Hospital Acquired Pneumonia - Causes and Prevention

1. Hospital-Acquired Pneumonia
or Health-Care Associated Pneumonia (HCAP)
Prevention and the Role of the Nurse
NRSG 200 Role Transition
Presented by: April, Derek, and Ken

2. Case Study
A 68-year-old man with hypertension, diabetes, and recent hip
fracture with poor functional status presents from a nursing
home with a productive cough, shortness of breath, and chills
of two-day duration.
His vital signs reveal a blood pressure of 162/80 mm/Hg,
temperature of 101.9°F, respirations of 26 breaths per minute,
and oxygen saturation of 88% on room air.

3. Nursing Considerations
What are some risk factors for HCAP for this patient?

4. The Risks
What are some risk factors for HCAP for this patient?
1. Age

5. The Risks
What are some risk factors for HCAP for this patient?
1. Age
2. Hip Fracture

6. The Risks
What are some risk factors for HCAP for this patient?
1. Age
2. Hip Fracture
3. Chronic Illness

7. HCAP
Health Care Associated Pneumonia is an infection of
the lungs that occurs in a patient during a hospital
stay. It is the single, most common HCI.
Major Site of Infection Estimated No.
Pneumonia 157,500
Gastrointestinal Illness 123,100
Urinary Tract Infections 93,300
Primary Bloodstream Infections 71,900
Surgical site infections from any inpatient surgery 157,500
Other types of infections 118,500
Estimated total number of infections in hospitals 721,800
Estimates of Healthcare-Associated Infections Occurring in Acute Care Hospitals in the
United States, 2011. Table Source: Centers for Disease Control

8. Pneumonia is a common lung infection.
Pneumonia can be caused by many
different types of bacteria, viruses, and
even fungi. Pneumonia is not a single
disease. It can have more than 30
different causes.
Pneumococcus is one of the most
common causes of severe pneumonia.
Respiratory viruses cause 1/3 of all
pneumonia cases, and are most
common in children and young adults.
Photo: fastpharma.net

9. How the germs are spread.
The single, most common cause in the spread of pneumonia is a
person’s hands. Specifically, unwashed hands. Also, sneezing
or coughing without covering your mouth contributes greatly to
the spread of these germs.
Photo: allhealthcaremonster.com
Photo: sophisticatededge.com

10. Patient Risk Factors
• Alcoholism
• Major Surgery
• Chronic Lung Disease
• Weak Immune System
Photos: alcoholic.org; medlous.com; vectorblog.org; tuftsmedicalcenter.org

11. Patient Risk Factors
• Severe Wounds
• Aspiration
• Certain Medications
Photos: detroitmi.gov; advanceweb.com; ihshomecare.org

12. Signs and Symptoms
• A cough with greenish or pus-like sputum
• Fever and Chills
• Malaise
• Loss of Appetite
• Nausea and Vomiting

13. Signs and Symptoms
• Shortness of Breath
• Sharp chest pain that worsens with coughing
• Decreased blood pressure, increased heart rate
• In the elderly, Mental Changes or Confusion

14. Exams and Tests
• Chest X-Ray
• CT Scan
• CBC, ABG
• Sputum Culture
• Gram Stain
Photo: iahealth.net

15. Treatments
• The usual treatment is IV antibiotics.
• Oxygen may be administered.
• Lung Treatments to loosen and remove mucus.
• In some instances, a ventilator may be used.
Photo: alfredicu.org
Photo: clevelandclinic.org

16. Prognosis
Hospital-Acquired pneumonia can be life-threatening
and long-term lung damage may occur. Patients may
not recover as well if they have other serious illnesses
along with pneumonia.

17. Current Practices
• Heidi Slusher, an RN at a long term and acute care facility, uses
good hand washing techniques, educates patients who smoke that
they are more susceptible to getting HCAP, and she will order a
chest x-ray if she notices symptoms so treatment can begin as soon
as possible if the patient is sick.
• Angela Vining, is a home health RN who also works at a local
hospital uses a spirometer, deep breathing exercises, and said a
dietitian may be consulted to determine if (the patient) at risk for
aspiration. Getting the patient up and ambulating helps too.
• Jill Kohl, RN, who works at a correctional facility, said she washes
her hands before and after patient care, does not come to work sick,
and cleans equipment between patients...like vital sign monitors and
stethoscopes.

18. Metron’s Guidelines
No specific guidelines exist for the prevention of HCAP, however there is
an INFECTION CONTROL procedure in place.
Residents are closely monitored for infections.
If a resident is having symptoms of a respiratory illness, a stat X-Ray is
ordered by the nurse. If the X-Ray shows signs of pneumonia, the
resident is immediately started on antibiotics.

19. Pine River Healthcare Center
• Guidelines are similar to Metron’s.
• Staff are encouraged to visit the CDC website
concerning infection control.

20. Prevention and the Role of the RN
• Always, always wash in and wash out.
• Remind visitors to wash their hands, and their children’s hands,
before and after a visit.
• Stay home if you are sick. Educate visitors about the risks of visiting
if they are sick.
• Keep a bottle of GermXTM or similar product available in the patient’s
room for quick use.
• Cover your mouth and nose when coughing or sneezing. Remind
visitors to do the same.
• Avoid touching your eyes, nose, and mouth. Teach visitors and your
patient to do the same.
• Avoid close contact if possible.

21. References
National Institutes of Health
http://www.nlm.nih.gov/medlineplus/ency/article/000146.htm
Centers for Disease Control
http://www.cdc.gov/HAI/surveillance/index.html
University of California, San Diego
http://hospitalmedicine.ucsd.edu/people/documents/HCAPJRDseyman.pdf