title: Prevention of hospital-acquired pneumonia in non-ventilated adult patients: a narrative review.
abstract: BACKGROUND
  Pneumonia is one of the leading hospital-acquired infections worldwide and has an important impact. Although preventive measures for ventilator-associated pneumonia (VAP) are well known, less is known about appropriate measures for prevention of hospital-acquired pneumonia (HAP).
  
  
  OBJECTIVE
  The purpose of this narrative review is to provide an overview of the current standards for preventing HAP in non-ventilated adult patients.
  
  
  METHODS
  A search of the literature up to May 2015 was conducted using Medline for guidelines published by national professional societies or professional medical associations. In addition, a comprehensive search for the following preventive measures was performed: hand hygiene, oral care, bed position, mobilization, diagnosis and treatment of dysphagia, aspiration prevention, viral infections and stress bleeding prophylaxis.
  
  
  RESULTS
  Regarding international guidelines, several measures were recommended for VAP, whilst no specific recommendations for HAP prevention in non-ventilated patients are available. There is reasonable evidence available that oral care is associated with a reduction in HAP. Early mobilization interventions, swift diagnosis and treatment of dysphagia, and multimodal programmes for the prevention of nosocomial influenza cross-infection, have a positive impact on HAP reduction. The impact of bed position and stress bleeding prophylaxis remains uncertain. Systematic antibiotic prophylaxis for HAP prevention should be avoided.
  
  
  CONCLUSIONS
  Scant literature and little guidance is available for the prevention of HAP among non-ventilated adult patients. In addition, the criteria used for the diagnosis of HAP and the populations targeted in the studies selected are heterogeneous. Oral care was the most studied measure and was commonly associated with a decrease in HAP rate, although a broad range of interventions are proposed. No robust evidence is available for other measures. Further high-quality studies are required to evaluate the impact of specific measures on HAP prevention in non-ventilated adult patients.
authors.affiliation: Infection Control Programme, Geneva University Hospitals and Medical School, Geneva, Switzerland.
authors.forename: Leonor
authors.initials: L
authors.lastname: Pássaro
authors.affiliation: Infection Control Programme, Geneva University Hospitals and Medical School, Geneva, Switzerland.
authors.forename: Stephan
authors.initials: S
authors.lastname: Harbarth
authors.affiliation: Infection Control Programme, Geneva University Hospitals and Medical School, Geneva, Switzerland ; Infection Control Unit, Centre Hospitalier Universitaire (CHU) Grenoble Alpes, CS 10217, 38043 Grenoble Cedex 9, France ; ThEMAS TIM-C UMR 5525, University Grenoble Alpes/CNRS, Grenoble, France.
authors.forename: Caroline
authors.identifier: 0000-0002-3592-1948
authors.initials: C
authors.lastname: Landelle
keywords: Hospital-acquired pneumonia; Low respiratory tract infection; Nosocomial pneumonia; Prevention