Interventions to prevent non-critical care hospital acquired pneumonia – a systematic review

Background: Hospital-acquired pneumonia is a significant burden to healthcare systems around the world. Although there is a considerable body of evidence on prevention of ventilator associated pneumonia, less is known about strategies to prevent hospital-acquired pneumonia in non-critical care settings. Objective: To systematically review the randomised controlled trial evidence for prevention of hospital-acquired pneumonia in non-critical care settings. Methods: We searched EMBASE, CINAHL+, MEDLINE and the Cochrane Library. Seventeen different searches were conducted in parallel through each database. Studies were included if they were randomised controlled trials reporting hospital-acquired pneumonia as an endpoint. Studies were excluded if they were performed in critical care or community settings. All studies published up to the end of December 2014 were considered, with no language restrictions. Data were independently extracted by two authors and the Delphi risk of bias tool was applied to assess trial quality. Results: Five thousand one hundred and one titles were identified across 17 searches. Only two studies were eligible for inclusion in the final review, one from a search of physical therapy interventions and one from a search of enteral feeding. The heterogeneity of the interventions did not permit meta-analysis. One trial suggested possible benefits to early mobilisation; the other trial suggested no benefit or harm from early enteral feeding via nasogastric tube. Both trials enrolled patients with acute stroke. No trials in non-stroke, non-critical care populations were eligible for inclusion in the review. Conclusions: There is currently insufficient trial evidence on preventing non-critical care hospital-acquired pneumonia to make recommendations on practice.