***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background Nonventilated hospital-acquired pneumonia ( NVHAP ) is a serious nosocomial infection that is increasingly attributed to antibiotic-resistant bacteria . Methods This is a retrospective case-control study comparing patients with and those without NVHAP from January 1 , 2014 to December 31 , 2014 at Barnes-Jewish Hospital , a 1,300-bed urban academic medical center in St. Louis , Missouri . Results One hundred seventy-four consecutive patients with NVHAP were enrolled . A r and om sample of 696 control patients matched by age , sex , race , and hospital admission date were selected from a total of 5,322 potential matched control subjects . NVHAP was pathogen-negative in 98 cases ( 56.3 % ) . Respiratory viruses were identified in 42 patients ( 24.1 % ) , gram-negative bacteria were seen in 25 patients ( 14.4 % ) , and gram-positive bacteria were identified in 20 patients ( 11.5 % ) . Individuals in whom NVHAP developed were more likely to die ( 15.5 % vs 1.6 % ; P < .01 ) , to require intensive care ( 56.3 % vs 22.8 % ; P < .01 ) or mechanical ventilation ( 19.0 % vs 3.9 % ; P < 0.01 ) , and to have a longer hospital length of stay ( 15.9 days [ range , 9.8 - 26.3 days ] vs 4.4 days [ range , 2.9 - 7.3 days ] ; P < 0.01 ) . This case-control study identified a strong association between hospital mortality and NVHAP , with patients who acquired NVHAP having an 8.4 times greater odds of death ( 95 % CI , 5.6 - 12.5 ) . Conclusions The occurrence of NVHAP was associated with significant increases in mortality , the use of intensive care and mechanical ventilation , and hospital length of stay . We also found that respiratory viruses were an important cause of NVHAP . These findings suggest that efforts aim ed at the successful prevention of NVHAP could improve patient outcomes and reduce health-care costs Background and Purpose — Dysphagia can lead to pneumonia and subsequent death after acute stroke . However , no prospect i ve study has demonstrated reduced pneumonia prevalence after implementation of a dysphagia screen . Methods — We performed a single-center prospect i ve interrupted time series trial of a quality initiative to improve dysphagia screening . Subjects included all patients with ischemic or hemorrhagic stroke admitted to our institution over 42 months with a 31-month ( n=1686 ) preintervention and an 11-month ( n=648 ) postintervention period . The intervention consisted of a dysphagia protocol with a nurse-administered bedside dysphagia screen and a reflexive rapid clinical swallow evaluation by a speech pathologist . Results — The dysphagia initiative increased the percentage of patients with stroke screened from 39.3 % to 74.2 % ( P<0.001 ) . Furthermore , this initiative coincided with a drop in hospital-acquired pneumonia from 6.5 % to 2.8 % among patients with stroke ( P<0.001 ) . Patients admitted postinitiative had 57 % lower odds of pneumonia , after controlling for multiple confounds ( odds ratio=0.43 ; confidence interval , 0.255–0.711 ; P=0.0011 ) . The best predictors of pneumonia were stroke type ( P<0.0001 ) , oral intake status ( P<0.0001 ) , dysphagia screening status ( P=0.0037 ) , and hospitalization before the beginning of the quality improvement initiative ( P=0.0449 ) . Conclusions — A quality improvement initiative using a nurse-administered bedside screen with rapid bedside swallow evaluation by a speech pathologist improves screening compliance and correlates with decreased prevalence of pneumonia among patients with stroke Abstract Objective To assess the efficacy of a single preoperative physiotherapy session to reduce  postoperative pulmonary complications ( PPCs )  after upper abdominal surgery . Design Prospect i ve , pragmatic , multicentre , patient and assessor blinded , parallel group , r and omised placebo controlled superiority trial . Setting Multidisciplinary preadmission clinics at three tertiary public hospitals in Australia and New Zeal and . Participants 441 adults aged 18 years or older who were within six weeks of elective major open upper abdominal surgery were r and omly assigned through concealed allocation to receive either an information booklet ( n=219 ; control ) or preoperative physiotherapy ( n=222 ; intervention ) and followed for 12 months . 