Abstract and Introduction
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.
Introduction
Hospital-acquired pneumonia (HAP) is one of the most common nosocomial infections[1,2] and is associated with significant clinical and economic burdens, such as long-term hospitalization, high medical costs, and increased morbidity and mortality.[3–7] From studies conducted worldwide, its incidence ranges from five to more than 20 cases per 1000 hospital admissions and from 2.5 to more than 6.1 cases per 1000 patients not admitted to the intensive care unit (ICU).[5,8,9] In addition, previous studies have found that older age and preexisting lung diseases, such as chronic obstructive pulmonary disease (COPD), asthma, and interstitial lung disease, or multiple organ system disorders increased the risk of HAP.[6,8] Moreover, aspiration, intubation, and mechanical ventilation (MV) were risk factors for HAP.[10,11]
Considering that HAP is an exogenous infection with nosocomial pathogens acquired from the hospital environment, evaluating hospital environment-related risk factors, such as hospital type, bed-to-nurse ratio, and hospital room type, would be necessary. However, studies on hospital environment-associated risk factors for HAP are limited. Furthermore, studies excluded poverty, which is a strong risk factor for other infectious diseases.[12,13] Thus, we conducted a comprehensive risk assessment, including sociodemographic, clinical, and hospital environmental factors associated with the incidence of HAP (Figure 1), using national health insurance claims data.
Figure 1.
Comprehensive risk assessment for hospital-acquired pneumonia
BMC Pulm Med. 2022;22(21) © 2022 BioMed Central, Ltd.
