Advertisement

Non-ventilator health care-associated pneumonia (NV-HAP)

      Abstract

      This guide is intended for IPs, nurses, and others who are involved in infection prevention efforts across the continuum of care. It reviews current literature, suggested prevention strategies, and potential tools and techniques to guide surveillance, detection, and prevention efforts for NV-HAP

      Key Words

      A 2015 study by Magill and colleagues found that 35% of healthcare-associated pneumonia diagnoses in the United States were classified as ventilator-associated pneumonia (VAP) and 65% were classified as non-ventilator healthcare-associated pneumonia (NV-HAP).
      • Magill S
      • O'Leary E
      • Janelle SJ
      • et al.
      Changes in prevalence of health care–associated infections in U.S. hospitals.
      Point prevalence studies from Europe also identified healthcare-associated pneumonia as the most common healthcare-associated infection.
      European Centre for Disease Prevention and Control
      Point Prevalence Survey of Healthcare Associated Infections and Antimicrobial use in European Acute Care Hospitals.
      A 2019 report from the Australian Commission on Safety and Quality in Australian hospitals reported that pneumonia and aspiration pneumonia were high-priority targets in preventing avoidable readmissions.

      Australian Commission on Safety and Quality in Health Care. The state of patient safety and quality in Australian hospitals2019. Available at: https://www.safetyandquality.gov.au/publications-and-resources/state-patient-safety-and-quality-australian-hospitals-2019. Accessed December 6, 2019.

      Data suggest that patients with VAP and those with NV-HAP have an equal risk of mortality.
      • Findley D
      A second breadth: hospital-acquired pneumonia in Pennsylvania, non-ventilated versus ventilated patients.
      A recent case-control study found that patients with NV-HAP are more likely to die in the hospital compared to patients with VAP.
      • Micek ST
      • Chew B
      • Hampton N
      • et al.
      A case-control study assessing the impact of nonventilated hospital-acquired pneumonia on patient outcomes.
      In 2016, See and colleagues published the results of a retrospective analysis of 250 adults and children with either pneumonia or lower respiratory tract infection as detected by IPs in 8 Pennsylvania hospitals.
      • See I
      • Chang J
      • Gualandi N
      • et al.
      Clinical correlates of surveillance events detected by National Healthcare Safety Network pneumonia and lower respiratory infection definition—Pennsylvania, 2011–2012.
      (The state of Pennsylvania requires tracking of all healthcare-associated infections.) Expert personnel from the Centers for Disease Control and Prevention and the Pennsylvania Department of Health reviewed these patients’ charts to confirm pneumonia and other respiratory diseases. The reviewers also looked for clinical diagnoses assigned at the time of pneumonia to assess the clinical significance of these surveillance events. Although many of the signs and symptoms were subjectively based on current definitions, the investigators identified a mortality rate of 31% in patients with confirmed NV-HAP. These epidemiological studies suggest that NV-HAP mortality can range from 15% to 31%.
      • Findley D
      A second breadth: hospital-acquired pneumonia in Pennsylvania, non-ventilated versus ventilated patients.
      • Micek ST
      • Chew B
      • Hampton N
      • et al.
      A case-control study assessing the impact of nonventilated hospital-acquired pneumonia on patient outcomes.
      • See I
      • Chang J
      • Gualandi N
      • et al.
      Clinical correlates of surveillance events detected by National Healthcare Safety Network pneumonia and lower respiratory infection definition—Pennsylvania, 2011–2012.
      In addition, in a 2018 article, Giuliano and colleagues reported an overall incidence of NV-HAP of 1.6%, reflecting a rate of 3.63 cases per 1,000 patient-days. In addition, they noted that NV-HAP was associated with increased hospital charges, a longer length of stay, and a greater likelihood of death than comparison groups.
      • Giulaino K
      • Baker D
      • Quinn B
      Incidence of non-ventilator hospital-acquired pneumonia in the United States.
      These findings underscore the importance of attention to NV-HAP. However, NV-HAP seems to be understudied and underreported, and most hospitals only conduct surveillance and prevention programs for VAP. Currently, few hospitals track or are actively engaged in strategies to prevent NV-HAP.
      • Klompas M
      Hospital-acquired pneumonia in nonventilated patients: the next frontier.
      In a 2019 APIC position statement on NV-HAP, authors called for a standardized NV-HAP prevention bundle. They acknowledged the challenges in tracking and preventing NV-HAP given the lack of consensus guidelines for a bundle and the challenges in identifying cases and standardizing surveillance protocols. The authors concluded that there is an urgent need to reduce the incidence of NV-HAP, and they recommended supporting improvement efforts and establishing prevalence rates through surveillance of high-risk patients and high-risk settings.

