Hospital-acquired pneumonia (HAP) in ICD10: Difference between revisions
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*The concept of "early onset" HAP is not an accepted one (and not one we will use), because BY DEFINITION, to be HAP the patient must have been in hospital >48 hours and THEN developed the clinical signs/symptoms of pneumonia. | *The concept of "early onset" HAP is not an accepted one (and not one we will use), because BY DEFINITION, to be HAP the patient must have been in hospital >48 hours and THEN developed the clinical signs/symptoms of pneumonia. | ||
*To decide about whether a HAP (or a CAP) has occurred, requires clinical correlation. | *To decide about whether a HAP (or a CAP) has occurred, requires clinical correlation. | ||
**For example, sputum is never sterile -- | **For example, sputum is never sterile -- [[Pathogens|pathogen]] will always grow from it. It's even true that bronchoscopic lower respiratory samples are almost never sterile, which is why quantitative culture is used to interpet them. THUS, respiratory fluid that grows [[Pathogens|pathogen]]s cannot by itself be used to interpret the presence of pneumonia EXCEPT in the rare cases of [[Pathogens|pathogen]]s that are NEVER pathogens in the respiratory system -- that list is mainly limited to: TB, Legionella, and Pneumocystis jiroveci. Thus, a (+) sputum culture can almost never by itself be used to identify the presence of a pneumonia. Instead, it's a combination of clinical signs such as fever, leukocytosis and new (or presumed new) CXR changes that helps to figure it out. Indeed, one can diagnose CAP or VAP in the absence of a (+)sputum culture in the right situation (e.g. patient has been on antibiotics for some reason prior). | ||
===Attribution of the HAP to a Hospital Location=== | ===Attribution of the HAP to a Hospital Location=== | ||
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{{Discussion}} | {{Discussion}} | ||
Can a patient with unresolved CAP ever be coded as HAP if ETC cultures become positive for a new | Can a patient with unresolved CAP ever be coded as HAP if ETC cultures become positive for a new [[Pathogens|pathogen]] or is it always going to be CAP? | ||
Do you need to follow the same guidelines for acceptable sources for cultures like for the VAP cultures? | Do you need to follow the same guidelines for acceptable sources for cultures like for the VAP cultures? | ||
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*The pt has CAP no culture is sent. The patient is in the ICU for 8 days not on a ventilator. The ventilation status gets worse. The CXR continues to have persisent infiltrates. The pt gets intubated and less than 48 hours on a ventilator a bronchoscopy is done and both ETC and quantitive cultures grow aspergillos. Is this still CAP or can it be called HAP? | *The pt has CAP no culture is sent. The patient is in the ICU for 8 days not on a ventilator. The ventilation status gets worse. The CXR continues to have persisent infiltrates. The pt gets intubated and less than 48 hours on a ventilator a bronchoscopy is done and both ETC and quantitive cultures grow aspergillos. Is this still CAP or can it be called HAP? | ||
*Same scenerio as above occurs but a patient isn't treated for what ever | *Same scenerio as above occurs but a patient isn't treated for what ever [[Pathogens|pathogen]] grows in the cultures. Do we code the [[Pathogens|pathogen]] or not. Do we call it colonization or ignore the culture?}} | ||
==RE:Aspiration and development of pneumonia less than 48 hours== | ==RE:Aspiration and development of pneumonia less than 48 hours== | ||