Prevention of Hospital-Acquired Pneumonia: Measuring Effect in Ounces, Pounds, and Tons (1995)

Editorials1 February 1995Prevention of Hospital-Acquired Pneumonia: Measuring Effect in Ounces, Pounds, and TonsDonald E. Craven, MDDonald E. Craven, MDBoston University Schools of Medicine and Public Health, Boston City Hospital, Boston, MA 02118Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-122-3-199502010-00013 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The idea that hospitals could be dangerous places emerged in the Middle Ages, when outbreaks of puerperal fever and typhus caused high mortality in infirmaries that were part of monasteries [1]. Even before the discovery of bacteria, Holmes and Semmelweis implicated health care workers in the transmission of puerperal fever; Nightengale and Farr emphasized that safe food and water and a clean environment could substantially reduce the rate of deaths caused by infection; and Simpson concluded that "hospitalism" contributed to patient death and illness [1]. In the 20th century, nosocomial infections have changed and their numbers have increased in response ...References1. LaForce FM. The control of infections in hospitals: 1750 to 1950. In: Wenzel RP, ed. Prevention and Control of Nosocomial Infections. 2d ed. Baltimore: Williams & Wilkins; 1993:1-12. Google Scholar2. Craven DE, Steger KA, Barber TW. Preventing nosocomial pneumonia: state of the art and perspectives for the 1990s. Am J Med. 1991; 91(3B):44S-53S. Google Scholar3. Tablan OC, Anderson LJ, Arden NH, Breiman RF, Butler JC, McNeil MM, et al. Guidelines for prevention of nosocomial pneumonia—1994. Infect Control Hosp Epidemiol. 1994; 15:587-90. Google Scholar4. Fagon JY, Chastre J, Hance AJ, Montravers F, Novara A, Gibert C. Nosocomial pneumonia in ventilated patients: a cohort study evaluating attributable mortality and hospital stay. Am J Med. 1993; 94:281-8. Google Scholar5. Chastre J, Fagon JY. Invasive diagnostic testing should be routinely used to manage mechanically ventilated patients with suspected pneumonia. Am J Respir Crit Care Med. 1994; 150:570-4. Google Scholar6. Niederman MS, Torres A, Summer W. Invasive diagnostic testing is not needed routinely to manage suspected ventilator-associated pneumonia. Am J Respir Crit Care Med. 1994; 150:565-9. Google Scholar7. el-Ebiary M, Torres A, Gonzalez J, de la Bellacasa JP, Garcia C, Jimenez de Anta MT, et al. Quantitative cultures of endotracheal aspirates for the diagnosis of ventilator-associated pneumonia. Am Rev Respir Dis. 1993; 148:1552-7. Google Scholar8. Valles J, Artigas A, Rello J, Bonsoms N, Fontanals D, Blanch LI, et al. Continuous aspiration of subglottic secretions in preventing ventilator-associated pneumonia. Ann Intern Med. 1995; 122:179-86. Google Scholar9. Mahul PH, Auboyer C, Jospe R, Ros A, Guerin C, Galliez M, et al. Prevention of nosocomial pneumonia (NP) in intubated patients: respective role of mechanical subglottic secretions drainage and stress ulcer prophylaxis. Intensive Care Med. 1992; 18:20-5. Google Scholar10. Driks MR, Craven DE, Celli BR, Manning M, Burke RA, Garvin GM, et al. Nosocomial pneumonia in intubated patients given sucralfate as compared with antacids or histamine type 2 blockers.: The role of gastric colonization. N Engl J Med. 1987; 317:1376-82. Google Scholar11. Prod'hom G, Leuenberger P, Koerfer J, Blum A, Chiolero R, Schaller MD, et al. Nosocomial pneumonia in mechanically ventilated patients receiving antacid, ranitidine, or sucralfate as prophylaxis for stress ulcer: a randomized, controlled trial. Ann Intern Med. 1994; 120:653-62. Google Scholar12. Cook DJ, Reeve BK, Scholes LC. Histamine-2-receptor antagonists and antacids in the critically ill population: stress ulceration versus nosocomial pneumonia. Infect Control Hosp Epidemiol. 1994; 15:437-42. Google Scholar13. Torres A, Serra-Batlles J, Ros E, Piera C, Puig de la Bellacasa J, Cobos A, et al. Pulmonary aspiration of gastric contents in patients receiving mechanical ventilation: the effect of body position. Ann Intern Med. 1992; 116:540-3. Google Scholar14. Rouby JJ, Lawrent P, Gosnach M. Risk factors and clinical relevance of nosocomial maxillary sinusitis in the critically ill. Am J Respir Crit Care Med. 1994; 150:776-83. Google Scholar15. Stoutenbeek CP, van Saene HK, Miranda DR, Zandstra DF. The effect of selective decontamination of the digestive tract on colonisation and infection rate in multiple trauma patients. Intensive Care Med. 1984; 10:185-92. Google Scholar16. Cockerill FR 3d. Indications for selective decontamination of the digestive tract. Semin Respir Infect. 