Hospital-acquired pneumonia
Nosocomial pneumonia; Ventilator-associated pneumonia; Health-care associated pneumonia; HCAPHospital-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.
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:
Pneumonia
Pneumonia is a breathing (respiratory) condition in which there is an infection of the lung. This article covers community-acquired pneumonia (CAP). ...
Read Article Now Book Mark Article- 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 ventilator, which is a machine that helps them breathe. This is called ventilator-associated pneumonia.
Hospital-acquired pneumonia can also be spread by health care workers, who can pass germs from their hands, clothes, or instruments 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:
- Use alcohol excessively
- 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
Lung disease
Lung disease is any problem in the lungs that prevents the lungs from working properly. There are three main types of lung disease:Airway diseases -...
Read Article Now Book Mark Article - 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 not mentally alert due to medicines or illness
- Are older
- Are on a breathing machine (ventilator)
Symptoms
In older adults, 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
- Fast heart rate
- Increased respiratory rate
Exams and Tests
If your health care provider suspects pneumonia, tests will be ordered. These may include:
- Arterial blood gases, to measure oxygen levels in the blood
Arterial blood gases
Blood gases are a measurement of how much oxygen and carbon dioxide are in your blood. They also determine the acidity (pH) of your blood.
Read Article Now Book Mark Article - Blood cultures, to see if the infection has spread to the blood
Blood cultures
A blood culture is a laboratory test to check for bacteria or other germs in a blood sample.
Read Article Now Book Mark Article - Chest x-ray or CT scan of the chest, to check the lungs
Chest x-ray
A chest x-ray is an x-ray of the chest, lungs, heart, large arteries, ribs, and diaphragm.
Read Article Now Book Mark ArticleCT scan of the chest
A chest CT (computed tomography) scan is an imaging method that uses x-rays to create cross-sectional pictures of the chest and upper abdomen....
Read Article Now Book Mark Article - Complete blood count (CBC)
CBC
A complete blood count (CBC) test measures the following:The number of white blood cells (WBC count)The number of red blood cells (RBC count)The numb...
Read Article Now Book Mark Article - Pulse oximetry, to measure oxygen levels in the blood
- Sputum culture or sputum Gram stain, to check what germs are causing the pneumonia
Sputum culture
Routine sputum culture is a laboratory test that looks for germs that cause infection. Sputum is the material that comes up from air passages when y...
Read Article Now Book Mark ArticleSputum Gram stain
A sputum Gram stain is a laboratory test used to detect bacteria in a sputum sample. Sputum is the material that comes up from your air passages whe...
Read Article Now Book Mark Article - Bronchoscopy, to get cultures directly from the lungs in some cases
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 or are suspected to be causing the infection.
- Oxygen to help you breathe better and lung treatments to loosen and remove thick mucus from your lungs.
- Ventilator (breathing machine) using a tube or a mask to support your breathing for more severe cases.
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 someone 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.
Prevent spreading germs
Infections are illnesses that are caused by germs such as bacteria, fungi, parasites, and viruses. Patients in the hospital are already ill. Exposi...
Read Article Now Book Mark ArticleAfter 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 provider to help prevent pneumonia.
Most hospitals have programs to prevent hospital-acquired infections.
References
Chastre J, Luyt CE. Ventilator-associated pneumonia. In: Broaddus VC, Ernst JD, King TE, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 7th ed. Philadelphia, PA: Elsevier; 2022:chap 49.
Kalil AC, Metersky ML, Klompas M, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. 2016;63(5):e61-e111. PMID: 27418577 pubmed.ncbi.nlm.nih.gov/27418577/.
Klompas M. Nosocomial pneumonia. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 301.
Metersky ML, Kalil AC. Hospital-acquired pneumonia. In: Broaddus VC, Ernst JD, King TE, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 7th ed. Philadelphia, PA: Elsevier; 2022:chap 48.
Pneumonia
Animation
Hospital-acquired pneumonia - illustration
Pneumonia acquired in the hospital is a very serious infection because the patient's defense mechanisms are often impaired by illness, and the infecting organisms are more dangerous than the ones generally encountered in the community.
Hospital-acquired pneumonia
illustration
Respiratory system - illustration
Air is breathed in through the nasal passageways, travels through the trachea and bronchi to the lungs.
Respiratory system
illustration
Hospital-acquired pneumonia - illustration
Pneumonia acquired in the hospital is a very serious infection because the patient's defense mechanisms are often impaired by illness, and the infecting organisms are more dangerous than the ones generally encountered in the community.
Hospital-acquired pneumonia
illustration
Respiratory system - illustration
Air is breathed in through the nasal passageways, travels through the trachea and bronchi to the lungs.
Respiratory system
illustration
- Pneumonia - InDepth(In-Depth)
Review Date: 8/13/2023
Reviewed By: Denis Hadjiliadis, MD, MHS, Paul F. Harron, Jr. Professor of Medicine, Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.