Hospital Acquired Pneumonia: Difference between revisions

No edit summary
No edit summary
 
(63 intermediate revisions by 8 users not shown)
Line 1: Line 1:
<div class="noeditbox">Welcome to [[Glasgow Caledonian University Cardiorespiratory Therapeutics Project]] This project is created by and for the students in the School of Physiotherapy at Glasgow Caledonian University. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!</div><div class="editorbox">
<div class="editorbox">
'''Original Editors '''- [[Glasgow Caledonian University Cardiorespiratory Therapeutics Project|Students from Glasgow Caledonian University's Cardiorespiratory Therapeutics Project.]]  
'''Original Editors '''- [[Glasgow Caledonian University Cardiorespiratory Therapeutics Project|Students from Glasgow Caledonian University's Cardiorespiratory Therapeutics Project.]]  


'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}} &nbsp;  
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}} &nbsp;  
</div>  
</div>  
== Definition/Description  ==
== Introduction ==
[[File:Multidrug-resistant Klebsiella pneumoniaeand neutrophil.jpeg|thumb|Multidrug-resistant bacteria and WBC]]
Hospital-acquired [[pneumonia]] (HAP) is defined as pneumonia that occurs 48 hours or more after hospital admission and is not incubating at hospital admission.


 
# Early-onset (occurring within 4 days of admission) HAP is usually caused by the same [[Bacterial Infections|bacteria]] and [[Viral Infections|viruses]] as community-acquired pneumonia and has a good prognosis.
 
# Late-onset (starting 5 days or more after admission) HAP has a worse prognosis and is usually caused by micro-organisms that are acquired from the hospital environment. MRSA, Pseudomonas aeruginosa and other non-pseudomonal Gram-negative bacteria are the most common causes."<ref>NICE [https://www.nice.org.uk/advice/esnm44 Hospital-acquired pneumonia caused by methicillin-resistant Staphylococcus aureus: telavancin] Available:http://www.nice.org.uk/advice/esnm44/chapter/full-evidence-summary (accessed 25.12.2022)</ref>
'''Distinguishing between pneumonia and Hospital-acquired pneumonia '''
HAP is the second most common hospital acquired infection (see [[Healthcare-Associated Infections]]), catheter-associated [[Urinary Tract Infection|urinary tract infections]] being the most common.<ref name=":1">American [https://www.myamericannurse.com/preventing-hospital-acquired-pneumonia/ Nurse Preventing hospital-acquired pneumonia]Available:https://www.myamericannurse.com/preventing-hospital-acquired-pneumonia/ (accessed 25.12.20220</ref>
 
 
'''Pneumonia'''
 
“Pneumonia is an infection of the lung tissue. When a person has pneumonia the air sacs in their lungs become filled with microorganisms, fluid and inflammatory cells and their lungs are not able to work properly. Diagnosis of pneumonia is based on symptoms and signs of an acute lower respiratory tract infection, and can be confirmed by a chest X-ray showing new shadowing that is not due to any other cause (such as pulmonary oedema or infarction)."&nbsp;<br>(NICE clinical guidelines 2014)
 
 
 
'''Hospital-acquired pneumonia'''
 
"Hospital-acquired pneumonia is defined as pneumonia that occurs 48 hours or more after hospital admission and is not incubating at hospital admission. Early-onset (occurring within 4 days of admission) hospital-acquired pneumonia is usually caused by the same bacteria and viruses as community-acquired pneumonia and has a good prognosis. Late-onset (starting 5 days or more after admission) hospital-acquired pneumonia has a worse prognosis and is usually caused by micro-organisms that are acquired from the hospital environment. MRSA, Pseudomonas aeruginosa and other non-pseudomonal Gram-negative bacteria are the most common causes."
 