432 completed the trial . Interventions Preoperatively , participants received an information booklet ( control ) or an additional 30 minute physiotherapy education and breathing exercise training session ( intervention ) . Education focused on PPCs and their prevention through early ambulation and self directed breathing exercises to be initiated immediately on regaining consciousness after surgery . Postoperatively , all participants received st and ardised early ambulation , and no additional respiratory physiotherapy was provided . Main outcome measures The primary outcome was a PPC within 14 postoperative hospital days assessed daily using the Melbourne group score . Secondary outcomes were hospital acquired pneumonia , length of hospital stay , utilisation of intensive care unit services , and hospital costs . Patient reported health related quality of life , physical function , and post-discharge complications were measured at six weeks , and all cause mortality was measured to 12 months . Results The incidence of PPCs within 14 postoperative hospital days , including hospital acquired pneumonia , was halved ( adjusted hazard ratio 0.48 , 95 % confidence interval 0.30 to 0.75 , P=0.001 ) in the intervention group compared with the control group , with an absolute risk reduction of 15 % ( 95 % confidence interval 7 % to 22 % ) and a number needed to treat of 7 ( 95 % confidence interval 5 to 14 ) . No significant differences in other secondary outcomes were detected . Conclusion In a general population of patients listed for elective upper abdominal surgery , a 30 minute preoperative physiotherapy session provided within existing hospital multidisciplinary preadmission clinics halves the incidence of PPCs and specifically hospital acquired pneumonia . Further research is required to investigate benefits to mortality and length of stay . Trial registration Australian New Zeal and Clinical Trials Registry ANZCTR 12613000664741 ABSTRACT Hospital-acquired pneumonia ( HAP ) contributes greatly to patient mortality and healthcare costs . Studies have shown that aggressive oral care in intensive care units ( ICUs ) can significantly reduce pneumonia rates , and hospitals have implemented stringent protocol s in this setting . However , little is known about the effectiveness of aggressive oral care in reducing HAP in non – intensive care wards , prompting us to conduct a nonr and omized controlled clinical trial . A structured toothbrushing program was provided to an experimental cohort of patients . A control group received usual care .  Patient demographics , toothbrushing frequency , and pneumonia diagnosis were recorded over a 3.5-month period . Difference in pneumonia rates was computed using unadjusted and multivariate logistic regression analyses . No significant difference in pneumonia rates between control and experimental groups was found ( 1.7 % versus 1.8 % ) . Toothbrushing rates increased significantly in the experimental group ( p = .002 ) but fell short of protocol frequency . It became apparent that aggressive toothbrushing program implementation requires nursing-led interdisciplinary involvement , more intensive training , a streamlined documentation system , and efficient compliance tracking . Lessons from this study should be used for future large-scale research . A secondary analysis of these data did , however , suggests that increasing toothbrushing rates may have the potential to reduce pneumonia in the non-ICU acute care setting OBJECTIVES Aspiration of oral secretions and their bacteria is increasingly being recognized as an important factor in pneumonia . We investigated whether oral care lowers the frequency of pneumonia in institutionalized older people . DESIGN Survey . SETTING Eleven nursing homes in Japan . PARTICIPANTS Four hundred seventeen patients r and omly assigned to an oral care group or a no oral care group .  INTERVENTION Nurses or caregivers cleaned the patients ' teeth by toothbrush after each meal . Swabbing with povidone iodine was additionally used in some cases . Dentists or dental hygienists provided professional care once a week . MEASUREMENTS Pneumonia , febrile days , death from pneumonia , activities of daily living , and cognitive functions . RESULTS During follow-up , pneumonia , febrile days , and death from pneumonia decreased significantly in patients with oral care . Oral care was beneficial in edentate and dentate patients . Activities of daily living and cognitive functions showed a tendency to improve with oral care . CONCLUSION We suggest that oral care may be useful in preventing pneumonia in older patients in nursing homes BACKGROUND Currently , no single U.S. surveillance system can provide estimates of the burden of all types of health care-associated infections across acute care patient population s. We conducted a prevalence survey in 10 geographically diverse states to determine the prevalence of health care-associated infections in acute care hospitals and generate up date d estimates of the national burden of such infections . METHODS We defined health care-associated infections with the use of National Healthcare Safety Network criteria .  