scholarly journals Comprehensive risk assessment for hospital-acquired pneumonia: sociodemographic, clinical, and hospital environmental factors associated with the incidence of hospital-acquired pneumonia

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Bo-Guen Kim ◽  
Minwoong Kang ◽  
Jihyun Lim ◽  
Jin Lee ◽  
Danbee Kang ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Health Insurance ◽  
Environmental Factors ◽  
Multivariable Analysis ◽  
Tube Feeding ◽  
Lower Airway ◽  
Chronic Obstructive ◽  
Factors Associated ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

Abstract Background Social and hospital environmental factors that may be associated with hospital-acquired pneumonia (HAP) have not been evaluated. Comprehensive risk assessment for the incidence of HAP including sociodemographic, clinical, and hospital environmental factors was conducted using national health insurance claims data. Methods This is a population-based retrospective cohort study of adult patients who were hospitalized for more than 3 days from the Health Insurance Review and Assessment Service-National Inpatient Sample data between January 1, 2016 and December 31, 2018 in South Korea. Multivariable logistic regression analyses were conducted to identify the factors associated with the incidence of HAP. Results Among the 512,278 hospitalizations, we identified 25,369 (5.0%) HAP cases. In multivariable analysis, well-known risk factors associated with HAP such as older age (over 70 vs. 20–29; adjusted odds ratio [aOR], 3.66; 95% confidence interval [CI] 3.36–3.99), male sex (aOR, 1.35; 95% CI 1.32–1.39), pre-existing lung diseases (asthma [aOR, 1.73; 95% CI 1.66–1.80]; chronic obstructive pulmonary disease [aOR, 1.62; 95% CI 1.53–1.71]; chronic lower airway disease [aOR, 1.79; 95% CI 1.73–1.85]), tube feeding (aOR, 3.32; 95% CI 3.16–3.50), suctioning (aOR, 2.34; 95% CI 2.23–2.47), positioning (aOR, 1.63; 95% CI 1.55–1.72), use of mechanical ventilation (aOR, 2.31; 95% CI 2.15–2.47), and intensive care unit admission (aOR, 1.29; 95% CI 1.22–1.36) were associated with the incidence of HAP. In addition, poverty (aOR, 1.08; 95% CI 1.04–1.13), general hospitals (aOR, 1.54; 95% CI 1.39–1.70), higher bed-to-nurse ratio (Grade ≥ 5; aOR, 1.45; 95% CI 1.32–1.59), higher number of beds per hospital room (6 beds; aOR, 3.08; 95% CI 2.77–3.42), and ward with caregiver (aOR, 1.19; 95% CI 1.12–1.26) were related to the incidence of HAP. Conclusions The incidence of HAP was associated with various sociodemographic, clinical, and hospital environmental factors. Thus, taking a comprehensive approach to prevent and treat HAP is important.

scholarly journals Impact of comorbidity assessment methods to predict non-cancer mortality risk in cancer patients: a retrospective observational study using the National Health Insurance Service claims-based data in Korea

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sanghee Lee ◽  
Yoon Jung Chang ◽  
Hyunsoon Cho
Keyword(s):  
Risk Assessment ◽  
Health Insurance ◽  
Cancer Patients ◽  
National Health Insurance ◽  
National Health ◽  
Cancer Mortality ◽  
Prediction Models ◽  
Assessment Methods ◽  
Chronic Obstructive ◽  
Mortality Risks

Abstract Background Cancer patients’ prognoses are complicated by comorbidities. Prognostic prediction models with inappropriate comorbidity adjustments yield biased survival estimates. However, an appropriate claims-based comorbidity risk assessment method remains unclear. This study aimed to compare methods used to capture comorbidities from claims data and predict non-cancer mortality risks among cancer patients. Methods Data were obtained from the National Health Insurance Service-National Sample Cohort database in Korea; 2979 cancer patients diagnosed in 2006 were considered. Claims-based Charlson Comorbidity Index was evaluated according to the various assessment methods: different periods in washout window, lookback, and claim types. The prevalence of comorbidities and associated non-cancer mortality risks were compared. The Cox proportional hazards models considering left-truncation were used to estimate the non-cancer mortality risks. Results The prevalence of peptic ulcer, the most common comorbidity, ranged from 1.5 to 31.0%, and the proportion of patients with ≥1 comorbidity ranged from 4.5 to 58.4%, depending on the assessment methods. Outpatient claims captured 96.9% of patients with chronic obstructive pulmonary disease; however, they captured only 65.2% of patients with myocardial infarction. The different assessment methods affected non-cancer mortality risks; for example, the hazard ratios for patients with moderate comorbidity (CCI 3–4) varied from 1.0 (95% CI: 0.6–1.6) to 5.0 (95% CI: 2.7–9.3). Inpatient claims resulted in relatively higher estimates reflective of disease severity. Conclusions The prevalence of comorbidities and associated non-cancer mortality risks varied considerably by the assessment methods. Researchers should understand the complexity of comorbidity assessments in claims-based risk assessment and select an optimal approach.

