While ventilator-associated pneumonia (VAP) is well recognized, non-ventilator hospital-acquired pneumonia (NV-HAP) poses a significant and often overlooked risk for patients.
Non-ventilator hospital-acquired pneumonia affects patients who are not mechanically ventilated and remains one of the most common yet under-recognized healthcare-associated infections (HAI).
While many hospital-acquired infections have seen reductions thanks to targeted prevention programs, NV-HAP has not received the same level of attention. Despite its association with increased length of stay, antimicrobial use, and patient morbidity and mortality, NV-HAP is not always tracked.
Preventing hospital-acquired pneumonia is difficult because the surveillance needed is further complicated by subjective, non-standardized criteria and NV-HAP's broad impact across hospitalized populations.
The cost of non-ventilator hospital-acquired pneumonia
Hospital-acquired pneumonias (HAPs) impose a significant financial burden on the U.S. healthcare system, with total costs, including post-acute and long-term care, reaching an estimated $3 billion annually. While VAP has been the focus of extensive research and prevention efforts, NV-HAP has only recently begun receiving meaningful attention. This supports expanding surveillance beyond device-related metrics to better capture overall patient harm.
As a result, this preventable condition continues to drive up healthcare costs and strain resources. With an average additional cost of $20,189 per case, NV-HAP places a significant financial strain on hospitals, driven by longer patient stays, increased treatments, and higher readmission rates.
A study published in JAMA Network Open in 2023 examined over six million hospital admissions across 284 hospitals and, using an electronic surveillance criterion, discovered the following:
- About 1 in 200 patients developed NV-HAP
- NV-HAP is attributed to 1 in 14 hospital deaths
- A 22% mortality rate was associated with NV-HAP
- Patients’ length of stay increased by 13 days
- Patient outcomes: 20% of patients with NV-HAP were discharged to skilled nursing care, 8% to hospice, 38% to home
In May 2022, the Society for Healthcare Epidemiology of America (SHEA) included NV-HAP in their updated "Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and non-ventilator hospital-acquired pneumonia in acute-care hospitals: 2022 Update" and offers updated, practical recommendations for infection preventionists (IPs) and hospital leaders to consider. Although CDC’s National Health Safety Network (NHSN) does not yet have an NV-HAP module, IPs may consider using the existing pneumonia (PNU) criteria and adapt as needed to identify NV-HAPs not associated with mechanical ventilation.
Modifiable and non-modifiable risks in hospital-acquired pneumonia prevention
Knowing the potential outcomes of NV-HAP, it’s important to understand the risk factors. These include:
- Older age
- Multiple comorbidities; especially cancer, chronic kidney and lung disease, and congestive heart failure.
- Altered mental status
- Dysphagia and/or history of aspiration
- The presence of nasogastric or orogastric tubes
- Prolonged hospitalization
- Poor mobility
Understanding the risk factors for NV-HAP is critical for targeted prevention efforts. While some are non-modifiable, others like poor mobility, dysphagia, and prolonged hospitalization, can be addressed through proactive interventions. Identifying and mitigating these modifiable risks can significantly reduce the incidence of NV-HAP and improve patient outcomes.
Strategies for preventing hospital-acquired pneumonia
To date, robust strategies to prevent NV-HAP are limited, but some interventions have some data to support their benefits. These include:
- Oral care: Additionally, daily toothbrushing supports dental health.
- Dysphagia identification and management: Identify and manage patients with difficulty swallowing, particularly in neurologically impaired patients.
- Early mobility programs
- Infection prevention to prevent viral infections during hospitalization: These include symptom screening, transmission-based precautions, and vaccination among others.
- Additional strategies include elevating the head of the patient’s bed, reducing the use of acid-suppressing medications, and minimizing sedating medication.
While robust data is still limited, implementing these evidence-based strategies can improving patient safety and reducing NV-HAP rates.
Non-ventilator hospital-acquired pneumonia prevention at your hospital
Don’t wait for surveillance of NV-HAP to be mandated. Consider reviewing current evidence to guide NV-HAP surveillance and assess its incidence in your hospital. Use resources to promote strategies among hospital leadership and staff, such as this one-pager developed by the Agency for Healthcare Research and Quality NV-HAP Prevention: Essential Practices. Creating preventive measures to prevent NV-HAP not only improves patient outcomes, decreases the length of stay, and reduces readmissions due to pneumonia, but also alleviates the significant financial strain that NV-HAP places on hospitals.
Preventing hospital-acquired pneumonia by adding the tracking of NV-HAPs means one more thing for your infection prevention team to review. With Sentri7 Infection Prevention, infection preventionists reduce the time spent reviewing charts by setting up customizable rules that monitor and identify at-risk patients, allowing them to focus more on patient outcomes.