      Association for Professionals in Infection Control and Epidemiology. APIC practice position statement: non-ventilator healthcare-associated pneumonia (NV-HAP). Available at:https://apic.org/wp-content/uploads/2019/10/PositionPaper_NVHAP_2019_v3.pdf. Published 2019. Accessed October 31, 2019.

      Scope of guide

      This guide is intended for IPs, nurses, and others who are involved in infection prevention efforts across the continuum of care. It reviews current literature, suggested prevention strategies, and potential tools and techniques to guide surveillance, detection, and prevention efforts for NV-HAP. The guide covers NV-HAP in all areas where healthcare is delivered (ie, both inpatient and outpatient settings).
      Key Points
      • NV-HAP is a serious concern.
        • Mortality may be as high as 31%.
        • Incidence of NV-HAP is almost twice the incidence of VAP.
        • Data underscore the importance of increased attention to NV-HAP.
      • NV-HAP is understudied.
        • VAP tends to be the primary focus of research on pneumonia.
        • Surveillance data on NV-HAP are limited.
        • There have been few NV-HAP prevention projects.
      • NV-HAP is a worldwide issue.
        • In the US, NV-HAP is one of the top-two most prevalent HAIs.
        • European incidence of NV-HAP is comparable to US incidence.

      References

        • Magill S
        • O'Leary E
        • Janelle SJ
        • et al.
        Changes in prevalence of health care–associated infections in U.S. hospitals.
        N Engl J Med. 2018; 379: 1732-1744
        • European Centre for Disease Prevention and Control
        Point Prevalence Survey of Healthcare Associated Infections and Antimicrobial use in European Acute Care Hospitals.
        ECDC, Stockholm, Sweden2013
      1. Australian Commission on Safety and Quality in Health Care. The state of patient safety and quality in Australian hospitals2019. Available at: https://www.safetyandquality.gov.au/publications-and-resources/state-patient-safety-and-quality-australian-hospitals-2019. Accessed December 6, 2019.

        • Findley D
        A second breadth: hospital-acquired pneumonia in Pennsylvania, non-ventilated versus ventilated patients.
        Pa Patient Saf Advis. 2018; 15 (Available at:http://patientsafety.pa.gov/ADVISORIES/Pages/201809_NVHAP.aspx. Accessed December 6, 2019): 1-12
        • Micek ST
        • Chew B
        • Hampton N
        • et al.
        A case-control study assessing the impact of nonventilated hospital-acquired pneumonia on patient outcomes.
        Chest. 2016; 150: 1008-1014
        • See I
        • Chang J
        • Gualandi N
        • et al.
        Clinical correlates of surveillance events detected by National Healthcare Safety Network pneumonia and lower respiratory infection definition—Pennsylvania, 2011–2012.
        Infect Control Hosp Epidemiol. 2016; 37: 818-824
        • Giulaino K
        • Baker D
        • Quinn B
        Incidence of non-ventilator hospital-acquired pneumonia in the United States.
        Am J Infect Control. 2018; 46: 322-327
        • Klompas M
        Hospital-acquired pneumonia in nonventilated patients: the next frontier.
        Infect Control Hosp Epidemiol. 2016; 37: 825-826
      2. Association for Professionals in Infection Control and Epidemiology. APIC practice position statement: non-ventilator healthcare-associated pneumonia (NV-HAP). Available at:https://apic.org/wp-content/uploads/2019/10/PositionPaper_NVHAP_2019_v3.pdf. Published 2019. Accessed October 31, 2019.

      Linked Article

      • Erratum
        American Journal of Infection ControlVol. 48Issue 8
        • Preview
          In the article “IMPLEMENTATION GUIDE: Non-Ventilator Healthcare-Associated Pneumonia (NV-HAP).” by Linda Greene. in the May supplement of the American Journal of Infection Control (2020;48(5S):A1-2) reference 4 was incorrectly cited.
        • Full-Text
        • PDF