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Semin Respir Crit Care Med 2002; 23(5): 489-496
DOI: 10.1055/s-2002-35720
DOI: 10.1055/s-2002-35720
Nonpharmacological Prevention of Hospital-Acquired Pneumonia
Further Information
Publication History
Publication Date:
25 November 2002 (online)
ABSTRACT
Hospital-acquired pneumonia (HAP) is the most common nosocomial infection occurring among mechanically ventilated patients. The benefits associated with the systematic prevention of HAP include fewer infections with high-risk antibiotic-resistant bacteria, lower rates of hospital mortality, reduced medical care costs, and shorter hospital lengths of stay. Unfortunately, many hospitals do not have an organized approach to the prevention of HAP. This review will describe the nonpharmacological approaches available for the prevention of HAP. It should help clinicians to design their own strategies for the prevention of this important hospital-acquired infection.
KEYWORDS
Hospital-acquired pneumonia - mechanical ventilation - ventilator-associated pneumonia
REFERENCES
- 1 Kollef M H. The prevention of ventilator-associated pneumonia: an evidence-based approach. N Engl J Med . 1999; 340 627-634
- 2 Simmons B, Bryant J, Neiman K, Spencer L, Arheart K. The role of handwashing in prevention of endemic intensive care unit infections. Infect Control Hosp Epidemiol . 1990; 11 589-594
- 3 Kjolen H, Andersen B M. Handwashing and disinfection of heavily contaminated hands-effective or ineffective?. J Hosp Infect . 1992; 21 61-71
- 4 Doebbeling B N, Stanley G L, Sheetz C T. Comparative efficacy of alternative hand-washing agents in reducing nosocomial infections in intensive care units. N Engl J Med . 1992; 327 88-93
- 5 Hartstein A I, Rashad A L, Liebler J M. Multiple intensive care unit outbreak of Acinetobacter calcoaceticus subspecies anitratus respiratory infection and colonization associated with contaminated, reusable ventilator circuits and resuscitation bags. Am J Med . 1988; 85 624-631
- 6 Archibald L K, Manning M L, Bell L M, Banerjee S, Jarvis W R. Patient density, nurse-to-patient ratio and nosocomial infection risk in a pediatric cardiac intensive care unit. Ped Infect Dis J . 1997; 16 1045-1048
- 7 Fridkin S K, Pear S M, Williamson T H, Galgiani J, Jarvis W R. The role of understaffing in central venous catheter-associated bloodstream infections. Infect Control Hosp Epidemiol . 1996; 17 150-158
- 8 Pittet D, Mourouga P, Perneger T V. Compliance with handwashing in a teaching hospital. Ann Intern Med . 1999; 130 126-130
- 9 Zaragoza M, Salles M, Gomez J, Bayas J M, Trilla A. Handwashing with soap or alcoholic solutions?. <~>A randomized clinical trial of its effectiveness. Am J Infect Control . 1999; 27 258-61
- 10 Maury E, Alzieu M, Baudel J L. Availability of an alcohol solution can improve hand disinfection compliance in an intensive care unit. Am J Respir Crit Care Med . 2000; 162 324-327
- 11 Klein B S, Perloff W H, Maki D G. Reduction of nosocomial infection during pediatric intensive care by protective isolation. N Engl J Med . 1989; 320 1714-1721
- 12 Hartstein A I, Denny M A, Morthland V H, LeMonte A M, Pfaller M A. Control of methicillin-resistant Staphylococcus aureus in a hospital and an intensive care unit. Infect Control Hosp Epidemiol . 1995; 16 405-411
- 13 Slaughter S, Hayden M K, Nathan C. A comparison of the effect of universal use of gloves and gowns with that of glove use alone on acquisition of vancomycin-resistant enterococci in a medical intensive care unit. Ann Intern Med . 1996; 125 448-456
- 14 Gleeson K, Eggli D F, Maxwell S L. Quantitative aspiration during sleep in normal subjects. Chest . 1997; 111 1266-1272
- 15 Ibanez J, Penafiel A, Raurich J M, Marse P, Jorda R, Mata F. Gastroesophageal reflux in intubated patients receiving enteral nutrition: effect of supine and semirecumbent positions. J Parenteral and Enteral Nutrition . 1992; 16 419-422
