prolonged hospital stays [and] patient morbidity." Researchers also noted an increased cost of around $40,000 for each case of hospital- acquired pneumonia. Another study published in 2012 by the Pennsylvania Patient Safety Authority, "The Breadth of Hospital-Acquired Pneumonia: Nonventilated versus Ventilated Patients in Pennsylvania," made the case for increased focus on non-ventilator HAP, as research- ers found the number of non-ventilator HAP cases surpassed the number of ventilator-associated infections from 2009 through 2011. Additionally, non-ventilator HAP "has the potential to be- come more costly than VAP [ventilator-associated pneumonia]," the researchers found. The bottom line is "more and more patients are in the hospital with pneumonia that is not associated with a ventilator," says Trudy Robertson RN, MSN, a clinical nurse specialist with Fraser Health Neurosurgery in New Westminster, British Columbia. Changes should be made so non-ventilator HAP can be monitored as dili- gently as VAP. Are you addressing the hidden issue affecting more patients at a greater cost than VAP? "More and more, patients are in the hospital with pneumonia that is not associated with a ventilator." — Trudy Robertson RN, MSN, clinical nurse specialist with Fraser Health Neurosurgery in New Westminster, British Columbia

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