Guias De Neumonia

Guidelines for the management of hospital-acquired pneumonia in the
UK: Report of the Working Party on Hospital-Acquired Pneumonia
of the British Society for Antimicrobial Chemotherapy
R. G. Masterton1*, A. Galloway2, G. French3, M. Street4, J. Armstrong5, E. Brown6, J. Cleverley7,
P. Dilworth8, C. Fry9, A. D. Gascoigne10, Alan Knox11, Dilip Nathwani12,
Robert Spencer13 and Mark Wilcox141Department of Microbiology, Crosshouse Hospital, Kilmarnock, UK; 2Department of Microbiology, Royal
Victoria Infirmary, Queen Victoria Road, Newcastle-upon-Tyne, UK; 3Department of Infection, Guy’s and
St Thomas’s NHS Foundation Trust and King’s College, St Thomas’ Hospital, London, UK; 4Department of
Intensive Care, Royal Sussex County Hospital, Brighton, UK; 5Department of Public Health, NorthDurham
Strategic Health Authority, Earls House, Durham, UK; 6Department of Microbiology, Frenchay Hospital,
Bristol, UK; 7Department of Radiology, Royal Free Hospital, London, UK; 8Department of Thoracic Medicine,
Royal Free Hospital, London, UK; 9Department of Health, London, UK; 10Royal Victoria Infirmary, Queen
Victoria Road, Newcastle-upon-Tyne, UK; 11Respiratory Medicine Unit, CityHospital, Nottingham, UK;
12Infection Unit, Ninewells Hospital and Medical School, Dundee, UK; 13Health Protection Agency,
Bristol Royal Infirmary, Marlborough St, Bristol, UK; 14University of Leeds, Leeds, UK
These evidence-based guidelines have been produced after a systematic literature review of a range
of issues involving prevention, diagnosis and treatment of hospital-acquired pneumonia(HAP).
Prevention is structured into sections addressing general issues, equipment, patient procedures and
the environment, whereas in treatment, the structure addresses the use of antimicrobials in prevention
and treatment, adjunctive therapies and the application of clinical protocols. The sections dealing with
diagnosis are presented against the clinical, radiological and microbiologicaldiagnosis of HAP.
Recommendations are also made upon the role of invasive sampling and quantitative microbiology of
respiratory secretions in directing antibiotic therapy in HAP/ventilator-associated pneumonia.
Keywords: hospital-acquired pneumonia, healthcare-associated pneumonia, evidence-based guidelines,
prevention, diagnosis, antimicrobial treatment
Contents
1. Introduction
2. Prevention2.1. General issues for the prevention of HAP
2.1.1. Role of staff education programmes
2.1.2. Role of clinical guidelines or protocols
2.1.3. Role of screening of patients or their environment
to prevent HAP
2.1.4. Immunization to prevent HAP
2.1.5. Importance of hand hygiene in preventing HAP
2.1.6. Role of personal protective equipment
2.2. Infection control issues related to the use ofequipment—
best methods of sterilization or disinfection of equipment
and maintenance of instruments
2.2.1. Mechanical ventilators
2.2.2. Ventilator circuits
2.2.3. Heated humidifiers and HMEs
2.2.4. Frequency of change of humidifiers
2.2.5. Nebulizers
2.2.6. Filters
2.2.7. Suction equipment
2.2.8. Resuscitation equipment
2.2.9. Anaesthetic machines and breathing equipment
2.2.10.Pulmonary function testing equipment
2.3. Patient procedures
2.3.1. Closed versus open suctioning
2.3.2. Use of non-invasive positive pressure ventilation
2.3.3. Method of ET intubation
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ....