Epidemiology

HAP is more common in patients in the intensive care unit, those who have recently had major surgery, and those who have been in hospital for a long time.[6] It is associated with high morbidity and mortality because these patients are usually critically ill and have multiple comorbidities or severe frailty.[7]

In England, at any time, 1.5% of hospital inpatients have a hospital-acquired respiratory infection. Of these patients, more than half have HAP. HAP is estimated to increase hospital stay by about 8 days and has a reported mortality rate that ranges between 30% and 70%.[3]

Risk factors

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poor infection control/hand hygiene

Pathogens that cause HAP, such as Acinetobacter baumannii, are transmitted to patients from healthcare workers' hands.

intubation and mechanical ventilation

Mechanical ventilation is the most significant risk factor for HAP (ventilator-associated pneumonia is not covered in this topic).[19][20]

multidrug-resistant bacteria

People at high risk of multidrug-resistant bacteria are at higher risk of HAP. This includes patients with symptoms or signs starting more than 5 days after hospital admission; a relevant comorbidity, such as severe lung disease or immunosuppression; recent use of a broad-spectrum antibiotic; colonisation with multidrug-resistant bacteria; and recent contact with health or social care settings before current admission.[7]

aspiration

A prior episode of a large-volume aspiration is associated with an increased risk of nosocomial pneumonia.[19]

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acid-suppression drugs

Use of acid-suppression medication is associated with 30% increased odds of developing HAP, with a statistically significant risk only for use of proton-pump inhibitors.[21]

depressed consciousness

HAP outside the intensive care unit is more prevalent in patients with depressed consciousness.[20]

chest or upper abdominal surgery

HAP outside the intensive care unit is more prevalent in patients undergoing thoracic and upper abdominal surgery.[19][20]

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