(NICE&nbsp;Hospital-acquired pneumonia caused by methicillin-resistant Staphylococcus aureus: telavancin. Published: 15 July 2014)
 
<br>


== Epidemiology  ==
== Epidemiology  ==


“At any time 1.5% of hospital inpatients in England have a hospital-acquired respiratory infection, more than half of which are hospital-acquired pneumonia and are not associated with intubation. Hospital-acquired pneumonia is estimated to increase hospital stay by about 8 days and has a reported mortality rate that ranges from 30–70%. Variations in clinical management and outcome occur across the UK.”
# HAP is a common cause of pneumonia in those admitted to [[Physiotherapists Role in ICU|intensive care units]] (ICU) or on mechanical [[Ventilation and Weaning|ventilation]]. 9/10 cases of HAP develope in ICUs occur in patients who are intubated and mechanically ventilated.
# The elderly are more are risk of developing HAP.<ref>Radiopedia [https://radiopaedia.org/articles/hospital-acquired-pneumonia-1?lang=us Hospital-acquired pneumonia] Available:https://radiopaedia.org/articles/hospital-acquired-pneumonia-1?lang=us (accessed 24.12.2022)</ref>


(NICE guidelines 2014)
== Clinical Manifestations ==


<br>
# Symptoms of HAP: includes cough, expectoration, [[Fever|a rise in body temperature]], chest pain or [[Dyspnoea|dyspnea]].
# Signs include of HAP include: fever, tachypnea, consolidations or crackles.<ref name=":2">Shebl E, Gulick PG. Nosocomial Pneumonia. InStatPearls [Internet] 2021 Jul 21. StatPearls Publishing.Available;https://www.ncbi.nlm.nih.gov/books/NBK535441/#!po=22.7273 (accessed 25.12.2022)</ref>


Ventilator-acquired pneumonia (VAP) has been studied more comprehensively than HAP. A clear reason for this is VAP is responsible for 86% of the HAP reported (Masterston). <br>
For more see [[Pneumonia]]
== Physiotherapy and Other Management  ==


The incidence rate of HAP is between 3 and 10 per 1000 hospital admissions (Kieninger, 2009, Stolbrink 2014)  
Other health professionals will be treating your patient. What is their input? When addressing HAP, respiratory physiotherapy interventions should be individually tailored around the patient’s symptoms, observing aspects such as degree of pain, mobility capabilities and an array of complex factors<ref name="denehy">Denehy L, Berney S. [https://www.researchgate.net/publication/233585155_Denehy_L_Berney_S_Physiotherapy_in_the_intensive_care_unit_Phys_Ther_Rev_20061149-56 Physiotherapy in the intensive care unit.] Physical Therapy Reviews. 2006;11(1):49. Available: https://www.researchgate.net/publication/233585155_Denehy_L_Berney_S_Physiotherapy_in_the_intensive_care_unit_Phys_Ther_Rev_20061149-56 (accessed 25.12.2022)</ref>. 


<br>  
Substantial evidence supports the role of physiotherapy in the respiratory managing HAP, demonstrating both short-term and longer term benefits<ref name="denehy" />. 


Mortality rates from VAP are between 24 and 50% (Masterston) but it is reported to jump to 76% if it is caused my multi drug resistant pathogens (mastersotn) that are often linked to later stage pneumonia (&gt; 5days in hospital). Although it is difficult to determine the exact cause of death in critically ill patients, which will cause discrepancies in any date, Liapikou reports that accurate antibiotics taken at the right time has shows to lower mortality rate for HAP.
Techniques may be found here [[Respiratory Physiotherapy]]  and [[Respiratory Physiotherapy for ICU Patients]] Examples include: 


<br>The chance of infection is estimated to be 3%/day during the first 5 days of ventilation, followed by 2%/day up to day 10 of ventilation and there- after 1%/day.  
* [[Manual Hyperinflation|Manual hyperinflation]]
* Percussion, shaking, vibrations, 
* [[Suctioning]] (if huffing or cough promoting techniques are proving ineffective in regards to sputum extraction),
* [[Breathing Exercises|Breathing exercises]]
* Mobilization<ref name="denehy" />. <br>


(American Thoracic Society 2005)<br><br>
== Prognosis ==
HAP is linked with increased death rates. The death rates associated with VAP ranges from 20% to 50% in different studies.<ref name=":2" />


== Aetiology ==
== Prevention ==
Several basic nursing interventions are associated with reducing HAP risk—


