Evaluation of multi-component interventions for prevention of nosocomial pneumonia in older adults: a randomized, controlled trial

Abstract

RCT to evaluate the efficacy of multi-component interventions for prevention of hospital-acquired pneumonia in hospitalized older patients. The multi-component interventions did not reduce hospital-acquired pneumonia but increased the mean time to next hospitalisation due to respiratory infection (11.5 months vs. 9.5 months; P = 0.049), and reduced the risk of hospitalisation in 1 year (18.6% vs. 34.4%; P = 0.049). This was likely due to the increased recognition of oropharyngeal dysphagia (35.6% vs. 20.3%; P < 0.001) and improved influenza (54.5% vs 17.2%; P < 0.001) and pneumococcal vaccination rates (52.5% vs. 20.3%; P < 0.001). A multi-component intervention for nosocomial pneumonia may not significantly reduce the incidence of hospital-acquired pneumonia but significantly increases the frequency of diagnosis of oropharyngeal dysphagia, improves vaccination rates and can reduce future hospitalisations for respiratory infections in older adults. To evaluate the efficacy of multi-component interventions for prevention of hospital-acquired pneumonia in older patients hospitalized in geriatric wards. A randomized, parallel-group, controlled trial was undertaken in patients aged 65 and above who were admitted to a tertiary hospital geriatric unit from January 1, 2016 to June 30, 2018 for an acute non-respiratory illness. Participants were randomized by to receive either a multi-component intervention (consisting of reverse Trendelenburg position, dysphagia screening, oral care and vaccinations), or usual care. The outcome measures were the proportion of patients who developed hospital-acquired pneumonia during hospitalisation, and mean time from randomization to the next hospitalisation due to respiratory infections in 1 year. A total of 123 participants (median age, 85; 43.1% male) were randomized, (n\u2009=\u200959) to intervention group and (n\u2009=\u200964) to control group. The multi-component interventions did not significantly reduce the incidence of hospital-acquired pneumonia but did increase the mean time to next hospitalisation due to respiratory infection (11.5 months vs. 9.5 months; P\u2009=\u20090.049), and reduced the risk of hospitalisation in 1 year (18.6% vs. 34.4%; P\u2009=\u20090.049). Implementation of multi-component interventions increased diagnoses of oropharyngeal dysphagia (35.6% vs. 20.3%; P\u2009<\u20090.001) and improved the influenza (54.5% vs 17.2%; P\u2009<\u20090.001) and pneumococcal vaccination rates (52.5% vs. 20.3%; P\u2009<\u20090.001). The nosocomial pneumonia multi-component intervention did not significantly reduce the incidence of hospital-acquired pneumonia during hospitalisation but reduce subsequent hospitalisations for respiratory infections. ClinicalTrial.gov, NCT04347395.