The impact of a bundle to prevent hospital-acquired pneumonia in a cohort of nonventilated patients on enteral nutrition

2020 ◽  
Vol 42 (1) ◽  
pp. 100-102
Author(s):  
Michelli Cristina Silva de Assis ◽  
Andreia Barcellos Teixeira Macedo ◽  
Célia Mariana Barbosa de Souza Martins ◽  
Loriane Rita Konkewicz ◽  
Luciana Verçoza Viana ◽  
...  
Keyword(s):  
Experimental Study ◽  
Enteral Nutrition ◽  
Tube Feeding ◽  
Enteral Tube Feeding ◽  
Quasi Experimental ◽  
Hospital Acquired Pneumonia ◽  
Bundle Compliance ◽  
Hospital Acquired ◽  
The Impact

AbstractWe conducted a quasi-experimental study to evaluate a bundle to prevent nonventilator hospital-acquired pneumonia (NV-HAP) in patients on enteral tube feeding. After the intervention, there was an increase in bundle compliance from 55.9% to 70.5% (P < .01) and a significant decrease (34%) in overall NV-HAP rates from 5.71 to 3.77 of 1,000 admissions.

Respiratory disorders

2019 ◽  
pp. 271-311
Author(s):  
Carl Waldmann ◽  
Andrew Rhodes ◽  
Neil Soni ◽  
Jonathan Handy
Keyword(s):  
Management Strategies ◽  
Upper Airway ◽  
Inhalation Injury ◽  
Community Acquired Pneumonia ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Respiratory Disorders ◽  
Hospital Acquired Pneumonia ◽  
Ventilatory Management ◽  
Hospital Acquired

This chapter discusses respiratory disorders and includes definitions, pathophysiology, and management strategies of upper airway obstruction, respiratory failure, pulmonary collapse and atelectasis, chronic obstructive pulmonary disease, and acute respiratory distress syndrome (diagnosis, general, and ventilatory management strategies). It also includes sections detailing pathophysiology and management of pneumothoraces, empyema, haemoptysis, inhalation injury, pulmonary thromboembolism, community-acquired pneumonia, hospital-acquired pneumonia, and pulmonary hypertension.

The Relationship of Paranasal Sinus Opacification to Hospital-Acquired Pneumonia in the Neurologic Intensive Care Unit Patient

2017 ◽  
Vol 34 (10) ◽  
pp. 844-850
Author(s):  
Phillip Huyett ◽  
Nicholas R. Rowan ◽  
Berrylin J. Ferguson ◽  
Stella Lee ◽  
Eric W. Wang
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Paranasal Sinus ◽  
Care Center ◽  
Tertiary Care ◽  
Lower Airway ◽  
Icu Admission ◽  
Airway Infections ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

Background: The association between intensive care unit (ICU) sinusitis and the development of lower airway infections remains unclear. The objective of this study was to determine the correlation between the development of radiographic sinus opacification and pneumonia in the neurologic ICU setting. Methods: A retrospective review of head computed tomography or magnetic resonance imaging of 612 patients admitted to the neurocritical care unit at a tertiary care center from April 2013 through April 2014 was performed. Paranasal sinus opacification was measured using Lund-Mackay scores (LMS). A diagnosis of pneumonia was determined by the ICU team from radiographic, laboratory, and pulmonary data. Exclusion criteria included a history of endonasal surgery, sinonasal malignancy, facial fractures, ICU admission less than 3 days, or inadequate imaging. Results: Worsening sinus opacification occurred in 42.6% of patients and pneumonia in 18.5% of patients during ICU admission. Of the patients who developed pneumonia, 71.7% also developed worsening sinus opacification ( P < .001). In 80.2% of cases, the sinus opacification developed prior to the diagnosis of pneumonia. The mean highest LMS for patients who developed pneumonia was 4.24 compared to 1.99 in patients who did not develop pneumonia ( P < .001). Sinus air–fluid levels or complete sinus opacification occurred in a larger proportion of patients who developed pneumonia (46.9% vs 19.4%, P < .001). Mortality rates for patients with no pneumonia or sinusitis, pneumonia only, sinusitis only, and sinusitis with pneumonia were 7.6%, 15.6%, 18.3%, and 25.9%, respectively ( P < .001). Conclusions: This study finds a strong relationship between worsening sinus opacification in the neurologic ICU patient to the development of hospital-acquired pneumonia and increased mortality.

scholarly journals Functional decline in geriatric rehabilitation ward; is it ascribable to Hospital Acquired Infection? A prospective cohort study.

