Nosocomial pneumonia decreases significantly after implementing a preventive protocol

What are nosocomial infections?

Nosocomial infections are infections acquired while a patient is in a health care environment, such as hospitals, clinics, ambulatory care centers or nursing homes. These infections are caused by microorganisms and in many cases can be prevented.

The prevention of nosocomial infections is based on compliance with standard precautions such as hand hygiene, among other measures on the part of healthcare professionals. In fact, most hospitals have equipment dedicated to the prevention, surveillance and control of nosocomial infections.

What is nosocomial pneumonia?

Nosocomial pneumonia is one of the first causes of nosocomial infection. Although its incidence is greater in the case of patients admitted to intensive care units (ICU) because they are intubated in many cases, more than half of the cases occur in conventional hospitalization areas.

The majority of studies on nosocomial pneumonia have been carried out in ICUs, although in recent years there has been increased interest in nosocomial pneumonia in general hospitalization units.

In fact, it is difficult to know the real incidence of nosocomial pneumonia outside the ICUs due to the dispersion of cases in the hospitals themselves, the possible presentation of the infection after a hospital discharge, the lack of optimal diagnostic criteria and the difficulty in making the etiological diagnosis.

Results of the research carried out

The initial objective of this line of research led by Dr. Sopena, a doctor in the nosocomial infection control group at the Germans Trias Hospital and a researcher at the Fight Infections Foundation, is to examine the incidence, risk factors and prognosis of Nosocomial pneumonia acquired in general hospitalization units.

In a multicenter study carried out by this group in 12 Spanish hospitals, the average incidence of nosocomial pneumonia in general hospitalization units was 3±1.4 cases/1000 admissions. 57.1% of cases presented complications (mainly respiratory failure), 9.2% required admission to the ICU and 32.7% died (27.7% related to pneumonia). The hospital stay of patients with nosocomial pneumonia increased by 26.3 days compared to controls and 32.8% were discharged from long-stay centers.

The prevention of nosocomial pneumonia in general hospitalization units is based on a series of measures such as the detection of dysphagia, oral hygiene, reduction of sedation when possible or early mobilization. However, there is not enough scientific evidence of the usefulness of these strategies, whether applied alone or in combination. Furthermore, although most of these preventive measures are part of standard care, compliance is not often assessed.

This paper published in the American Journal of Infection Control evaluates in a pilot way the efficiency of the multidisciplinary intervention, based on the implementation of various measures to reduce the incidence of nosocomial pneumonia outside the ICU and the determination of compliance with preventive measures.

Study conclusions

The incidence of nosocomial pneumonia outside the ICU decreased significantly after the implementation of this multidisciplinary strategy based on basic care procedures and reaching training processes for staff. This reduction coincided with greater adherence to most measures.

Dr. Sopena comments: “Although the detection of nosocomial pneumonia in conventional hospitalization units still needs to be improved, the implementation of a preventive protocol greatly reduces its incidence.” Likewise, Ella Sopena adds that the prevention of this pneumonia should be based on interventions that modify individual risk factors, such as the risk of aspiration. Efforts to improve adherence to preventive measures are essential to reduce the incidence of nosocomial pneumonia.