Evaluation of multi-component interventions for prevention of nosocomial pneumonia in older adults: a randomized, controlled trial

Barbara H Rosario, Humaira Shafi, Anthony C A Yii, Louis Y Tee, Arron S H Ang, Gek Kheng Png, Wendy S T Ang, Yan Qing Lee, Pei Ting Tan, Aniruddha Sahu, Lin Fang Zhou, Yi Ling Zheng, Roslinda Binte Slamat, Aza A M Taha, Barbara H Rosario, Humaira Shafi, Anthony C A Yii, Louis Y Tee, Arron S H Ang, Gek Kheng Png, Wendy S T Ang, Yan Qing Lee, Pei Ting Tan, Aniruddha Sahu, Lin Fang Zhou, Yi Ling Zheng, Roslinda Binte Slamat, Aza A M Taha

Abstract

Aims: To evaluate the efficacy of multi-component interventions for prevention of hospital-acquired pneumonia in older patients hospitalized in geriatric wards.

Methods: A randomized, parallel-group, controlled trial was undertaken in patients aged 65 and above who were admitted to a tertiary hospital geriatric unit from January 1, 2016 to June 30, 2018 for an acute non-respiratory illness. Participants were randomized by to receive either a multi-component intervention (consisting of reverse Trendelenburg position, dysphagia screening, oral care and vaccinations), or usual care. The outcome measures were the proportion of patients who developed hospital-acquired pneumonia during hospitalisation, and mean time from randomization to the next hospitalisation due to respiratory infections in 1 year.

Results: A total of 123 participants (median age, 85; 43.1% male) were randomized, (n = 59) to intervention group and (n = 64) to control group. The multi-component interventions did not significantly reduce the incidence of hospital-acquired pneumonia but did increase the mean time to next hospitalisation due to respiratory infection (11.5 months vs. 9.5 months; P = 0.049), and reduced the risk of hospitalisation in 1 year (18.6% vs. 34.4%; P = 0.049). Implementation of multi-component interventions increased diagnoses of oropharyngeal dysphagia (35.6% vs. 20.3%; P < 0.001) and improved the influenza (54.5% vs 17.2%; P < 0.001) and pneumococcal vaccination rates (52.5% vs. 20.3%; P < 0.001).

Conclusions: The nosocomial pneumonia multi-component intervention did not significantly reduce the incidence of hospital-acquired pneumonia during hospitalisation but reduce subsequent hospitalisations for respiratory infections.

Clinical trial registration: ClinicalTrial.gov, NCT04347395.

Keywords: Multi-component interventions; Nosocomial infection; Older adults; Pneumonia; Randomized controlled trial.

Conflict of interest statement

The main author attended a Pneumococcal Vaccine Expert Input forum in 2019 (an honorarium was received and donated to the Geriatric Department) and received sponsorship from Pfizer to attend an Asia Pneumococcal and Meningococcal Disease Conference in Hong Kong in 2016. The remaining authors declare no conflict of interest, and this paper has not been published or presented elsewhere.

© 2021. European Geriatric Medicine Society.

Figures

Fig. 1
Fig. 1
Reverse Trendelenburg position or whole bed tilt
Fig. 2
Fig. 2
Flow chart showing enrolment, randomization, allocation, follow-up and analysis phases
Fig. 3
Fig. 3
Proportion of participants with re-admissions to hospital for acute respiratory infections over time. Log-rank test comparing the prevention bundle to usual care shows a significant difference in mean time from randomization to next hospitalization due to acute respiratory infections (9.5 months vs. 11.5 months; P = 0.049). One year after randomization, the intervention group had a lower risk of hospitalization for acute respiratory infections (18.6% vs. 34.4%; P = 0.049)
Fig. 4
Fig. 4
Dysphagia screen undertaken by Research Team Members (adapted from the Toronto Bedside Swallowing Screening Test (TOR-BSST) (Martino et al., 2008))

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