HCAP

Hospital-Acquired Pneumoniaor Health-Care Associated Pneumonia (HCAP)

Prevention and the Role of the Nurse

NRSG 200 Role Transition

Presented by: April, Derek, and Ken

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.

Nursing Considerations

What are some risk factors for HCAP for this patient?

The Risks

What are some risk factors for HCAP for this patient?

1. Age

The Risks

What are some risk factors for HCAP for this patient?

1. Age

2. Hip Fracture

The Risks

What are some risk factors for HCAP for this patient?

1. Age

2. Hip Fracture

3. Chronic Illness

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.

Estimates of Healthcare-Associated Infections Occurring in Acute Care Hospitals in the

United States, 2011. Table Source: Centers for Disease Control

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

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

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

Patient Risk Factors

• Alcoholism

• Major Surgery

• Chronic Lung Disease

• Weak Immune System

Photos: alcoholic.org; medlous.com; vectorblog.org; tuftsmedicalcenter.org

Patient Risk Factors

• Severe Wounds

• Aspiration

• Certain Medications

Photos: detroitmi.gov; advanceweb.com; ihshomecare.org

Signs and Symptoms

• A cough with greenish or pus-like sputum

• Fever and Chills

• Malaise

• Loss of Appetite

• Nausea and Vomiting

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

Exams and Tests

• Chest X-Ray

• CT Scan

• CBC, ABG

• Sputum Culture

• Gram Stain

Photo: iahealth.net

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

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.

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.

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.

Pine River Healthcare Center

• Guidelines are similar to Metron’s.

• Staff are encouraged to visit the CDC website

concerning infection control.

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.

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