2018 National Teaching Institute Research Abstracts

RESEARCH ORAL POSTER PRESENTATION AWARD WINNERS RS1 Sepsis Incidence: Nonventilator HospitalAcquired Pneumonia Versus Pneumonia as an Admitting Diagnosis Karen Giuliano, Dian Baker, Barbara Quinn; Northeastern University, Boston, MA Purpose: In the fourth study of our hospital-acquired pneumonia prevention initiative, the incidence of sepsis associated with nonventilator hospital-acquired pneumonia (NV-HAP) was compared with the incidence in patients admitted with pneumonia (AP). Specifically, we investigated: (1) sepsis incidence, (2) differences in hospital length of stay (LOS) and total hospital charges, and (3) the population characteristics of patients with NV-HAP or AP in whom sepsis developed. Background/Significance: Despite the substantial worldwide efforts to decrease sepsis, sepsis incidence and related mortality rates continue to increase. Current efforts are focused on early recognition and treatment; preventive strategies have not been deployed as aggressively. Although fundamental benefits of prevention-oriented strategies have been recognized by the Centers for Disease Control and Prevention, sepsis prevention through prevention of infection, particularly hospital-acquired infection, remains a clinical challenge. Method: The 2012 Healthcare Utilization Project data set was used to identify patients with a diagnosis of sepsis associated with either NV-HAP or AP. We compared overall sepsis incidence, LOS, and total charges between NV-HAP patients and AP patients. We also compared data from both groups on the following characteristics: age, sex, race, number of chronic conditions, elective versus nonelective hospital admission, operating room procedure (yes/no), admission and discharge transfer status, and in-hospital mortality. We then compared these costs with the costs associated with ventilator-associated pneumonia (VAP). Results: Sepsis incidence associated with NV-HAP was 19 times greater than that associated with AP (36.3% vs 1.9%). LOS was significantly longer and total hospital charges were significantly greater for patients with sepsis associated with NV-HAP (both P < .001). The risk of sepsis developing was 28.8 times greater with NV-HAP than with AP. Although patients who had NV-HAP or AP and in whom sepsis developed had a greater need for additional health care on hospital discharge (NV-HAP, 7.3%-39.4%; AP, 6.0%-29.5%), the magnitude of the increase was larger for NV-HAP patients with sepsis (32.1%) than for AP patients with sepsis (23.5%). There were 16 340 more patients in the NV-HAP group than in the AP group who were transferred to other health care facilities after being discharged from the hospital. Conclusion: NV-HAP represents a more substantial risk for sepsis-related morbidity and mortality than does AP. Total hospital charges associated with NV-HAP were 8.5 times higher than those associated with AP and VAP combined ($7 282 901 516 vs $858 705 796). With pneumonia as the leading cause of sepsis, our findings suggest that a reduction in NV-HAP may lead to a reduction in sepsis. Prevention of NV-HAP should be elevated to the same level of concern, attention, and effort as prevention of VAP in hospitals. Disclosure: When this work was started, Karen Giuliano was an employee of Stryker Medical. Barbara Quinn and Dian Baker were previously members of the Sage/Stryker speakers' bureau. Sage did not provide funding or resources for this study.