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

Autor: Rosario BH; Department of Geriatric Medicine, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore. rosario.barbara.helen@singhealth.com.sg., Shafi H; Department of Infectious Diseases, Changi General Hospital, Singapore, Singapore., Yii ACA; Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore, Singapore., Tee LY; Department of Geriatric Medicine, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore., Ang ASH; Department of Accident and Emergency, Changi General Hospital, Singapore, Singapore., Png GK; Department of Geriatric Medicine, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore., Ang WST; Department of Geriatric Medicine, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore., Lee YQ; Department of Geriatric Medicine, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore., Tan PT; Clinical Trials and Research Unit, Changi General Hospital, Singapore, Singapore., Sahu A; Department of Geriatric Medicine, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore., Zhou LF; Department of Geriatric Medicine, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore., Zheng YL; Department of Geriatric Medicine, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore., Slamat RB; Department of Geriatric Medicine, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore., Taha AAM; Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore, Singapore.
Jazyk: angličtina
Zdroj: European geriatric medicine [Eur Geriatr Med] 2021 Oct; Vol. 12 (5), pp. 1045-1055. Date of Electronic Publication: 2021 Jun 03.
DOI: 10.1007/s41999-021-00506-3
Abstrakt: 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.
(© 2021. European Geriatric Medicine Society.)
Databáze: MEDLINE
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