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
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 naso-tracheal 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
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.