Infections acquired in hospital, known as ‘nosocomial infections’ are an important issue across the globe. They have immense health and economic cost and need to be addressed urgently. One form of these diseases is hospital acquired pneumonia (HAP) and it carries the highest mortality of all nosocomial infections. HAP is poorly studied outside of intensive care units and therefore was the focus of this thesis. Frailty, a similarly important problem in global populations is an emerging area of interest and also of personal interest to the researcher. This latter problem was studied later on in this work as it emerged as a possible issue in the context of HAP.
This thesis consists of four chapters; the first introduces the topics of interest, contextualises them and introduces the two novel pieces of work. The second describes a scoping review of the literature exploring risk factors for acquisition and mortality from HAP. This scoping review informs the third chapter where a novel pilot study into frailty in the context of HAP is described. The final chapter of this thesis then concludes with a summary of the work with further contextualisation, synthesis of concepts and recommendations for policy, research and practice.
The outcome of the scoping review was a synthesis of novel models describing the evidence. A novel model explaining how patients are put at risk of acquiring HAP was produced, as was a model for how the literature was found to be fractured. It also concluded that further research into HAP mortality risk was urgently needed to allow a similar model for risk to be produced. The novel pilot study performed in Chapter Three studied the issue of frailty and its relationship to HAP after frailty emerged as an important issue. It therefore began the work to produce a model for HAP mortality. The thesis concludes by stating that further research is urgently needed and recommendations for focus and methodology are made. Further research into the issue of frailty in the context of HAP is urgently needed, more specifically the relationship between frailty and mortality. This will continue the work in Chapter Three and aid the production of new models. These models may then be able to inform patient care.