- 16 Orozco-Levi M, Torres A, Ferrer M. Semirecumbent position protects from pulmonary aspiration but not completely from gastroesophageal reflux in mechanically ventilated patients. Am J Respir Crit Care Med . 1995; 152 1387-1390
- 17 Torres A, Serra-Battles J, Ros E. Pulmonary aspiration of gastric contents in patients receiving mechanical ventilation: the effect of body position. Ann Intern Med . 1992; 116 540-543
- 18 Drakulovic M B, Torres A, Bauer T T, Nicolas J M, Nogue S, Ferrer M. Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial. Lancet . 1999; 354 1851-1858
- 19 Bergmans D C, Bonten M JM, Gaillard C A. Prevention of ventilator-associated pneumonia by oral decontamination: a prospective, randomized, double-blind, placebo-controlled study. Am J Respir Crit Care Med . 2001; 164 382-388
- 20 Rouby J J, Laurent P, Gosnach M. Risk factors and clinical relevance of nosocomial maxillary sinusitis in the critically ill. Am J Respir Crit Care Med . 1994; 150 776-783
- 21 Meduri G U, Mauldin G L, Wunderink R G. Causes of fever and pulmonary densities in patients with clinical manifestations of ventilator-associated pneumonia. Chest . 1994; 106 221-235
- 22 Scannapieco F A, Stewart E M, Mylotte J M. Colonization of dental plaque by respiratory pathogens in medical intensive care patients. Crit Care Med . 1992; 20 740-745
- 23 Craven D E, Goularte T A, Make B J. Contaminated condensate in mechanical ventilator circuits: a risk factor for nosocomial pneumonia?. Am Rev Respir Dis . 1984; 129 625-628
- 24 Holzapfel L, Chevret S, Madinier G. Influence of long-term oro- or nasotracheal intubation on nosocomial maxillary sinusitis and pneumonia: results of a prospective, randomized, clinic trial. Crit Care Med . 1993; 21 1132-1138
- 25 Niederman M S, Craven D E. Devising strategies for preventing nosocomial pneumonia: should we ignore the stomach?. Clin Infect Dis . 1997; 24 320-323
- 26 Bonten M J, Gaillard C A, de Leeuw W P, Stobberingh E E. Role of colonization of the upper intestinal tract in the pathogenesis of ventilator-associated pneumonia. Clin Infect Dis . 1997; 24 309-319
- 27 Montejo J C. Enteral nutrition-related gastrointestinal complications in critically ill patients: a multicenter study. The Nutrition and Metabolic Working Group of the Spanish Society of Intensive Care Medicine and Coronary Units. Crit Care Med . 1999; 27 1447-1453
- 28 Mentec H, Dupont H, Bocchetti M, Cani P, Ponche F, Bleichner G. Upper digestive intolerance during enteral nutrition in critically ill patients: frequency, risk factors, and complications. Crit Care Med . 2001; 219 1955-1961
- 29 Marian M, Rappaport W, Cunningham D. The failure of conventional methods to promote spontaneous transpyloric feeding tube passage and the safety of intragastric feeding in the critically ill ventilated patient. Surg Gynecol Obstetr . 1993; 176 475-479
- 30 Metheny N A, Eisenberg P, Spies M. Aspiration pneumonia in patients fed through nasoenteral tubes. Heart Lung . 1986; 15 256-261
- 31 Treloar D M, Stechmiller J. Pulmonary aspiration in tube-fed patients with artificial airways. Heart Lung . 1984; 13 667-671
- 32 Montecalvo M A, Steger K A, Farber H W. Nutritional outcome and pneumonia in critical care patients randomized to gastric versus jejeunal tube feedings. Crit Care Med . 1992; 20 281-288
- 33 Moore F A, Moore E E, Jones T N, McCroskey B L, Peterson V M. TEN versus TPN following major abdominal trauma-reduced septic morbidity. J Trauma . 1989; 29 916-923
- 34 Cook D J, De Jonghe B, Heyland D K. The relation between nutrition and nosocomial pneumonia: randomized trials in critically ill patients. Crit Care . 1997; 1 3-9
- 35 Heyland D K, Drover J W, MacDonald S, Novak F, Lam M. Effect of postpyloric feeding on gastroesophageal regurgitation and pulmonary microaspiration: results of a randomized controlled trial. Crit Care Med . 2001; 29 1495-1501
