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July 2011, Volume 41 Number 7 , p 59 - 62


  • Kathleen Dobbin MS, RN, ACNP-CS
  • Valerie Howard EdD, MS, RN


THE SHIFT of intensive treatments and patient care to outpatient areas has created a category of respiratory infections in ambulatory patients that can resemble more serious hospital-acquired infections. Called healthcare-associated pneumonia (HCAP), it's associated with a more complicated course, longer hospital stay, and higher mortality than pneumonia acquired in the community.Nurses must recognize patients with pneumonia who may have acquired the infection through recent healthcare contact outside of hospitalization. Without a detailed health history and physical assessment, the patient's signs and symptoms may be presumed to indicate a community-acquired infection, leading to inadequate treatment and a poor outcome.This article describes how to take a careful history to recognize HCAP and care for a patient who has this condition.Pneumonia is the seventh leading cause of death in America. Studies indicate that HCAP may account for almost one third of CAP, and this number may not be accurate because many patients' recent healthcare contact may not be recognized.1 Since 2005, the designation of HCAP has been used to differentiate patients from those with: * hospital-acquired pneumonia (HAP) * ventilator-acquired pneumonia (VAP) * community-acquired pneumonia (CAP).For details, see Classifying pneumonia.Patients developing HCAP tend to be older adults with chronic diseases. They're also more likely to have multidrug resistant (MDR) pathogens and be at a higher risk of death from infection.2Acquired during recent contact with the healthcare system, HCAP may resemble HAP more closely than CAP. Identifying HCAP early is imperative because inappropriate antibiotic coverage can worsen this dangerous infection and increase mortality.1In 2005, the American Thoracic Society and the Infectious Disease Society of America published joint guidelines for the identification and management of adults with HAP, VAP, and HCAP.3 These guidelines identify those patients at risk for HCAP,

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