Hospital Acquired Pneumonia – Literature

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Please see the below literature on hospital acquired pneumonia:


Klompas M, Branson R, Cawcutt K et al. (2022) Infection Control & Hospital Epidemiology June;43(6):687-713

A US prevention guideline. HAP is a quality indicator that patients use when choosing hospitals. The key interventions recommended are 1) toothbrushing 2) diagnosing and managing dysphagia 3) early mobilisation 4) bundles of care.


Poor oral health is linked to hospital acquired infections including pneumonia. The Mouth Care Matters programme aimed to increase awareness of the importance of good mouth care and how it impacts on general health and quality of life, through the healthcare team.

The team developed a toolkit covering audits, staff and patient surveys, training ideas, people to collaborate with in a hospital and how to develop a mouth care improvement plan

Wolfensberger A, Clack L, von Felten S et al. (In press) The Lancet Infectious Diseases.

In this study, a five-measure HAP prevention bundle consisted of oral care, dysphagia screening and management, mobilisation, discontinuation of non-indicated proton-pump inhibitors, and respiratory therapy was tested in 9 different departments of a Swiss hospital. All patients in these departments were monitored over a three-year period including baseline.


Enne VI, Aydin A, Baldan R INHALE WP1 Study Group, et al. (2022) Thorax 77:1220-1228

The INHALE trial, looking at clinical outcomes, is ongoing. This interim publication demonstrates the limitations of current microbiological investigation and the importance of viruses and multi-pathogen infections.

Burton LA, Price R, Barr KE et al. (2016)

In this paper the team demonstrate clearly where the syndromic definition of HAP breaks down and the limitations of radiology.

BMJ Best Practice (last reviewed January 2023) outlining key diagnostic and risk factors.


Stern S E, Christensen M A, Nevers M R et al. (2023)  Infection Control & Hospital Epidemiology, 1–7

This US study compared the accuracy of automatable electronic surveillance criteria for detecting HAP with the usual manual surveillance, including clinical diagnosis, observed deterioration and clinical review.



NICE guideline on antimicrobial prescribing for HAP recommends sputum sampling to determine the underlying pathogen for guidance on prescribing.


NICE guideline for pneumonia diagnosis and management include recommendations for the treatment of CAP and reference to the prescribing guideline for HAP. No further recommendations for management are included, however the guideline poses research questions for HAP. This guideline is currently under exceptional review to incorporate findings from the Covid-19 pandemic

International ERS/ESICM/ESCMID/ALAT guidelines for the management of HAP and ventilator-associated pneumonia (VAP) (Torres A et al. 2017)

2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society (Kalil et al. 2016)

These guidelines underpin the Advancing Quality Programme HAP measure set, however many of the measures are based on clinical consensus around best practice as specific guidance on effective interventions for HAP management is sparse.


Follow-up and characteristics of HAP Patients


Nosocomial pneumonia (NP) remains associated with excess morbidity and mortality. The effect of NP on measures such as re-admission at 30 days remains unclear. Moreover, differing types of NP may have varying impacts on re-admissions.


Russell CD, Koch O, Laurenson IF, et al. (2016)  Journal of Hospital Infection 92:3. 273-279
Evaluation of the accuracy of diagnosis and description of the demographic and microbiological features of adult patients with HAP in a UK tertiary hospital.

Economic aspects

Guest JF, Keating T, Gould D, et al. (2020) BMJ Open 0:e033367

HAP is included in the modelling for this study, with pneumonia and respiratory tract infections cited as accounting for the largest proportion of healthcare-associated infections in NHS hospitals in England, at 22.8%. Although the economic impact of HAP is not specifically modelled, this does give some idea of the burden of hospital acquired infection in terms of mortality and resource implications both for patients and health care providers.

Manoukian S, Stewart S, Graves N et al. (2021) 114, 43-50

This study evaluated the inpatient cost of healthcare-associated infection in two Scottish NHS hospitals as part of the Evaluation of Cost of Nosocomial Infection (ECONI) study. The inpatient cost of HAI is presented in terms of bed-days lost, bed-day costs, and cash costs. Specific costs for pneumonia were modelled with an estimated annual bed day loss of 10,270.

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