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Hospital-acquired pneumonia

Definition

Hospital-acquired pneumonia is an infection of the lungs that occurs during a hospital stay. This type of pneumonia can be very severe. Sometimes it can be fatal.

Alternative Names

Nosocomial pneumonia; Ventilator-associated pneumonia; Health-care associated pneumonia; HCAP 

Causes

Pneumonia is a common illness. It is caused by many different germs. Pneumonia that starts in the hospital tends to be more serious than other lung infections because:

• Patients in the hospital are often very sick and cannot fight off germs.
• The types of germs present in a hospital are often more dangerous than those outside in the community.

Pneumonia occurs more often in patients who are using a breathing machine (respirator). This machine helps them breathe.

Hospital-acquired pneumonia can also be spread by health care workers, who can pass germs from their hands or clothes from one patient to another. This is why hand-washing, wearing gowns, and using other safety measures is so important in the hospital.

Patients who are more prone to getting pneumonia while in the hospital:

• Are alcoholic
• Have had chest surgery or other major surgery
• Have a weak immune system from cancer treatment, certain medicines, or severe wounds
• Have long-term (chronic) lung disease
• Breathe saliva or food into their lungs as a result of not being fully alert or having swallowing problems
• Are older

Symptoms

Symptoms may include:

• In an elderly person, the first sign of hospital-acquired pneumonia may be mental changes or confusion
• A cough with greenish or pus-like phlegm (sputum)
• Fever and chills
• General discomfort, uneasiness, or ill feeling (malaise)
• Loss of appetite
• Nausea and vomiting
• Sharp chest pain that gets worse with deep breathing or coughing
• Shortness of breath
• Decreased blood pressure and high heart rate

Exams and Tests

Tests to check for hospital-acquired pneumonia may include:

• Arterial blood gases, to measure oxygen levels in the blood
• Blood cultures, to see if the infection has spread to the blood
• Chest x-ray or CT scan, to check the lungs 
• Complete blood count (CBC)
• Pulse oximetry, to measure oxygen levels in the blood
• Sputum culture or sputum gram stain, to check for what germs are causing the pneumonia

Treatment

• You will receive antibiotics through your veins (IV) to treat your lung infection. The antibiotic you are given will fight the germs that are in your sputum culture.
• You may also receive oxygen to help you breathe better and lung treatments to loosen and remove thick mucus from your lungs.
• You may need a ventilator (breathing machine) to support your breathing.

Outlook (Prognosis)

Patients who have other serious illnesses do not recover as well from pneumonia as patients who are not as sick.

Hospital-acquired pneumonia can be a life-threatening illness. Long-term lung damage may occur.

Prevention

Persons visiting loved ones in the hospital need to take steps to prevent spreading germs. The best way to stop the spread of germs is to wash your hands often. Stay home if you are sick. Keep your immunizations up to date.

After any surgery, you will be asked to take deep breaths to help keep your lungs open. Follow the advice of your doctor and nurse to help prevent pneumonia.

Most hospitals have programs to prevent hospital-acquired infections.

References

American Thoracic Society. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005 Feb 15;171(4):388-416.

Chastre J, Luyt CE. Ventilator-associated pneumonia. In: Mason RJ, Broaddus VC, Martin TR, et al., eds. Murray& Nadel's Textbook of Respiratory Medicine. 5th ed. Philadelphia, PA: Elsevier Saunders; 2010:chap 33.

Craven DE, Chroneou A. Nosocomial pneumonia. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, PA: Elsevier Churchill-Livingstone; 2009:chap 303.

Fishman N, Calfee DP. Prevention and control of health care-associated infections. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 290.

Limper AH. Overview of pneumonia.In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 97.

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