Hospital and Institutional Acquired Pneumonia – Causes, Risk Factors, Symptoms, Treatment, Complications

Hospitals are the places for curing the diseases of the patients; however patients may also get certain disease from hospitals. A Hospital-acquired pneumonia is one such infection that gets transmitted to the hospitalized patients after about 2 days or more of hospitalization.

In case of Institution-acquired pneumonia, people in close contact with the nursing homes or hospital facilities; get infected with pneumonia.

A Hospital-acquired pneumonia is more severe than Institution-acquired pneumonia because the infectious agents in the former are harder to treat. Another reason is that hospitalised patients have are already sick and have weakened immune system.

Moreover, the types of infectious agents present in a hospital are more lethal than those present in the community.

Causes of HAP/IAP

HAP/IAP is caused by wide variety of infectious agents including Bacteria, Viruses, Fungi, parasites, etc. The infection may vary from mild to life-threatening.

Common Bacteria: Streptococcus pneumonia, anaerobic organisms, Mycobacterium tuberculosis.

Common Viruses: Rhinoviruses, Coronaviruses, Influenza virus, Respiratory syncytial virus (RSV), Adenovirus

Common parasites: Toxoplasma gondii, Strongyloides stercoralis

Common Fungi: Histoplasma capsulatum, blastomyces, Cryptococcus Neoformans

Risk Factors of HAP/IAP

Risk factors for HAP/IAP comprises of the following.

• Individuals working on ventilator

• Alcoholism

• Being on a breathing machine

• Breathing saliva

• Taking food into the lungs (aspiration)

• Chest surgery

• Immuno-suppression

• Long-term (chronic) lung disease

• Not being fully alert

• Older age

• Recent illness

Symptoms of HAP/IAP

Common Symptoms

• Cold and Cough

• Fever

• Shaking chills

• Difficulty in breathing

• Severe Chest Pain

• Clammy skin due to excessive sweating

• Weakness and fatigue

• State of Confusion in elderly people

• Loss of appetite

• Headache

Diagnostic Tests

HAP/IAP can be diagnosed by conducting the following tests.

• Physical examination to detect the presence of crackles, decreased oxygen and respiratory distress

• Chest x-ray or CT scan

• Arterial blood gases

• Complete blood count (CBC)

• Sputum culture

• Sputum gram stain

• Blood cultures

Treatment for HAP/IAP

The treatment of HAP/IAP depends on the infectious agent responsible for the infection. Depending on the severity of the infection, the treatment can be done at home or hospital.

• Bacteria (gram negative, s.pneumoniae) are treated with intravenous antibiotics after they are identified using sputum culture.

• Atypical Bacteria are treated with different set of antibiotics

• Viral Pneumonia is treated with set of anti-virals

• Severely ill patients are placed in intensive care unit and put on a ventilator

• Supplemental oxygen for loosening and expelling thick mucus from the lungs

• Intravenous fluids for preventing dehydration is given patients in hospitals

• Use of humidified air helps in loosening the mucus

• Patient may take aspirin, NSAIDs, for controlling fever. However, Aspirin should not be given to children.

• Patient is advised to take plenty of rest.

• Chest therapy is used for loosening the mucus so that it can be expelled out by deep coughing.

Complications

The complications of the HAP/IAP pneumonia may lead to serious health conditions.

• Acute respiratory distress syndrome (ARDS)

• Lung abscess

• Bacteraemia

• Septicaemia

• Low blood pressure