- 36 Boivin M A, Levy H. Gastric feeding with erythromycin is equivalent to transpyloric feeding in the critically ill. Crit Care Med . 2001; 29 1916-1919
- 37 Kearns P J, Chin D, Mueller L, Wallace K, Jensen W A, Kirsch C M. The incidence of ventilator-associated pneumonia and success in nutrient delivery with gastric versus small intestinal feeding: a randomized clinical trial. Crit Care Med . 2000; 28 1742-1746
- 38 Ibrahim E H, Mehringer L, Prentice D. Early- versus late-onset enteral feeding of mechanically ventilated medical patients: results of a clinical trial. JPEN . 2002; 26 174-181
- 39 Dreyfuss D, Djedaini K, Weber P. Prospective study of nosocomial pneumonia and of patient and circuit colonization during mechanical ventilation with circuit changes every 48 hours versus no change. Am Rev Resp Dis . 1991; 143 738-743
- 40 Kollef M H, Shapiro S D, Fraser V J. Mechanical ventilation with or without 7-day circuit changes: a randomized controlled trial. Ann Intern Med . 1995; 123 168-174
- 41 Long M N, Wickstrom G, Grimes A, Benton C F, Belcher B, Stamm A M. Prospective, randomized study of ventilator-associated pneumonia in patients with one versus three ventilator circuit changes per week. Infect Control Hosp Epidemiol . 1996; 17 14-19
- 42 Han J N, Liu Y P, Ma S. Effects of decreasing the frequency of ventilator circuit changes to every 7 days on the rate of ventilator-associated pneumonia in a Beijing hospital. Respir Care . 2001; 46 891-896
- 43 Hess D, Burns E, Romagnoli D, Kacmarek R M. Weekly ventilator circuit changes: a strategy to reduce costs without affecting pneumonia rates. Anesthesiology . 1995; 82 903-911
- 44 Fink J B, Krause S A, Barrett L, Schaaff D, Alex C G. Extending ventilator circuit change interval beyond 2 days reduces the likelihood of ventilator-associated pneumonia. Chest . 1998; 113 405-411
- 45 Kotilainen H R, Keroack M A. Cost analysis and clinical impact of weekly ventilator circuit changes in patients in intensive care unit. Am J Infect Control . 1997; 25 117-120
- 46 Lareau S C, Ryan K J, Diener C F. The relationship between frequency of ventilator circuit changes and infectious hazard. Am Rev Respir Dis . 1978; 118 493-496
- 47 Craven D E, Connolly Jr G M, Lichtenberg D A, Primeau P J, McCabe W R. Contamination of mechanical ventilators with tubing changes every 24 hours or 48 hours. N Engl J Med . 1982; 306 1505-1509
- 48 Malecka-Griggs B, Kennedy C, Ross B. Microbial burdens in disposable and nondisposable ventilator circuits used for 24 and 48 hours in intensive care units. J Clin Microbiol . 1989; 27 495-503
- 49 Gorman L J, Sanai L, Notman A W, Grant I S, Masterton R G. Cross infection in an intensive care unit by Klebsiella pneumoniae from ventilator condensate. J Hosp Infect . 1993; 23 27-34
- 50 Gilmour I J, Boyle M J, Streifel A, McComb R C. The effects of circuit and humidifier type on contamination potential during mechanical ventilation: a laboratory study. Am J Infect Control . 1995; 23 65-72
- 51 Craven D E, Lichtenberg D A, Goularte T A, Make B J, McCabe W R. Contaminated medication nebulizers in mechanical ventilator circuits: source of bacterial aerosols. Am J Med . 1984; 77 834-838
- 52 Ricard J D, Markowicz P, Djedaini K, Mier L, Coste F, Dreyfuss D. Bedside evaluation of efficient airway humidification during mechanical ventilation of the critically ill. Chest . 1999; 115 1646-1652
- 53 Decker M D, Lancaster A D, Latham R H, Bunce C P, Becker N R, Burns K. Influence of closed suctioning system on ventilator-associated pneumonias. Abstracts of the Third Annual Meeting of the Society for Hospital Epidemiology of
America 1993: A6
Reference Ris Wihthout Link
- 54 Deppe S A, Kelly J W, Thoi L L. Incidence of colonization, nosocomial pneumonia, and mortality in critically ill patients using a Trach Care closed-suction system versus an open-suction system: prospective, randomized study. Crit Care Med . 1990; 18 1389-1393