* Following infection prevention standards
* Elevating the head of the bed 30 to 45 degrees to prevent aspiration
* Seeing to good oral hygiene (cleaning teeth, gums, tongue, dentures)
* Increasing patient mobility with ambulation to eg three times a day (as appropriate)
* Educating patient re coughing and deep breathing, and use of incentive spirometry.<ref name=":1" />


For more see [[Infection Prevention and Control]]


The most common cause is an accumulation of bacteria, most ordinarily gram-negative bacilli and staphlycoccus aureus, which inhabit the oropharynx and upper airways in seriously ill and ventilated patients. A less common cause is seeding of the lung due to bacteremia; a bacterium that originates in the patients’ blood supply and is transferred to the lungs during gas exchange. Finally inhalation of bacterially contaminated aerosols which transport airborne particles containing Legionella sp, Aspergillus sp, or influenza virus, although this is a relative unfamiliar form of contracting hospitalized pneumonia.
<br>Endotracheal intubation and other forms of mechanical ventilation poses the greatest overall risk. Ventilation Associated Pneumonia is a subcategory of hospitalized and contributes more than 85% of all cases, with pneumonia occurring in up to 27% of ventilated patients. Endotracheal intubation related bacteria embed themselves deep into the endotracheal tube cuff enabling them to avoid the body nature immune response while also providing a biofilm of protection from antibiotics.
<br>In nonintubated patients, risk factors include previous antibiotic treatment, high gastric pH, resulting from cardiac, pulmonary, hepatic, or renal deficiencies. Major risk factors for postoperative pneumonia are patients older than 70, abdominal or thoracic surgery, and cardiorespiratory functional depletion.
== Investigations  ==
This may well include any investigations used to gain a diagnosis or that you might need to gain information about your patient assessment.
== Clinical Manifestations<br> ==
A patient that develops new or extra pulmonary infiltrates and a fever are signs of HAP. In order to differentiate HAP and other pathologies diagnosis should be based on a radiographic x-ray. To diagnose HAP radiological opacity with alveolar condensation must be present.
Management of Hospital-Associated Pneumonia in the Intensive Care Unit J. Rello, L. Vidaur, E. Dıaz, A. Rodrıguez – chapter 42
The time of onset of HAP is a large determinate of the type of bacteria causing the infection:
'''Early-onset HAP'''&nbsp;''occurring in the first 4 days of hospitalization) is often caused by community-acquired pathogens such as'': <br>Haemophilus influenzae, <br>Streptococcus pneumoniae, or <br>methicillin-susceptible S aureus (MSSA). <br>In this context, pathogens with strong intrinsic or acquired antimicrobial resistances are rarely causative.
'''Late-onset HAP''' ''developing ≥ 5 days after hospitalization is often caused by aerobic Gram-negative bacilli such as:''<br>P aeruginosa, <br>Enterobacteriaceae, or <br>Acinetobacter) or <br>Methicillin-resistant Staphylococcus aureus (MRSA) Late-onset pneumonia is due to P aeruginosa, Acinetobacter, or MRSA in 30 to 71% of cases.<br>
== Physiotherapy and Other Management  ==
Physiotherapy and other management. Other health professionals will be treating your patient. What is their input?
== Prevention  ==
Brief consideration of how this pathology could be prevented and the physiotherapy role in health promotion in relation to prevention of disease or disease progression.
== Resources <br>  ==
add appropriate resources here
== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])  ==
see tutorial on [[Adding PubMed Feed|Adding PubMed Feed]]
<div class="researchbox">
<rss>addfeedhere|charset=UTF-8|short|max=10</rss>
</div>
== References  ==
== References  ==
see [[Adding References|adding references tutorial]].


<references />  
<references />  


[[Category:Glasgow Caledonian University Project]]
[[Category:Glasgow_Caledonian_University_Project]]
[[Category:Acute Care]]
[[Category:Cardiopulmonary]]
[[Category:Older People/Geriatrics]]
[[Category:Acute Respiratory Disorders - Conditions]]
[[Category:Older People/Geriatrics - Conditions]]

Latest revision as of 03:18, 25 December 2022

Original Editors - Students from Glasgow Caledonian University's Cardiorespiratory Therapeutics Project.

