Hospital-acquired pneumonia prevention

Campbell GD, Niederman MS, Broughton WA, et al. Official ATS statement Hospital-acquired pneumonia in adults Diagnosis, assessment of severity, initial antimicrobial therapy and preventative strategies. Am J Respir Crit Care Med 1995 153 1711-1725. 

Wenzel RP. Hospital acquired pneumonia overview of the current state of the art of prevention and control. Eur J Clin Microbiol Infect Dis 1989 8 56-60. 

Craven DE, Steger KA, Fleming CA. Preventing hospital-acquired pneumonia current concepts and strategies. Semin Respir Crit Care Med 1997 18 185-200. 

Craven DE. Prevention of hospital-acquired pneumonia measuring effect in ounces, pounds and tons. Ann Intern Med 1995 122 229-231. 

Hamer DH, Barza M. Prevention of hospital-acquired pneumonia in critically ill patients. Antimicrob Agents Chemother 1993 37 931-938. 

Because of the difficulty in accurately establishing the diagnosis of a hospital-acquired pneumonia or tracheitis in a critically ill child, a standardized approach for defining these infections offers the best opportunity for interhospital comparisons. The Centers for Disease Control and Prevention (CDC) definitions for lower respiratory tract infections in children are included in Tables 2 and 3 (27). However, pneumonia and tracheitis may still be diagnosed and treated in children who do not satisfy these criteria. Also, children who fulfill these criteria may not truly have a nosocomial LRI. This occurs most commonly when the child exhibits a deterioration in his or her underlying pulmonary condition. 

Prevention of Hospital-Acquired and Ventilator-Associated Pneumonia... 

According to the CDC, almost 1.7 million hospital-acquired infections (HAIs) occur yearly, contributing to approximately 99,000 deaths. Such infections were long accepted by clinicians as an inevitable hazard. Recent efforts demonstrate that simple measures can prevent the majority of common infections. Hospitals and providers must work to reduce the burden of these infections. Four specific infections account for more than 80 percent of all hospital-related infections. They are surgical site infections, catheter-associated urinary tract infections, central venous catheter-related bloodstream infections, and ventilator-associated pneumonia. Preventing the transmission of antibiotic-resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA) remains an important infection control priority. Effective measures exist to prevent the most common healthcare-related infections. 

Nosocomial pneumonias are the second most frequently reported hospital-acquired infection, accounting for 16% to 19% of all nosocomial infections and affecting approximately 300,000 patients in the United States each year (1). The overall or crude mortality rate is 30% (90,000 deaths), and the direct or attributable mortality rate is 10% (30,000 deaths). Therefore, one-third of the deaths are directly due to the pneumonia and two-thirds to the underlying diseases (2). Furthermore, the extra length of hospital stay directly attributable to the pneumonias is estimated to be 9 days (2.7 million patient-days per year in the United States). Thus, morbidity rates, mortality rates, and direct costs are great. For these reasons, prevention of nosocomial pneumonias is clearly of great importance. 

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