- 55 Ritz R, Scott L R, Coyle M B, Pierson D J. Contamination of a multiple-use suction catheter in a closed-circuit system compared to contamination of a disposable, single-use suction catheter. Respir Care . 1986; 31 1087-1091
- 56 Prentice D, Weilitz P B, Fraser V J. A prospective randomized trial comparing outcomes of closed versus open suctioning system. Crit Care Med . 1994; 22 A92
- 57 Johnson K L, Kearney P A, Johnson S B, Niblett J B, McMillan N L, McClain R E. Closed versus open endotracheal suctioning: costs and physiologic consequences. Crit Care Med . 1994; 22 658-666
- 58 Depew C L, Moseley M J, Clark E G, Morales C C. Open- versus closed-system endotracheal suctioning: a cost comparison. Crit Care Nurse . 1994; 14 94-100
- 59 Cobley M, Atkins M, Jones F L. Environmental contamination during tracheal suction: a comparison of disposable conventional catheters with a multiple-use closed system device. Anesthesia . 1991; 46 957-961
- 60 Kollef M H, Prentice D, Shapiro S D. Mechanical ventilation with or without daily changes of in-line suction catheters. Am J Respir Crit Care Med . 1997; 156 466-472
- 61 Branson R D, Chatburn R L. Humidification of inspired gases during mechanical ventilation. Respir Care . 1993; 38 461-468
- 62 Kirton O C, DeHaven B, Morgan J P, Morejon O, Civetta J M. A prospective randomized comparison of an in-line heat moisture exchange filter and heated wire humidifiers: rates of ventilator-associated (community-acquired) or late-onset (hospital acquired) pneumonia and incidence of endotracheal tube occlusion. Chest . 1997; 112 1055-1059
- 63 Greene R, Thompson S, Jantsch H S. Detection of pooled secretions above endotracheal-tube cuffs: value of plain radiographs in sheep cadavers and patients. Am J Roentgenol . 1994; 163 1333-1337
- 64 Rello J, Sonora R, Jubert P, Artigas A, Rue M, Valles J. Pneumonia in intubated patients: role of respiratory airway care. Am J Respir Crit Care Med . 1996; 154 111-115
- 65 Mahul P, Auboyer C, Jospe R. Prevention of nosocomial pneumonia in intubated patients: respective role of mechanical subglottic secretions drainage and stress ulcer prophylaxis. Intensive Care Med . 1992; 18 20-25
- 66 Valles J, Artigas A, Rello J. Continuous aspiration of subglottic secretions in preventing ventilator-associated pneumonia. Ann Intern Med . 1995; 122 179-186
- 67 Kollef M H, Skubas N J, Sundt T M. A randomized clinical trial of continuous aspiration of subglottic secretions in cardiac surgery patients. Chest . 1999; 116 1339-1346
- 68 Smulders K, van der Hoeven H, Weers-Pothoff. A randomized clinical trial of intermittent subglottic secretion drainage in mechanically ventilated patients. Chest . 2002; 121 858-862
- 69 Cook D J, Hebert P C, Heyland D K. How to use an article on therapy or prevention: pneumonia prevention using subglottic secretion drainage. Crit Care Med . 1997; 25 1502-1513
- 70 Shorr A F, O'Malley P G. Continuous subglottic suctioning for the prevention of ventilator-associated pneumonia: potential economic implications. Chest . 2001; 119 228-235
- 71 Pingleton S K. Complications of acute respiratory failure. Am Rev Respir Dis . 1988; 137 1463-1493
- 72 Anzueto A, Peters J I, Seidner S R, Cox W J, Schroeder W, Coalson J J. Effects of continuous bed rotation and prolonged mechanical ventilation on healthy, adult baboons. Crit Care Med . 1997; 25 1560-1564
- 73 Fink M P, Helsmoortel C M, Stein K L, Lee P C, Cohn S M. The efficacy of an oscillating bed in the prevention of lower respiratory tract infection in critically ill victims of blunt trauma: a prospective study. Chest . 1990; 97 132-137
- 74 Gentilello L, Thompson D A, Tonnesen A S. Effect of rotating bed on the incidence of pulmonary complications in critically ill patients. Crit Care Med . 1988; 16 783-786
- 75 Summer W R, Curry P, Haponik E F, Nelson S, Elston R. Continuous mechanical turning of intensive care unit patients shortens length of stay in some diagnostic-related groups. J Crit Care . 1989; 4 45-53
