Practices to prevent non-ventilator hospital acquired pneumonia: a narrative review.

Nosocomial infection has significant consequences in healthcare, at the individual level driving increased morbidity and mortality, but also at the organisational level due to increased costs. Hospital acquired pneumonia(HAP) is the most common nosocomial infection and is associated with high excess mortality, frequent use of broad spectrum anti-microbials and increased length of stay. In this review we explore the preventative strategies that have been examined in non-ventilator acquired hospital associated pneumonia (NVHAP). We discuss management of aspiration risk, interventions for oral hygiene, the role of mobilisation and physiotherapy, modification of environmental factors, and vaccination. Many of these interventions are low risk, acceptable to patients and have good cost-benefit ratios. However, the evidence base for prevention of NVHAP is weak. We identify lack of a unified research definition, under-recruitment to studies, and variation in intervention and outcome measures as limitations in the existing literature. Given the core risk factors for acquisition of NVHAP are increasing there is an urgent need for research to address the prevention of NVHAP. In this review we call for a unified definition, identification of a core outcome set for studies in NVHAP and suggest future directions for research in NVHAP. Improving care for people with NVHAP will reduce morbidity, mortality, and healthcare costs significantly.