One-day surveys of r and omly selected in patients were performed in participating hospitals . Hospital personnel collected demographic and limited clinical data . Trained data collectors review ed medical records retrospectively to identify health care-associated infections active at the time of the survey . Survey data and 2010 Nationwide Inpatient Sample data , stratified according to patient age and length of hospital stay , were used to estimate the total numbers of health care-associated infections and of in patients with such infections in U.S. acute care hospitals in 2011 . RESULTS Surveys were conducted in 183 hospitals . Of 11,282 patients , 452 had 1 or more health care-associated infections  ( 4.0 % ; 95 % confidence interval , 3.7 to 4.4 ) . Of 504 such infections , the most common types were pneumonia ( 21.8 % ) , surgical-site infections ( 21.8 % ) , and gastrointestinal infections ( 17.1 % ) . Clostridium difficile was the most commonly reported pathogen ( causing 12.1 % of health care-associated infections ) . Device-associated infections ( i.e. , central -catheter-associated bloodstream infection , catheter-associated urinary tract infection , and ventilator-associated pneumonia ) , which have traditionally been the focus of programs to prevent health care-associated infections , accounted for 25.6 % of such infections . We estimated that there were 648,000 patients with 721,800 health care-associated infections in U.S. acute care hospitals in 2011 . CONCLUSIONS Results of this multistate prevalence survey of health care-associated infections indicate that public health surveillance and prevention activities should continue to address C. difficile infections . As device- and procedure-associated infections decrease , consideration should be given to exp and ing surveillance and prevention activities to include other health care-associated infections INTRODUCTION The purpose of this point-of-care study was to test the efficacy of a prevention-based oral care protocol in reducing non-ventilator-associated hospital-acquired pneumonia in a neurosurgical population outside the critical care environment . The research ers hypothesized that an enhanced oral care protocol would decrease the incidence of pneumonia . METHODS This quasi-experimental , comparative study took place on an acute neurosurgical unit at a tertiary care trauma hospital in Western Canada . Subjects were non-intubated , care-dependent adults with a primary diagnosis of neurologic injury/insult , and at high risk for pneumonia . The prospect i ve study group comprised 34 subjects ; two subjects were excluded from the study analysis . The retrospective study group comprised 51 subjects . Data were collected for both groups for a six-month period . Retrospective data were collected through chart review . The prospect i ve group were eligible neurosurgical patients who received the enhanced oral care protocol .  Data collection tools were developed and diagnostic criteria for hospital-acquired pneumonia were determined . The pneumonia rates between subjects who received st and ard oral care  ( retrospective group ) and those who received an enhanced , prevention-based , oral care protocol ( prospect i ve group ) were compared . RESULTS A statistically significant decrease in the pneumonia rate occurred in the prospect i ve group ( p < 0.05 ) . DISCUSSION An enhanced oral care protocol was beneficial in reducing the incidence of non-ventilator-associated hospital-acquired pneumonia . IMPLICATION S Nurses play a vital role in preventing hospital-acquired pneumonia . Foundational nursing practice s , such as regular oral hygiene , are important aspects of care in preventing nosocomial infections and related costs , optimizing health , and promoting quality care BACKGROUND Hospital-acquired pneumonia ( HAP ) is one of the leading nosocomial infections and is associated with high morbidity and mortality . Numerous studies on HAP have been performed in intensive care units ( ICUs ) , whereas very few have focused on patients in general wards . This study examined the incidence of , risk factors for , and outcomes 
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To date , interventions to reduce NV-HAP appear to be based broadly on the themes of improving oral care , increased mobility or movement and dysphagia management