Introduction
Hospital-acquired pneumonia (HAP), also known as nosocomial pneumonia, is a lung infection that develops 48 hours or more after a patient is admitted to the hospital, and it was not incubating at the time of admission. It is one of the most common and serious healthcare-associated infections, leading to increased morbidity, mortality, longer hospital stays, and higher medical costs.
Understanding the risk factors and implementing effective prevention strategies are essential to reducing the incidence of HAP and improving patient outcomes.
What Is Hospital-Acquired Pneumonia?
Hospital-acquired pneumonia is a lung infection contracted during a hospital stay. It differs from community-acquired pneumonia because it involves bacteria resistant to many antibiotics and often occurs in patients who are already critically ill or have compromised immune systems.
HAP can occur in any hospitalized patient but is particularly common in those who are intubated or receiving mechanical ventilation—a subtype called ventilator-associated pneumonia (VAP).
Causes and Risk Factors of Hospital-Acquired Pneumonia
Common Causes
- Bacterial pathogens:
- Pseudomonas aeruginosa
- Staphylococcus aureus (including MRSA)
- Klebsiella pneumoniae
- Escherichia coli
- Acinetobacter species
Risk Factors
- Mechanical ventilation: Intubated patients are at the highest risk due to the direct airway access.
- Prolonged hospital stay: Longer stays increase exposure to hospital pathogens.
- Advanced age: Older adults have weaker immune defenses.
- Underlying chronic diseases: COPD, diabetes, kidney or liver disease.
- Immunosuppression: Cancer, HIV, or steroid use.
- Previous antibiotic use: Can promote resistant bacteria growth.
- Poor oral hygiene: Increases bacterial colonization.
- Sedation and reduced mobility: Decreased coughing and clearance of secretions.
Symptoms and Diagnosis
Symptoms
- Fever and chills
- Cough producing sputum (which may be purulent)
- Shortness of breath or rapid breathing
- Chest pain
- Fatigue and confusion (especially in elderly patients)
Diagnosis
- Chest X-ray: Shows new infiltrates or consolidation
- Sputum culture: To identify causative bacteria
- Blood tests: To check for infection markers
- Pulse oximetry or arterial blood gases: Assess oxygen levels
Treatment of Hospital-Acquired Pneumonia
Treatment involves the use of broad-spectrum antibiotics tailored to the patient’s clinical condition and local resistance patterns. Early empirical treatment is often started while awaiting culture results.
- Antibiotics: Choices depend on suspected pathogens and hospital antibiograms. MRSA coverage is often included.
- Supportive care: Oxygen therapy, hydration, and respiratory support.
- Mechanical ventilation adjustments: To improve airway clearance and reduce infection risk.
Prevention Strategies for Hospital-Acquired Pneumonia
1. Hand Hygiene and Infection Control
- Strict handwashing protocols for healthcare workers and visitors.
- Use of personal protective equipment (PPE).
- Isolation of infected or colonized patients.
2. Ventilator Care Bundle
- Elevate the head of the bed to 30–45 degrees to prevent aspiration.
- Daily sedation vacations and assessment for extubation readiness.
- Oral care with antiseptic solutions.
- Subglottic suctioning to remove secretions above the endotracheal tube cuff.
3. Antibiotic Stewardship
- Judicious use of antibiotics to prevent resistance.
- Regular review and de-escalation of antibiotic therapy based on culture results.
4. Early Mobilization
- Encouraging movement and physical therapy as soon as possible to improve lung function.
5. Oral Hygiene
- Regular oral care reduces bacterial colonization that can be aspirated into the lungs.
Challenges in Managing Hospital-Acquired Pneumonia
- Increasing antibiotic resistance complicates treatment.
- Diagnosing HAP can be difficult due to overlapping symptoms with other conditions.
- Patients often have multiple co-morbidities that worsen outcomes.
Conclusion
Hospital-acquired pneumonia is a serious complication that affects many hospitalized patients, especially those on mechanical ventilation. Understanding the risk factors and implementing evidence-based prevention strategies such as strict hand hygiene, ventilator care bundles, and antibiotic stewardship can significantly reduce HAP incidence. Early diagnosis and appropriate treatment remain vital to improving survival and reducing hospital stays.
Hospitals and healthcare providers must remain vigilant to protect vulnerable patients from this preventable infection.
FAQS:
What is hospital-acquired pneumonia (HAP)?
HAP is a lung infection that develops 48 hours or more after hospital admission, not present at the time of admission.
Who is at highest risk for hospital-acquired pneumonia?
Patients on mechanical ventilation, older adults, those with weakened immune systems, and people with chronic diseases are at higher risk.
How can hospital-acquired pneumonia be prevented?
Preventive measures include strict hand hygiene, ventilator care protocols, antibiotic stewardship, oral care, and early patient mobilization.
What bacteria commonly cause hospital-acquired pneumonia?
Common bacteria include Pseudomonas aeruginosa, Staphylococcus aureus (including MRSA), Klebsiella pneumoniae, and Escherichia coli.
How is hospital-acquired pneumonia treated?
Treatment involves broad-spectrum antibiotics tailored to suspected bacteria, supportive care, and sometimes respiratory therapy or ventilator management.