2020 ◽  
Author(s):  
Marie Laurent ◽  
Nadia Oubaya ◽  
Jean Philippe David ◽  
Florence Canoui Poitrine ◽  
Lola Corsin ◽  
...  
Keyword(s):  
Prospective Cohort ◽  
Rating Scale ◽  
Functional Decline ◽  
Multivariable Analysis ◽  
Psychiatric Disease ◽  
Geriatric Rehabilitation ◽  
Rehabilitation Unit ◽  
Hospital Acquired Infection ◽  
Factors Associated ◽  
Hospital Acquired

Abstract Background: Some patients may not benefit from their stay in a geriatric rehabilitation unit and paradoxically worsened their functional status. The incidence of functional decline in these units and factors associated with this decline have not been clearly identified. Methods: We used a prospective cohort of consecutive patients aged ≥ 75 years admitted to a geriatric rehabilitation unit in a French university hospital. The main endpoint was functional decline defined by at least an one-point decrease in Activities of Daily Living (ADL) score during the stay. Baseline social and geriatric characteristics were recorded and comorbidities were sought by the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). During follow-up, hospital-acquired infection (HAI) was recorded, as was ADL score at discharge. Multivariate logistic regression and mediation analyses were used to identify factors associated with ADL decrease. Results : Among the 252 eligible patients, 165 (median age 85 years [interquartile range (IQR) 81-90] had available ADL scores at baseline (median score 7 [IQR 4-10]) and at discharge (median 9 [6-12]). Median CIRS-G score was 11 [9-13], 24 (14.5%) had a pulmonary HAI; 30 (18.2%) showed functional decline. On multivariable analysis, functional decline was associated with comorbidities (global CIRS-G score, P=0.02, CIRS-G for respiratory disease [CIRS-G-R] ≥2, P=0.03, or psychiatric disease, P=0.02) and albumin level < 35 g/l (p=0.02). Significant association were found between functional decline and CIRS-G for respiratory diseases (CIRS-G-R) (OR 2.82 [95% CI 1.18-6.71], p=0.016), between functional decline and pulmonary HAI (OR 4.09 [1.48-11.34],p=4.09), and between CIRS-G-R and pulmonary HAI (OR 10.9 [5.26-22.5],p=0.0001). Theses associations and the reduced effect of CIRS-G-R on functional decline after adjusting for pulmonary HAI (OR 1.91 [0.71-5.16], p=0.20) suggested partial mediation of pulmonary HAI in the relation between CIRS-G-R and functional decline. Conclusion : Baseline comorbidities were independently associated with functional decline in patients hospitalized in a geriatric rehabilitation unit. Pulmonary HAI may have mediated this association. We need to better identify patients at risk of functional decline before transfer to a rehabilitation unit and to test the implementation of modern and individual programs of rehabilitation outside the hospital for these patients.

Modifiable risk factors for mortality in revision total hip arthroplasty for periprosthetic fracture

2020 ◽  
Vol 102-B (5) ◽  
pp. 580-585
Author(s):  
Victoria N. Gibbs ◽  
Robert A. McCulloch ◽  
Paula Dhiman ◽  
Andrew McGill ◽  
Adrian H. Taylor ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hip Fracture ◽  
Modifiable Risk Factors ◽  
Revision Total Hip Arthroplasty ◽  
Factors Associated ◽  
Time To Surgery ◽  
Revision Tha ◽  
Hospital Acquired Pneumonia ◽  
One Year ◽  
Hospital Acquired

Aims The aim of this study was to identify modifiable risk factors associated with mortality in patients requiring revision total hip arthroplasty (THA) for periprosthetic hip fracture. Methods The electronic records of consecutive patients undergoing revision THA for periprosthetic hip fracture between December 2011 and October 2018 were reviewed. The data which were collected included age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, the preoperative serum level of haemoglobin, time to surgery, operating time, blood transfusion, length of hospital stay, and postoperative surgical and medical complications. Univariate and multivariate logistic regression analyses were used to determine independent modifiable factors associated with mortality at 90 days and one year postoperatively. Results A total of 203 patients were identified. Their mean age was 78 years (44 to 100), and 108 (53%) were female. The median time to surgery was three days (interquartile range (IQR) 2 to 5). The mortality rate at one year was 13.8% (n = 28). The commonest surgical complication was dislocation (n = 22, 10.8%) and the commonest medical complication within 90 days of surgery was hospital-acquired pneumonia (n = 25, 12%). Multivariate analysis showed that the rate of mortality one year postoperatively was five-fold higher in patients who sustained a dislocation (odds ratio (OR) 5.03 (95% confidence interval (CI) 1.60 to 15.83); p = 0.006). The rate of mortality was also four-fold higher in patients who developed hospital-acquired pneumonia within 90 days postoperatively (OR 4.43 (95% CI 1.55 to 12.67); p = 0.005). There was no evidence that the time to surgery was a risk factor for death at one year. Conclusion Dislocation and hospital-acquired pneumonia following revision THA for a periprosthetic fracture are potentially modifiable risk factors for mortality. This study suggests that surgeons should consider increasing constraint to reduce the risk of dislocation, and the early involvement of a multidisciplinary team to reduce the risk of hospital-acquired pneumonia. We found no evidence that the time to surgery affected mortality, which may allow time for medical optimization, surgical planning, and resource allocation. Cite this article: Bone Joint J 2020;102-B(5):580–585.

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