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:

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

      Pneumonia occurs more often in people who are using a 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 person to another. This is why hand-washing, wearing gowns, and using other safety measures is so important in the hospital.

      People can be more likely to get pneumonia while in the hospital if they:

      • Abuse alcohol
      • 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 (for example, after a stroke)
      • Are older
  • Symptoms
    • In an elderly person, the first sign of hospital-acquired pneumonia may be mental changes or confusion

      Other symptoms may include:

      • 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 fast heart rate
  • Exams and Tests
  • Treatment
    • Treatments may include:

      • Antibiotics through your veins (IV) to treat the lung infection. The antibiotic you are given will fight the germs that are found in your sputum culture.
      • Oxygen to help you breathe better and lung treatments to loosen and remove thick mucus from your lungs
      • Ventilator (breathing machine) to support your breathing
  • Outlook (Prognosis)
    • People who have other serious illnesses do not recover as well from pneumonia as people who are not as sick.

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

  • Prevention
    • People 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 and move around as soon as possible to help keep your lungs open. Follow the advice of your health care provider 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;171:388-416. PMID: 15699079

      Chastre J, Luyt CE. Ventilator-associated pneumonia. In: Mason RJ, Broaddus VC, Martin TR, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 6th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 34.

      Klompas M. Nosocomial pneumonia. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 303.