- 76 de Boisblanc P B, Castro M, Everret B, Grender J, Walker C D, Summer W R. Effect of air-supported continuous postural oscillation on the risk of early ICU pneumonia in nontraumatic critical illness. Chest . 1993; 103 1543-1547
- 77 Whiteman K, Nachtmann L, Kramer D, Sereika S, Bierman M. Effects of continuous lateral rotation therapy on pulmonary complications in liver transplant patients. Am J Crit Care . 1995; 4 133-139
- 78 Kollef M H. Outcomes research as a tool for defining the role of respiratory care practitioners in the intensive care unit setting. New Horizons . 1998; 6 91-98
- 79 Inglis T J. New insights into the pathogenesis of ventilator-associated pneumonia. J Hosp Infect . 1995; 30 409-413
- 80 Inglis T J, Lim T M, Ng M L, Tang E K, Hui K P. Structural features of tracheal tube biofilm formed during prolonged mechanical ventilation. Chest . 1995; 108 1049-1052
- 81 Stewart P S. Theoretical aspects of antibiotic diffusion into microbial biofilms. Antimicrobial Agents Chemotherapy . 1996; 40 2517-2522
- 82 Gorman S, Adair C, O'Neill F, Goldsmith C, Webb H. Influence of selective decontamination of the digestive tract on microbial biofilm formation on endotracheal tubes from artificially ventilated patients. European J Clin Microbiol Infect Dis . 1993; 12 9-17
- 83 Stickler D J, Morris N S, Williams T J. An assessment of the ability of a silver-releasing device to prevent bacterial contamination of urethral catheter drainage systems. Brit J Urology . 1996; 78 579-588
- 84 Jansen B, Kohnen W. Prevention of biofilm formation by polymer modification. J Industrial Microbiol . 1995; 15 391-396
- 85 Olson M E, Harmon B G, Kollef M H. Silver-coated endotracheal tubes associated with reduced bacterial burden in the lungs of mechanically ventilated dogs. Chest . 2002; 121 863-870
- 86 Berwick D M. Continuous improvement as an idea in healthcare. N Engl J Med . 1989; 320 53-56
- 87 Joiner G A, Salisbury D, Bollin G E. Utilizing quality assurance as a tool for reducing the risk of nosocomial ventilator-associated pneumonia. Am J Medical Quality . 1996; 11 100-103
- 88 Kelleghan S I, Salemi C, Padilla S. An effective continuous quality improvement approach to the prevention of ventilator-associated pneumonia. Am J Infect Control . 1993; 21 322-330
- 89 Boyce J M, White R L, Spruill E Y. Cost-effective application of the Centers for Disease Control Guidelines for Prevention of Nosocomial Pneumonia. Am J Infect Control . 1985; 13 228-232
- 90 Gaynes R P, Solomon S. Improving hospital-acquired infection rates: the CDC experience. Joint Commission Journal on Quality Improvement . 1996; 22 457-467
- 91 Kollef M H, Horst H M, Prang L. Reducing the duration of mechanical ventilation: three examples of change in the intensive care unit. New Horizons . 1998; 6 52-60
- 92 Zack J E, Garrison T, Trovillion E. Effect of an education program aimed at reducing the occurrence of ventilator-associated pneumonia (in press). Crit Care Med 2002;
- 93 Hilbert G, Gruson D, Vargas F. Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure. N Engl J Med . 2001; 344 481-487
- 94 Girou E, Schortgen F, Delclaux C. Association of noninvasive ventilation with nosocomial infections and survival in critically ill patients. JAMA . 2000; 284 2361-2367
- 95 Nourdine K, Combes P, Carton M J, Beuret P, Cannamela A, Ducreux J C. Does noninvasive ventilation reduce the ICU nosocomial infection risk? A prospective
clinical survey. Intensive Care Med 1999 25: 567-573
Reference Ris Wihthout Link
- 96 Ely E W, Baker A M, Dunagan D P. Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. N Engl J Med . 1996; 335 1864-1869
- 97 Kollef M H, Shapiro S D, Silver P. A randomized, controlled trial of protocol-directed versus physician-directed weaning from mechanical ventilation. Crit Care Med . 1997; 25 567-574