Identifying patients at increased risk of non-ventilator-associated pneumonia on admission to hospital: a pragmatic prognostic screening tool to trigger preventative action
Identifying patients at increased risk of non-ventilator-associated pneumonia on admission to hospital: a pragmatic prognostic screening tool to trigger preventative action
Background: non-ventilator healthcare-associated pneumonia (NV-HAP) is an important healthcare-associated infection. This study tested the feasibility of using routine admission data to identify those patients at high risk of NV-HAP who could benefit from targeted, preventive interventions.
Methods: patients aged ≥64 years who developed NV-HAP five days or more after admission to elderly-care wards, were identified by retrospective case note review together with matched controls. Data on potential predictors of NV-HAP were captured from admission records. Multi-variate analysis was used to build a prognostic screening tool (PRHAPs); acceptability and feasibility of the tool was evaluated.
Results: a total of 382 cases/381 control patients were included in the analysis. Ten predictors were included in the final model; nine increased the risk of NV-HAP (OR between 1.68 and 2.42) and one (independent mobility) was protective (OR 0.48; 95% CI 0.30–0.75). The model correctly predicted 68% of the patients with and without NV-HAP; sensitivity 77%; specificity 61%. The PRHAPs tool risk score was 60% or more if two predictors were present and over 70% if three were present. An expert consensus group supported incorporating the PRHAPs tool into electronic logic systems as an efficient mechanism to identify patients at risk of NV-HAP and target preventative strategies.
Conclusions: this prognostic screening (PRHAPs) tool, applied to data routinely collected when a patient is admitted to hospital, could enable staff to identify patients at greatest risk of NV-HAP, target scarce resources in implementing a prevention care bundle, and reduce the use of antimicrobial agents.
Healthcare-associated pneumonia, Infection prevention, Prognostic screening, Risk factors, Risk score, Prognosis, Humans, Risk Factors, Healthcare-Associated Pneumonia/diagnosis, Hospitals, Pneumonia, Ventilator-Associated/prevention & control, Aged, Retrospective Studies, Cross Infection/epidemiology
49-57
Wilson, J.
3ec53fe6-cf2e-4b32-9551-70205c8e42ed
Griffin, H.
e9f49928-e0e9-44af-9de9-6fb575d32429
Görzig, A.
220a1c79-fdc0-404f-b15f-8d4b390e6072
Prieto, J.
47dd42cd-35d5-4ece-8fc6-fdb8fe1f01cc
Saeed, K.
87cb67e5-71e8-4759-bf23-2ea00ebd8b39
Garvey, M.I.
f68927d3-4d6d-45dc-ab4a-81e44b056e65
Holden, E.
c5383b01-2a5e-4bf3-b2e8-6e8602c349eb
Tingle, A.
02866aea-dba1-4240-af6f-48055cee8f7c
Loveday, H.
7ad981e9-bae4-484a-8c16-88c85451b56f
December 2023
Wilson, J.
3ec53fe6-cf2e-4b32-9551-70205c8e42ed
Griffin, H.
e9f49928-e0e9-44af-9de9-6fb575d32429
Görzig, A.
220a1c79-fdc0-404f-b15f-8d4b390e6072
Prieto, J.
47dd42cd-35d5-4ece-8fc6-fdb8fe1f01cc
Saeed, K.
87cb67e5-71e8-4759-bf23-2ea00ebd8b39
Garvey, M.I.
f68927d3-4d6d-45dc-ab4a-81e44b056e65
Holden, E.
c5383b01-2a5e-4bf3-b2e8-6e8602c349eb
Tingle, A.
02866aea-dba1-4240-af6f-48055cee8f7c
Loveday, H.
7ad981e9-bae4-484a-8c16-88c85451b56f
Wilson, J., Griffin, H., Görzig, A., Prieto, J., Saeed, K., Garvey, M.I., Holden, E., Tingle, A. and Loveday, H.
(2023)
Identifying patients at increased risk of non-ventilator-associated pneumonia on admission to hospital: a pragmatic prognostic screening tool to trigger preventative action.
Journal of Hospital Infection, 142, .
(doi:10.1016/j.jhin.2023.09.020).
Abstract
Background: non-ventilator healthcare-associated pneumonia (NV-HAP) is an important healthcare-associated infection. This study tested the feasibility of using routine admission data to identify those patients at high risk of NV-HAP who could benefit from targeted, preventive interventions.
Methods: patients aged ≥64 years who developed NV-HAP five days or more after admission to elderly-care wards, were identified by retrospective case note review together with matched controls. Data on potential predictors of NV-HAP were captured from admission records. Multi-variate analysis was used to build a prognostic screening tool (PRHAPs); acceptability and feasibility of the tool was evaluated.
Results: a total of 382 cases/381 control patients were included in the analysis. Ten predictors were included in the final model; nine increased the risk of NV-HAP (OR between 1.68 and 2.42) and one (independent mobility) was protective (OR 0.48; 95% CI 0.30–0.75). The model correctly predicted 68% of the patients with and without NV-HAP; sensitivity 77%; specificity 61%. The PRHAPs tool risk score was 60% or more if two predictors were present and over 70% if three were present. An expert consensus group supported incorporating the PRHAPs tool into electronic logic systems as an efficient mechanism to identify patients at risk of NV-HAP and target preventative strategies.
Conclusions: this prognostic screening (PRHAPs) tool, applied to data routinely collected when a patient is admitted to hospital, could enable staff to identify patients at greatest risk of NV-HAP, target scarce resources in implementing a prevention care bundle, and reduce the use of antimicrobial agents.
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Accepted/In Press date: 17 September 2023
e-pub ahead of print date: 10 October 2023
Published date: December 2023
Additional Information:
Funding Information: this research was funded by the Healthcare Infection Society. Major Research Grant. MRG 20/18/004. The views expressed in this publication are those of the authors and not necessarily those of the Healthcare Infection Society.
Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.
Keywords:
Healthcare-associated pneumonia, Infection prevention, Prognostic screening, Risk factors, Risk score, Prognosis, Humans, Risk Factors, Healthcare-Associated Pneumonia/diagnosis, Hospitals, Pneumonia, Ventilator-Associated/prevention & control, Aged, Retrospective Studies, Cross Infection/epidemiology
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Local EPrints ID: 485484
URI: http://eprints.soton.ac.uk/id/eprint/485484
ISSN: 0195-6701
PURE UUID: 136f8c7d-a1e1-4670-b262-488f9545a7f8
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Date deposited: 07 Dec 2023 17:34
Last modified: 18 Mar 2024 03:52
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Author:
J. Wilson
Author:
H. Griffin
Author:
A. Görzig
Author:
K. Saeed
Author:
M.I. Garvey
Author:
E. Holden
Author:
A. Tingle
Author:
H. Loveday
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