Hospital-acquired pneumonia (HAP) in ICD10: Difference between revisions
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Ttenbergen (talk | contribs) →RE:A Patient with CAP on Admission: cleaned out the discussion tags and tried to break it into different concepts, but I don't want to make this MORE confusing by applying my IT skills to it :-) , so could someone else have a go at cleaning this up? |
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* Patients from [[Grace Nursing Home Ward]] - even though this is considered a nursing home type ward, for patients who acquire a pneumonia and meet the HAP criteria '''code HAP'''. | * Patients from [[Grace Nursing Home Ward]] - even though this is considered a nursing home type ward, for patients who acquire a pneumonia and meet the HAP criteria '''code HAP'''. | ||
== | === Don't need to follow VAP Guidelines for this === | ||
Do you need to follow the same guidelines for acceptable sources for cultures like for the VAP cultures? | |||
*AG REPLY -- for HAP, no. Indeed, the main thing that distinguishes a CAP from a HAP is whether the patient has been in a LOCATION that qualifies for it being a HAP. | |||
===RE:A Patient with CAP on Admission=== | |||
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? | 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? | ||
*AG REPLY -- this is a very difficult clinical determination. Since our ability to identify the lung pathogen in ANY type of pneumonia isn't that good (even WITH bronchoscopy and quantitative BAL or protected specimen brush, which is almost NEVER done in Winnipeg) it is very very difficult to tell whether a new pathogen is a new infection. This is especially true since it is well known that hospitalized and intubated patients quickly get colonized in their airways with bugs that don't usually live there (e.g. gram negative rods) -- thus again just identifying a new bug in sputum that is a POTENTIAL pathogen is far from a diagnosis that that potential pathogen is actually the bug for an actual pneumonia or bronchitis. Thus, there can be no real rule here. It IS possible to get a new HAP/VAP after being admitted for a CAP, and even without cure of the CAP, but that determination requires things like: 1-A new potential pathogen PLUS 2-chest imaging that shows infiltrates in an area that was virtually COMPLETELY clear before PLUS 3-a clinical decision about this whole thing. | *AG REPLY -- this is a very difficult clinical determination. Since our ability to identify the lung pathogen in ANY type of pneumonia isn't that good (even WITH bronchoscopy and quantitative BAL or protected specimen brush, which is almost NEVER done in Winnipeg) it is very very difficult to tell whether a new pathogen is a new infection. This is especially true since it is well known that hospitalized and intubated patients quickly get colonized in their airways with bugs that don't usually live there (e.g. gram negative rods) -- thus again just identifying a new bug in sputum that is a POTENTIAL pathogen is far from a diagnosis that that potential pathogen is actually the bug for an actual pneumonia or bronchitis. Thus, there can be no real rule here. It IS possible to get a new HAP/VAP after being admitted for a CAP, and even without cure of the CAP, but that determination requires things like: 1-A new potential pathogen PLUS 2-chest imaging that shows infiltrates in an area that was virtually COMPLETELY clear before PLUS 3-a clinical decision about this whole thing. | ||
If a patient with CAP on admission that hasn't cleared but isn't ventilated for days then has to go on a ventilator less than 48 hour ventilated develops a positive culture (quantitive bronchoscopically obtained) and a change in respiratory status can this be called HAP? Or are you saying it's CAP the whole admission? It seems according to the VAP quidelines patients with CAP can develop VAP under the right conditions so couldn't they also get HAP? Are you saying patients with CAP can never get HAP? | |||
I will give an example cases: | I will give an example cases: | ||
*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 | *Same scenario 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? | ||
*AG REPLY -- as I've said above, it IS possible to get a VAP or HAP superimposed on a CAP -- but making that diagnosis is very difficult, requires clinical judgement and SHOULD require the 3 items I've listed above. | *AG REPLY -- as I've said above, it IS possible to get a VAP or HAP superimposed on a CAP -- but making that diagnosis is very difficult, requires clinical judgement and SHOULD require the 3 items I've listed above. | ||
== Aspiration and development of pneumonia less than 48 hours== | == Aspiration and development of pneumonia less than 48 hours== | ||