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Healthcare-associated pneumonia A.

Disease Condition Pneumonia is a common lung disease that originates from different microorganisms such as viruses, bacteria, fungi and parasites. Primarily, it is an inflammation of the alveoli or in other cases; the alveoli are filled with fluid. On an acute state of pneumonia, it can cause severe sickness and death. This disease is very dangerous to old people, babies and those with damaged immune systems although it can also strike those who are healthy and young. Healthcare-associated is a type of pneumonia that occurs in patients undergoing outpatient therapies, those living in non-hospital health care facilities, those who have just been released from the hospital and those with considerably large immune suppression. Furthermore, this type of pneumonia occurs less than or equal to 48 hours of hospital admission in patients with more than one of the following risk factors for multidrug resistant bacteria (MDR) as cause of infection: hospitalization for more than or equal to two days in an acute care facility within 90 days of infection; residence in a nursing home or long-term care facility; anti-biotic therapy, chemotherapy or wound care within 30 days of current infection; hemodialysis treatment at a hospital or clinic; home infusion therapy or home wound care; and has a family member with infection due to MDR bacteria. B. Etiology Pneumonia is a common lung disease that originates from different microorganisms such as viruses, bacteria, fungi and parasites. Primarily, it is an inflammation of the alveoli or in other cases; the alveoli are filled with fluid. On an acute state of pneumonia, it can cause severe sickness and death. This disease is very dangerous to old people, babies and those with damaged immune systems although it can also strike those who are healthy and young. Healthcare-associated is a type of pneumonia that occurs in patients undergoing outpatient therapies, those living in non-hospital health care facilities, those who have just been released from the hospital and those with considerably large immune suppression. C. Incidence WHO (2004) states that 4.2 million deaths in the world (roughly 7.1% of all total deaths) is caused by pneumonia. CDC (2006) declared that 56,000 deaths in U.S.A. was caused by pneumonia. It is also accountable for 1.2 million of all the 35 million yearly U.S. hospitalization. These statistics are for pneumonia in general. Statistics of HCAP does not have enough information that states the incidence. D. Pathophysiology

Development of pneumonia is caused by either intrinsic or extrinsic. Intrinsic factors are those causes related to the host such as loss of airway reflexes that leads to accidental inhalation of upper airway fluids while extrinsic factors are causes that include exposure to pulmonary irritants or pulmonary injury. Bacterial pneumonia originates from bacteria from the upper airways transferring to the lung parenchyma. Susceptibility to infection may increase due to immune response impairment, dysfunctional defense mechanism. Another inclining factor is poor dentition or periodontitis. E. Clinical Manifestation Bacteria induced pneumonia are more common than those induced by virus. Despite of having higher risk of pneumonia, children and old people have fewer and milder symptoms than expected. Pneumonia commonly begins with symptoms the same as colds and leads to high fever and cough with phlegm. Symptoms may vary depending on the conditions and causes but there are several symptoms that is common to every type of pneumonia involving cough with green mucus from the lungs, fever, irregularity of breathing, chills, pains across the chest area, fatigue, weakness, nausea accompanied by vomiting, diarrhea, excessive sweating, head and muscle ache, delirium and irregularity of skin color due to poorly oxygenated blood. Thus, during pulmonary infection, acute inflammation results in the migration of neutrophils out of capillaries and into the air spaces, forming a marginated pool of neutrophils that is ready to respond when needed. These neutrophils phagocytize microbes and kill them with reactive oxygen species, antimicrobial proteins, and degradative enzymes; they also extrude a chromatin meshwork containing antimicrobial proteins that trap and kill extracellular bacteria, known as neutrophil extracellular traps (NETs). Various membrane receptors and ligands are involved in the complex interaction between microbes, cells of the lung parenchyma, and immune defense cells.

F. Prognosis Treatments of pneumonia vary on its type and acuteness of the symptoms. Treatments for viral pneumonias are rest and significant ingestion of fluids; treatments for bacterial pneumonias are usually antibiotics and treatments for fungal pneumonias are antifungal medications. Over-the-counter medications include decrease fever, pains and coughing. These medications are given to patients so that they can cope easily. Other than medications, sleeping, rest and lots of fluids can sometimes be helpful to decrease the effects of pneumonia. Pneumonia resulting from suppressed immune system may need hospital attention. Intravenous antibiotics and oxygen may be administered to a pneumonia patient at the hospital. Prevention of pneumonia is an indispensable to everyone beginning at a very young age. There are several vaccines are available, one is for prevention of pneumococcal disease, pneumococcal conjugate vaccine and pneumococcal polysaccharide vaccine. Pneumococcal conjugate vaccine is usually given along with

infant immunization and recommended at the ages 2 to 4. Pneumococcal polysaccharide vaccine is administered to adults to prevent pneumococcal pneumonia by reducing the risk of obtaining it from diabetes, heart, lung or kidney disease, and spleen absence. Not only can it reduce severity of future pneumonia among adults but it can also prevent it completely. Aside from vaccinations, the medical authorities recommend everyone to wash hands, refrain from smoking and excessive drinking and exercise.