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Procedure-associated Module
PPP

Post-Procedure Pneumonia (PPP) Event
Introduction: Patients who undergo thoraco-abdominal operations are at increased risk
of acquiring healthcare-associated pneumonia, even in the absence of mechanical
ventilation.1,2,3 Based on NNIS system reports, pneumonia was the third most frequently
reported healthcare-associated infection among hospitalized surgical patients (15%), and
among thoracic surgery patients, 34% of the healthcare-associated infections reported
were pneumonia. Further, when NNIS surgical patients with healthcare-associated
infections died and the death was attributed to the infection, pneumonia was the most
frequently associated infection (38%). In this group, the risk of surgical patient death due
to healthcare-associated pneumonia was similar whether or not a mechanical ventilator
was used.4 Prevention of postoperative pneumonia includes ambulation and deep
breathing as soon as possible after operation and, in some patients, the use of incentive
spirometry.
Settings: Surveillance of surgical patients will occur in any inpatient setting where the
selected NHSN operative procedure(s) are performed.
Requirements: Select at least one NHSN operative procedure and indicate selected
operation on the Patient Safety Monthly Reporting Plan (CDC 57.106). Collect
numerator and denominator data on all selected operations for at least one month.
Definitions: Pneumonia (PNEU) is identified by using a combination of radiologic,
clinical, and laboratory criteria (see definitions section under VAP event [Chapter 6]).
Post-procedure pneumonia: A pneumonia that meets the criteria after an inpatient
operation takes place.
REPORTING INSTRUCTIONS:
 Report as PPP those pneumonias that are detected prior to discharge following
inpatient operations.
 Do not report PPP following outpatient operations.
Numerator Data: All inpatients having the selected procedure are monitored for signs of
PPP. The Pneumonia (PNEU) form (CDC 57.111) is completed for each such patient
found to have a PPP. The Instructions for Completion of Pneumonia Form (Tables of
Instructions, Tables 4 and 2a) includes brief instructions for collection and entry of each
data element on the form. The PNEU form includes patient demographic information
and information about the operative procedure, including the date and type of procedure.
Additional data include the specific criteria met for identifying the PNEU, whether the
PNEU was also associated with the use of a ventilator, whether the patient developed a
secondary bloodstream infection, whether the patient died, and the organisms isolated
from cultures and the organisms’ antimicrobial susceptibilities.

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Procedure-associated Module
PPP

Denominator Data: For all patients having a procedure selected for surveillance during
the month, complete a Denominator for Procedure form (CDC 57.121). The data are
collected individually for each inpatient operative procedure performed during the month
specified on the Patient Safety Monthly Surveillance Plan (CDC 57.106). The
Instructions for Completion of Denominator for Procedure (Tables of Instructions, Table
13) includes brief instructions for collection and entry of each data element on the form.
Data Analyses: The PPP rates per 100 operative procedures are calculated by dividing
the number of PPPs by the number of specific operative procedures and multiplying the
results by 100. These calculations will be performed separately for the different types of
operative procedures.
1

Celis R, Torres A, Gatell JM, Almela M, Rodriguez-Roisin R, Agusti-Vidal A. Healthcareassociated pneumonia: a multivariate analysis of risk and prognosis. Chest 1988;93:318-24.

2

Hooton TM, Haley RW, Culver DH, White JW, Morgan WM, Carroll RC. The joint association
of multiple risk factors with the occurrence of healthcare-associated infection. Am J Med
1981;70:960-70.

3

Windsor JA, Hill GL. Risk factors for postoperative pneumonia: the importance of protein
depletion.Am Surg 1988;208:209-14.

4

Horan TC, Culver DH, Gaynes RP, Jarvis WR, Edwards JR, Reid CR, and the National
Healthcare-associated Infections Surveillance (NNIS) System. Healthcare-associated infections in
surgical patients in the United States, January 1986-June 1992. Infect Control Hosp Epidemiol
1993;14:73-80.

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