Nonventilator hospital-acquired pneumonia (NV-HAP) is one of the most prevalent and deadly hospital-acquired infections (HAI) and significantly affects patient outcomes. Findings from a 2023 study conducted in 284 US hospitals revealed that NV-HAP contributed to 1 in 14 hospital deaths, posing an inpatient mortality rate of 22.4%. Furthermore, NV-HAP was linked to substantial morbidity and mortality, incidence of sepsis, extended hospital stays, increased transfers to skilled nursing facilities and hospice, higher expenses, and greater intensive care unit (ICU) utilization.
The Centers for Disease Control and Prevention (CDC) acknowledged the harm inflicted by HAIs in 1965 through the Comprehensive Hospital Infections Project (CHIP). Consequently, several hospitals willingly established infection control programs. This approach resulted in a demand for healthcare professionals specializing in infection control, leading to the development of new professional specializations and HAI-focused professional organizations. Research on central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), and surgical site infections (SSIs) emerged as part of these efforts.
Lamentably, the most common of the HAIs, NV-HAP, does not feature among the conditions addressed by the National Healthcare Safety Network (NHSN) and Centers for Medicare & Medicaid Services (CMS) hospital-acquired condition penalty payment system, even today. This omission demands an understanding of why NV-HAP was excluded and why its presence continues to be inconspicuous, even when it is a significant issue in plain sight.
Studies suggest that the prevention of NV-HAP infection lies in maintaining the oral microbiota, which serves as a primary source for the development of pneumonia. Hospitalization changes the oral microbiota within its first 48 hours, thereby elevating the risk of pneumonia. Commendably, several studies conducted over the past two decades demonstrate that evidence-based oral hygiene programs can avert this risk by mitigating the negative shift in oral flora during hospitalisation.
One major barrier to NV-HAP prevention resides in the challenges associated with its diagnosis. Diagnostic ambiguity, predominantly owing to complications in obtaining direct cultures for establishing infection, leads to the neglect of pneumonia in hospital HAI prevention strategies, a strategy mandated by the NHSN. That said, the past few years have ushered in new methods offering precise and efficient surveillance.
Hospitals are intricate systems fraught with multiple competing demands, rendering the implementation of oral hygiene for NV-HAP prevention challenging indeed. However, despite the magnitude of these challenges, evidence-based protocols and supportive toolkits offer valuable solutions. Moreover, acknowledging the crucial role of oral hygiene in maintaining patient health can effectively alleviate the challenges of NV-HAP prevention. Therefore, the onus lies with healthcare providers to prioritize oral health, employ accurate and efficient diagnostic tools and implement robust preventive strategies to combat this pervasive and deadly infection.