Guidelines for preventing health-care-associated pneumonia, 2003; recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee
Corporate Authors:Hospital Infection Control Practices Advisory Committee (U.S.) ; Centers for Disease Control and Prevention (U.S.) ; National Center for Infectious Diseases (U.S.), Division of Bacterial and Mycotic Diseases. ; ... More ▼
Keywords:Adenovirus Infections, Human
Aspergillosis, Allergic Bronchopulmonary
Prevention & Control
Respiratory Syncytial Virus Infections
Severe Acute Respiratory Syndrome
Adenovirus Infections, Human/Prevention & Control
Aspergillosis, Allergic Bronchopulmonary/Prevention & Control
Cross Infection/Prevention & Control
Influenza, Human/Prevention & Control
Legionnaires' Disease/Prevention & Control
Paramyxoviridae Infections/Prevention & Control
Pneumonia, Bacterial/Prevention & Control
Pneumonia/Prevention & Control
Pulmonary Aspergillosis/Prevention & Control
Respiratory Syncytial Virus Infections/Prevention & Control
Severe Acute Respiratory Syndrome/Prevention & Control
Whooping Cough/Prevention & Control
Series:MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports ; v. 53, no. RR-3
Description:Introduction -- Key Terms Used In the Guideline -- Abbreviations Used In the Guideline -- -- Part I. Background -- Health-care-associated bacterial pneumonia -- Health-care-associated legionnaires disease -- Health-care-associated pertussis -- Health-care-associated aspergillosis -- Health-care-associated viral infections -- Health-care-associated respiratory syncytial virus infection -- Health-care-associated parainfluenza infection -- Health-care-associated adenovirus infection -- Health-care-associated influenza -- Severe acute respiratory syndrome -- -- [Part II]: Categorization of Recommendations -- Prevention of Health-Care-Associated Bacterial Pneumonia -- Prevention and Control of Health-Care-Associated Legionnaires Disease -- Prevention and Control of Health-Care-Associated Pertussis -- Prevention and Control of Health-Care-Associated Pulmonary Aspergillosis -- Prevention and Control of Health-Care-Associated Respiratory Syncytial Virus, Parainfluenza Virus, and Adenovirus Infections -- Prevention and Control of Health-Care-Associated Influenza -- Severe Acute Respiratory Syndrome -- Part III: Performance Indicators -- References
This report updates, expands, and replaces the previously published CDC "Guideline for Prevention of Nosocomial Pneumonia”. The new guidelines are designed to reduce the incidence of health-care-associated pneumonia and other severe, acute lower respiratory tract infections in acute-care hospitals and in other health-care settings (e.g., ambulatory and long-term care institutions) and other facilities where health care is provided.
Among the changes in the recommendations to prevent bacterial pneumonia, especially ventilator-associated pneumonia, are the preferential use of oro-tracheal rather than nasotracheal tubes in patients who receive mechanically assisted ventilation, the use of noninvasive ventilation to reduce the need for and duration of endotracheal intubation, changing the breathing circuits of ventilators when they malfunction or are visibly contaminated, and (when feasible) the use of an endotracheal tube with a dorsal lumen to allow drainage of respiratory secretions; no recommendations were made about the use of sucralfate, histamine-2 receptor antagonists, or antacids for stress-bleeding prophylaxis. For prevention of health-care-associated Legionnaires disease, the changes include maintaining potable hot water at temperatures not suitable for amplification of Legionella spp., considering routine culturing of water samples from the potable water system of a facility’s organ-transplant unit when it is done as part of the facility’s comprehensive program to prevent and control health-care-associated Legionnaires disease, and initiating an investigation for the source of Legionella spp. when one definite or one possible case of laboratory-confirmed health-care-associated Legionnaires disease is identified in an inpatient hemopoietic stem-cell transplant (HSCT) recipient or in two or more HSCT recipients who had visited an outpatient HSCT unit during all or part of the 2-10 day period before illness onset. In the section on aspergillosis, the revised recommendations include the use of a room with high-efficiency particulate air filters rather than laminar airflow as the protective environment for allogeneic HSCT recipients, and the use of high-efficiency respiratory-protection devices (e.g., N95 respirators) by severely immunocompromised patients when they leave their rooms when dust-generating activities are ongoing in the facility. In the respiratory syncytial virus (RSV) section, the new recommendation is to determine, on a case-by-case basis, whether to administer monoclonal antibody (palivizumab) to certain infants and children aged <24 months who were born prematurely and are at high risk for severe RSV infection. In the section on influenza, the new recommendations include the addition of oseltamivir (to amantadine and rimantadine) for prophylaxis of all patients without influenza illness and oseltamivir and zanamivir (to amantadine and rimantadine) as treatment for patients who are acutely ill with influenza in a unit where an influenza outbreak is recognized.
In addition to the revised recommendations, the guideline contains new sections on pertussis and lower respiratory tract infections caused by adenovirus and human parainfluenza viruses, and refers readers to the source of updated information about prevention and control of severe acute respiratory syndrome.
Parts II and III also published as: MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports ; v. 53, no. RR-3. March 16, 2004.
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