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Lahey Health is now part of Beth Israel Lahey Health

by Horn D
(Nosocomial Pneumonia)


Pneumonia is an infection of the lungs. It is deep in the small airways and air sacs of the lungs. These air sacs swell and fill with fluid or pus. It will cause shortness of breath and severe coughing.

Hospital-acquired pneumonia (HAP) is one that develops more than 48 hours after being in a hospital. It is an infection that was not there when someone entered the hospital.


HAP is caused by:

  • Bacteria (most common) including MRSA
  • Fungus—more common in people with health problems that weaken the body’s ability to fight illnesses

Risk Factors

Factors that may increase your risk of HAP include:

  • Prior hospital stay
  • Use of tube in the throat to open the airway or give medicine
  • Increased age
  • Recent heart or lung surgery
  • Health issues, such as kidney disease, lung disease, or a problem with central nervous system
  • Poor nutrition or problem getting nutrition
  • Some medicine, such as proton pump inhibitors and H2 receptor blockers


Symptoms may include:

  • New fever
  • Increased coughed up fluid
  • New or increased cough
  • Shortness of breath
  • Changes in thought process or how you behave—more common in people over 70 years of age


The doctor will ask about symptoms and past health. They may also ask about any recent medical care. An exam will be done.

Images of the lungs may be taken with:

Fluids will be tested to find out which germ is causing the problem. This can be done with:

  • Blood tests
  • Test of coughed up fluid


Medicine to fight the infection may include:

  • Antibiotics—for HAP caused by bacteria
  • Antifungal medicine—for HAP caused by a fungus

Over-the-counter medicine may also be needed. It can help to ease fever and pain.

Fluid in the lungs may block the flow of oxygen into the blood. Oxygen therapy may be needed. It will increase the level of oxygen in the blood.


To decrease your risk of picking up pneumonia while in the hospital:

  • Talk to your doctor about the pneumococcal vaccine if you are:
    • An adult 65 years of age or older
    • An adult with a high risk of infection
  • Stop smoking before surgery. Smokers have a higher risk of problems after surgery.

Hospital staff will take steps to reduce your chance of HAP, such as:

  • Washing their hands.
  • Wearing gloves or masks.
  • Keeping the hospital bed raised when possible. It will lower the chance of germs getting to the lungs.

To reduce the chances of HAP you can:

  • Wash your hands often. Remind visitors and staff to do the same.
  • Remind your care team to wear gloves or masks when needed.
  • If you smoke, find tools to help you quit. Smoking makes lungs weaker.


American Lung Association 

Centers for Disease Control and Prevention 


Public Health Agency of Canada 

Lung Association 


Hospital-acquired pneumonia. EBSCO DynaMed website. Available at: . Accessed February 26, 2020.

Hospital-acquired pneumonia. Merck Manual Professional Version website. Available at: Accessed February 26, 2020.

Hospital-acquired pneumonia (HAP) prevention. Craig Hospital website. Available at: Accessed February 26, 2020.

Hospital acquired pneumonia. Radiopaedia website. Available at: Accessed February 26, 2020.

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