Infectious Diseases, Rheumatology and Immunology

A bundle of preventive measures reduces hospital-acquired pneumonia by one third

PD Dr. med. Aline Wolfensberger 

University Hospital Zurich 

Prof. Dr. Lauren Clack

University Hospital Zurich
University of Zurich 

Hospital-acquired pneumonia is one of the most common healthcare-associated infections and affects stationary patients who are not intubated. The implications for patients range from prolonged hospital stay to increased mortality. However, little is known about many aspects of this nosocomial infection. 

The aim of Aline Wolfensberger, Lauren Clack and their team was to test a bundle of five specific measures to prevent such hospital-acquired pneumonia in non-ventilated patients (nvHAP). These measures included oral care, dysphagia screening and management, mobilisation, discontinuation of non-indicated proton-pump inhibitors, and respiratory therapy. The study was conducted in nine surgical and medical departments at the University Hospital Zurich over a period of 38 months.

The scientists showed that implementation of the nvHAP bundle effectively lowered the incidence rate of infections by 31%. Departments with higher implementation success (defined as high acceptability, appropriateness, fidelity, and sustainability) showed a higher reduction of new infections. The implementation success was associated with alignment of the prevention measures with the “core business” of the department, high perceived nvHAP risk, physical proximity of the different professions involved in nvHAP prevention, and favourable individual traits. 

The finding that a bundle of preventive measures led to a reduction of hospital-acquired pneumonia is of great practical benefit, since nvHAP is a common, but so far little studied infection. The knowledge of the determinants of implementation success might help in upscaling nvHAP prevention.

Prevention of non-ventilator-associated hospital-acquired pneumonia in Switzerland: a type 2 hybrid effectiveness-implementation trial. Aline Wolfensberger*, Lauren Clack*, Stefanie von Felten, Mirjam Faes Hesse, Dirk Saleschus, Marie-Theres Meier, Katharina Kusejko, Roger Kouyos, Leonhard Held, Hugo Sax. Lancet Infect Dis. 2023 Jul;23(7):836-846 
*Contributed equally