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Infect Control Hosp Epidemiol. 2020 Jan 15:1-6. doi: 10.1017/ice.2019.368. [Epub ahead of print]

A successful program preventing nonventilator hospital-acquired pneumonia in a large hospital system.

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Kaiser Permanente Northern California, Risk and Patient Safety, Oakland, California.
Kaiser Permanente Northern California, Quality and Operations Support, Oakland, California.
The Permanente Medical Group, Executive Offices, Oakland, California.



To develop and evaluate a program to presvent hospital-acquired pneumonia (HAP).


Prospective, observational, surveillance program to identify HAP before and after 7 interventions. An order set automatically triggered in programmatically identified high-risk patients.


All 21 hospitals of an integrated healthcare system with 4.4 million members.


All hospitalized patients.


Interventions for high-risk patients included mobilization, upright feeding, swallowing evaluation, sedation restrictions, elevated head of bed, oral care and tube care.


HAP rates decreased between 2012 and 2018: from 5.92 to 1.79 per 1,000 admissions (P = .0031) and from 24.57 to 6.49 per 100,000 members (P = .0014). HAP mortality decreased from 1.05 to 0.34 per 1,000 admissions and from 4.37 to 1.24 per 100,000 members. Concomitant antibiotic utilization demonstrated reductions of broad-spectrum antibiotics. Antibiotic therapy per 100,000 members was measured as follows: carbapenem days (694 to 463; P = .0020), aminoglycoside days (154 to 61; P = .0165), vancomycin days (2,087 to 1,783; P = .002), and quinolone days (2,162 to 1,287; P < .0001). Only cephalosporin use increased, driven by ceftriaxone days (264 to 460; P = .0009). Benzodiazepine use decreased between 2014 to 2016: 10.4% to 8.8% of inpatient days. Mortality for patients with HAP was 18% in 2012% and 19% in 2016 (P = .439).


HAP rates, mortality, and broad-spectrum antibiotic use were all reduced significantly following these interventions, despite the absence of strong supportive literature for guidance. Most interventions augmented basic nursing care. None had risks of adverse consequences. These results support the need to examine practices to improve care despite limited literature and the need to further study these difficult areas of care.


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