Hospital Acquired Pneumonia

Hospital Acquired Pneumonia (HAP) refers to a respiratory infection that develops more than 48 hours after hospital admission. It is differentiated from a community acquired pneumonia (CAP) as the pathogen is likely to be different and hence so will the antimicrobial treatment. HAP is more likely to be caused by bacteria rather than a virus, and there is higher risk of it being a multi-drug resistant bacteria.  

HAP has a high mortality rate, with studies finding it prolongs hospital admission by 7-9 days, and is the most common healthcare associated infection (HCAI) contributing to death.

Diagnosis of HAP can be based on the presence of:

  • Purulent airway secretions

  • Temperature > 38 degrees Celsius

  • Raised inflammatory markers (WCC and CRP)

  • New or progressive infiltrates on radiography

Prevention

Although not entirely preventable, there are some things we can do as health care professionals to reduce the incidence of HAP. 

The following simple interventions can have huge impact on prevention of HAP:

  • Early mobilisaton

    • Mobilising enables improved lung expansion and increased tidal volumes.

    • Patients should sit out of bed daily as able.

  • Analgesia

    Following surgery or trauma, pain can restrict patient’s movement, and their ability to take deep breaths and cough. All of which increases the risk of developing a HAP.

  • Oral mouthcare

    The oral cavity is a breeding ground for bacteria, especially in patients who are not eating or drinking. Ensure regular oral care with toothbrush and toothpaste, and chlorhexidine mouthwash.

  • Infection control

    • Diligent hand-washing.

    • Use of personal protective equipment (PPE).

    • Antibiotic stewardship.

  • HAP Assessment

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  • HAP Management

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