While ventilator-associated pneumonia (VAP) is well recognized, non-ventilator hospital-acquired pneumonia (NV-HAP) poses a significant and often overlooked risk for patients.
Non-ventilator hospital-acquired pneumonia affects patients who are not mechanically ventilated and remains one of the most common yet under-recognized healthcare-associated infections (HAI).
While many hospital-acquired infections have seen reductions thanks to targeted prevention programs, NV-HAP has not received the same level of attention. Despite its association with increased length of stay, antimicrobial use, and patient morbidity and mortality, NV-HAP is not always tracked.
Preventing hospital-acquired pneumonia is difficult because the surveillance needed is further complicated by subjective, non-standardized criteria and NV-HAP's broad impact across hospitalized populations.
The cost of non-ventilator hospital-acquired pneumonia
Hospital-acquired pneumonias (HAPs) impose a significant financial burden on the U.S. healthcare system, with total costs, including post-acute and long-term care, reaching an estimated $3 billion annually. While VAP has been the focus of extensive research and prevention efforts, NV-HAP has only recently begun receiving meaningful attention. This supports expanding surveillance beyond device-related metrics to better capture overall patient harm.
As a result, this preventable condition continues to drive up healthcare costs and strain resources. With an average additional cost of $20,189 per case, NV-HAP places a significant financial strain on hospitals, driven by longer patient stays, increased treatments, and higher readmission rates.
A study published in JAMA Network Open in 2023 examined over six million hospital admissions across 284 hospitals and, using an electronic surveillance criterion, discovered the following:
- About 1 in 200 patients developed NV-HAP
- NV-HAP is attributed to 1 in 14 hospital deaths
- A 22% mortality rate was associated with NV-HAP
- Patients’ length of stay increased by 13 days
- Patient outcomes: 20% of patients with NV-HAP were discharged to skilled nursing care, 8% to hospice, 38% to home
In May 2022, the Society for Healthcare Epidemiology of America (SHEA) included NV-HAP in their updated "Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and non-ventilator hospital-acquired pneumonia in acute-care hospitals: 2022 Update" and offers updated, practical recommendations for infection preventionists (IPs) and hospital leaders to consider. Although CDC’s National Health Safety Network (NHSN) does not yet have an NV-HAP module, IPs may consider using the existing pneumonia (PNU) criteria and adapt as needed to identify NV-HAPs not associated with mechanical ventilation.
Modifiable and non-modifiable risks in hospital-acquired pneumonia prevention
Knowing the potential outcomes of NV-HAP, it’s important to understand the risk factors. These include:
- Older age
- Multiple comorbidities; especially cancer, chronic kidney and lung disease, and congestive heart failure.
- Altered mental status
- Dysphagia and/or history of aspiration
- The presence of nasogastric or orogastric tubes
- Prolonged hospitalization
- Poor mobility
Understanding the risk factors for NV-HAP is critical for targeted prevention efforts. While some are non-modifiable, others like poor mobility, dysphagia, and prolonged hospitalization, can be addressed through proactive interventions. Identifying and mitigating these modifiable risks can significantly reduce the incidence of NV-HAP and improve patient outcomes.