Risk-factors for nosocomial pneumonia - Focus on prophylaxis

Despite an increased understanding of the pathogenesis of nosocomial pneumonia and advances in diagnosis and treatment, the risk, cost, morbidity, and mortality of nosocomial pneumonia remain unacceptably high. The authors identify specific risk factors for nosocomial pneumonia, including the host, infection control practices, use of pharmacologic agents, and invasive devices that are potential targets for prophylaxis. Data are presented from recently published guidelines for prevention of nosocomial pneumonia that are simple and cost effective but not commonly integrated into routine patient care. The authors recommend that strategies for prophylaxis of nosocomial and ventilator-associated pneumonia be implemented by a multidisciplinary team comprised of physicians (critical care, pulmonary medicine, infectious diseases, and primary care), critical care and infection control nurses, and respiratory therapists. The goal should be better overall patient care, even if it may result in decreased professional autonomy and freedom.