1993; 8:300-7. Google Scholar17. Duncan RA, Steger KA, Craven DE. Selective decontamination of the digestive tract: Risks outweigh benefits for intensive care unit patients. Semin Respir Infect. 1993; 8:308-24. Google Scholar18. Maki DG. Control of colonization and transmission of pathogenic bacteria in the hospital. Ann Intern Med. 1978; 89:777-80. Google Scholar19. Klein BS, Perloff WH, Maki DG. Reduction of nosocomial infection during pediatric intensive care by protective isolation. N Engl J Med. 1989; 320:1714-21. Google Scholar20. Fischl MA, Uttamchandani RB, Daikos GL, Poblete RB, Moreno JN, Reyes RR, et al. An outbreak of tuberculosis caused by multiple-drug-resistant tubercle bacilli among patients with HIV infection. Ann Intern Med. 1992; 117:177-83. Google Scholar21. Goetz MB, O'Brien H, Musser JM, Ward JI. Nosocomial transmission of disease caused by nontypeable strains of Haemophilus influenzae. Am J Med. 1994; 96:342-7. Google Scholar22. Pallares R, Gudiol F, Linares J, Ariza J, Rufi G, Murgui L, et al. Risk factors and response to antibiotic therapy in adults with bacteremic pneumonia caused by penicillin-resistant pneumococci. N Engl J Med. 1987; 317:18-22. Google Scholar23. Singer C, Armstrong D, Rosen PP, Schottenfeld D. Pneumocystis carinii pneumonia: a cluster of eleven cases. Ann Intern Med. 1975; 82:772-7. Google Scholar Author, Article, and Disclosure InformationAffiliations: Boston University Schools of Medicine and Public Health, Boston City Hospital, Boston, MA 02118Corresponding Author: Donald E. Craven, MD, Boston City Hospital, Thorndike Building #303, 818 Harrison Avenue, Boston, MA 02118.Acknowledgment: The author thanks Kathleen Steger, RN, MPH, Michael Niederman, MD, and Ophelia Tablan, MD, for their helpful comments. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoContinuous Aspiration of Subglottic Secretions in Preventing Ventilator-Associated Pneumonia Jordi Valles , Antonio Artigas , Jordi Rello , Natalia Bonsoms , Dionisia Fontanals , Lluis Blanch , Rafael Fernandez , Francisco Baigorri , and Jaume Mestre Metrics Cited byPrevention of VAP: Is Zero Rate Possible?Safety in Critical Care and Pulmonary MedicineVentilator-associated pneumonia: prevention is better than cureReduced burden of bacterial airway colonization with a novel silver-coated endotracheal tube in a randomized multiple-center feasibility study*Randomized clinical trial to determine the effect of nasogastric drainage on tracheal acid aspiration following oesophagectomyA low-volume, low-pressure tracheal tube cuff reduces pulmonary aspiration*The effect of gel lubrication on cuff leakage of double lumen tubes during thoracic surgery*Air leakage around endotracheal tube cuffsThe Incidence and Immediate Respiratory Consequences of Pulmonary Aspiration of Enteral Feed as Detected Using a Modified Glucose Oxidase TestGastroesophageal Reflux and Tracheal Aspiration in the Thoracotomy Position: Should Ranitidine Premedication be Routine?The Prevention of Pulmonary Aspiration with Control of Tracheal Wall Pressure Using a Silicone CuffA Randomized Clinical Trial of Continuous Aspiration of Subglottic Secretions in Cardiac Surgery PatientsA cuff pressure controller for tracheal tubes and laryngeal mask airwaysPrevention of tracheal aspiration using the pressure-limited tracheal tube cuffInfection in the Immobile Host: A Practical Review for the Intensive Care PhysicianA Comparative Study of Levofloxacin and Ceftriaxone in the Treatment of Hospitalized Patients with PneumoniaVentilator-associated pneumonia: Clinical significance and implications for nursingNosocomial pneumonia: Problems and progress 1 February 1995Volume 122, Issue 3Page: 229-231KeywordsAntibioticsBronchoalveolar lavageBronchoscopyDecontaminationGastrointestinal tractMortalityNosocomial infectionsPneumoniaVentilator associated pneumoniaVentilators Issue Published: 1 February 1995 Copyright & PermissionsCopyright © 1995 by American College of Physicians. 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