Hospital Acquired Pneumonia (HAP)

Hospital –acquired pneumonia or (Nosocomial Pneumonia) is an infection of the lungs that occurs during a hospital stay. HAP refers to any pneumonia contracted by a patient in a hospital at least 48-72 hours after being admitted. This type of pneumonia can be very severe, sometimes it can be fatal.

Types of HAP:

1)    Ventilator-Associated Pneumonia ( VAP ):

Is a sub-type of HAP which occurs in people who are receiving mechanical ventilation while in hospital.

2)    Healthcare- Acquired Pneumonia ( HCAP ):

Is a condition in patients who can come from the community and have frequent contact with the healthcare environment.

3)    Nursing Home-Acquired Pneumonia:

Is an important sub-group of HCAP, residents of long term care facilities may become infected through their contacts with the healthcare system.

Causes:

1)    HAP is a common illness, it is caused by many different germs that are gram negative bacilli ( 52% ), Staphylococcus Aureus ( 19% ), Haemophilus spp (5% ), Pseudomonas Aeruginosa (17.4%), Haemophilus Infleunza ( 4.9% ), Enterobacter spp ( 18.1% ), Klebsiella Pneumonia ( 18.1% )

2)    HAP is the second most common nosocomial infection (after urinary tract infection) and counts for 15-20% of the total. It is the primary cause of death in intensive care units.

3)    Pneumonia occurs more often in patients who are using a breathing machine (respirator), HAP can also be spread by health care workers, who can pass germs from their hands or cloths from one patient to another.

Signs & Symptoms:

1)    In an elderly person, the first sign of HAP may be mental changes or confusion.

2)    A cough with greenish or pus-like phlegm (sputum).

3)    Fever and chills

4)    General discomfort, uneasiness or ill feeling (malaise).

5)    Loss of appetite, nausea, vomiting.

6)    Sharp chest pain that gets worse with deep breathing or coughing.

7)    Shortness of breath.

8)    Decreased blood pressure and high heart rate

    Diagnosis (Exam & Test):

Tests to check for HAP may include;

1)    Arterial Blood Gases: to measure oxygen level  in blood

2)    Blood cultures: to see if the infection has spread to the blood

3)    Chest x-ray or CT scan: to check the lungs infection

4)    Complete blood count (CBC )

5)    Pulse oximetry: to measure oxygen level in the blood

6)    Sputum culture or sputum gram stain: to check for what grams are causing the pneumonia

7)    Pleural effusion thoracentesis: is performed for examination of pleural fluid

8)    Bronchoscopy ( BAC ): is suggested for suspected ventilator-associated pneumonia      `

   Prognosis:

1)    Patients who have other illnesses do not recover as well from pneumonia as patient who is not as sick.

2)    HAP can be life threatening illness, long term lung damage may occur.

Risk Factors:

Among the factors contributing to contracting HAP are;

1)    Are old age

2)    Are alcoholic

3)    Decreased infiltration of inspired air

4)    Intrinsic respiratory

5)    Neurologic

6)    Other diseases that result in respiratory tract obstruction

7)    Trauma, abdominal surgery

8)    Medications

9)    Diminished lung volumes

10)Decreased clearance of secretions may diminish the defenses of lungs

11)Poor hand washing and inadequate disinfection of respiratory devices

12)Have weak immune system from cancer treatment

Treatment:

1)    You will receive antibiotics through veins (IV) to treat your lung infections. The antibiotics you are given will fight the germs that are your sputum culture. Initial antibiotics are Erythromycin or Flouroquinolone. A Third generation Cephalosporin ( Ceftazidime ) , Carbapenens ( Imipenem ), Betalactam & Beta lactamase inhibitors ( Piperacillin / Tazobactam )

2)    You may also receive oxygen o help you better and lungs treatment s to loosen and remove thick mucus from your lungs

3)    You may need a ventilator ( breathing machine ) to support you breathing

Prevention:

1)    Persons visiting loved ones in hospital need to take steps to prevent spreading germs

2)    The best way to stop germs is to wash hands often

3)    Stay home if you are sick & keep your immunization up to date

4)    After any surgery, you will be asked to take deep breath to help keep your lungs open

5)    Follow the advice of your doctor & nurses to help prevent pneumonia

NAZNEEN ZULFIQAR

PHARM-D

LOWESTOFT, SUFFOLK

UNITED KINGDOM

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