Top Contributors - Bertie Elles, Lucinda hampton, Kim Jackson, Adam Vallely Farrell, 127.0.0.1, Admin, Michelle Lee, Karen Wilson and Lauren Lopez  

Introduction[edit | edit source]

Multidrug-resistant bacteria and WBC

Hospital-acquired pneumonia (HAP) is defined as pneumonia that occurs 48 hours or more after hospital admission and is not incubating at hospital admission.

  1. Early-onset (occurring within 4 days of admission) HAP is usually caused by the same bacteria and viruses as community-acquired pneumonia and has a good prognosis.
  2. Late-onset (starting 5 days or more after admission) HAP has a worse prognosis and is usually caused by micro-organisms that are acquired from the hospital environment. MRSA, Pseudomonas aeruginosa and other non-pseudomonal Gram-negative bacteria are the most common causes."[1]

HAP is the second most common hospital acquired infection (see Healthcare-Associated Infections), catheter-associated urinary tract infections being the most common.[2]

Epidemiology[edit | edit source]

  1. HAP is a common cause of pneumonia in those admitted to intensive care units (ICU) or on mechanical ventilation. 9/10 cases of HAP develope in ICUs occur in patients who are intubated and mechanically ventilated.
  2. The elderly are more are risk of developing HAP.[3]

Clinical Manifestations[edit | edit source]

  1. Symptoms of HAP: includes cough, expectoration, a rise in body temperature, chest pain or dyspnea.
  2. Signs include of HAP include: fever, tachypnea, consolidations or crackles.[4]

For more see Pneumonia

Physiotherapy and Other Management[edit | edit source]

Other health professionals will be treating your patient. What is their input? When addressing HAP, respiratory physiotherapy interventions should be individually tailored around the patient’s symptoms, observing aspects such as degree of pain, mobility capabilities and an array of complex factors[5].

Substantial evidence supports the role of physiotherapy in the respiratory managing HAP, demonstrating both short-term and longer term benefits[5].

Techniques may be found here Respiratory Physiotherapy and Respiratory Physiotherapy for ICU Patients Examples include:

Prognosis[edit | edit source]

HAP is linked with increased death rates. The death rates associated with VAP ranges from 20% to 50% in different studies.[4]

Prevention[edit | edit source]

Several basic nursing interventions are associated with reducing HAP risk—

  • Following infection prevention standards
  • Elevating the head of the bed 30 to 45 degrees to prevent aspiration
  • Seeing to good oral hygiene (cleaning teeth, gums, tongue, dentures)
  • Increasing patient mobility with ambulation to eg three times a day (as appropriate)
  • Educating patient re coughing and deep breathing, and use of incentive spirometry.[2]

For more see Infection Prevention and Control

References[edit | edit source]

  1. ↑ NICE Hospital-acquired pneumonia caused by methicillin-resistant Staphylococcus aureus: telavancin Available:http://www.nice.org.uk/advice/esnm44/chapter/full-evidence-summary (accessed 25.12.2022)
  2. ↑ 2.0 2.1 American Nurse Preventing hospital-acquired pneumoniaAvailable:https://www.myamericannurse.com/preventing-hospital-acquired-pneumonia/ (accessed 25.12.20220
  3. ↑ Radiopedia Hospital-acquired pneumonia Available:https://radiopaedia.org/articles/hospital-acquired-pneumonia-1?lang=us (accessed 24.12.2022)
  4. ↑ 4.0 4.1 Shebl E, Gulick PG. Nosocomial Pneumonia. InStatPearls [Internet] 2021 Jul 21. StatPearls Publishing.Available;https://www.ncbi.nlm.nih.gov/books/NBK535441/#!po=22.7273 (accessed 25.12.2022)
  5. ↑ 5.0 5.1 5.2 Denehy L, Berney S. Physiotherapy in the intensive care unit. Physical Therapy Reviews. 2006;11(1):49. Available: https://www.researchgate.net/publication/233585155_Denehy_L_Berney_S_Physiotherapy_in_the_intensive_care_unit_Phys_Ther_Rev_20061149-56 (accessed 25.12.2022)
Retrieved from "https://www.physio-pedia.com/index.php?title=Hospital_Acquired_Pneumonia&oldid=323908"