Prevention can be focused on issues related to infection control and avoidance of certain procedures/exposures.
Infection control
Hand hygiene is the single most important primary prevention strategy a healthcare worker can perform, as it prevents the transmission of multidrug-resistant (MDR) pathogens that cause HAP, such as Acinetobacter.[22]Schleder B, Stott K, Lloyd RC. The effect of a comprehensive oral care protocol on patients at risk for ventilator-associated pneumonia. Crit Care Nurse Clinic N Am. 2002;4:27-30.[23]Allegranzi B, Pittet D. Preventing infections acquired during health-care delivery. Lancet. 2008;372:1719-1720.
http://www.ncbi.nlm.nih.gov/pubmed/19013310?tool=bestpractice.com
[24]Boyce JM, Pittet D. Guideline for hand hygiene in health-care settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. MMWR Recomm Rep. 2002;51:1-44.
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5116a1.htm
http://www.ncbi.nlm.nih.gov/pubmed/12418624?tool=bestpractice.com
Other infection control measures such as staff education and isolation to reduce cross-infection with MDR pathogens should be used routinely.[25]Tablan OC, Anderson LJ, Besser R, et al. Guidelines for preventing health-care-associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep. 2004;53:1-36.
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5303a1.htm
http://www.ncbi.nlm.nih.gov/pubmed/15048056?tool=bestpractice.com
Surveillance of intensive care unit infections accomplishes several tasks: identifies and quantifies endemic and new MDR pathogens, prepares timely data for infection control, and guides appropriate antimicrobial therapy in patients with suspected HAP.[25]Tablan OC, Anderson LJ, Besser R, et al. Guidelines for preventing health-care-associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep. 2004;53:1-36.
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5303a1.htm
http://www.ncbi.nlm.nih.gov/pubmed/15048056?tool=bestpractice.com
Without the practice of infection prevention and control, a patient may be admitted without an infection and be discharged with a serious morbidity, or even die before discharge. The process starts with colonisation with an MDR organism, proceeds to invasion of sterile tissue (e.g., lung, blood) with the colonised pathogen, and ends with disease (e.g., HAP, bacteraemia) or even death.
Exposures to avoid
There is insufficient evidence to determine the effect of vitamin C or vitamin D supplementation in the prevention (or treatment) of pneumonia.[26]Padhani ZA, Moazzam Z, Ashraf A, et al. Vitamin C supplementation for prevention and treatment of pneumonia. Cochrane Database Syst Rev. 2021 Nov 18;(11):CD013134.
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013134.pub3/full
http://www.ncbi.nlm.nih.gov/pubmed/34791642?tool=bestpractice.com
[27]Public Health England. Insufficient evidence for vitamin D preventing or treating ARTIs. Jul 2020 [internet publication].
https://www.gov.uk/government/news/insufficient-evidence-for-vitamin-d-preventing-or-treating-artis
Influenza vaccine may be indicated for those in a facility where an outbreak is occurring, or who meet local criteria. Bacterial pneumonia can follow influenza, so immunisation is important.
Pneumococcal vaccination is not specifically indicated for patients admitted to hospital, but may help prevent infection due to Streptococcus pneumoniae in patients who have comorbidities.
Information on vaccines, vaccination procedures, special patient populations, and current vaccination schedules in the UK can be found in latest UK Health Security Agency vaccination schedule.[93]UK Health Security Agency. The complete routine immunisation schedule from February 2022. Feb 2022 [internet publication].
https://www.gov.uk/government/publications/the-complete-routine-immunisation-schedule/the-complete-routine-immunisation-schedule-from-february-2022#contents
Vaccination schedules vary by location; consult local guidance for recommendations.