Policy Manual sample

MDT Home Health Care Agency, Inc. the other pneumonia specific site criteria. 3Ventilator-associated pneumonia (ie, pneumonia in persons who had a device to assist or control respiration continuously through a tracheostomy or by endotracheal intubation within the 48-hour period before the onset of infection, inclusive of the weaning period) should be so designated when reporting data. 4When assessing a patient for presence of pneumonia, it is important to distinguish between changes in clinical status due to other conditions such as myocardial infarction, pulmonary embolism, respiratory distress syndrome, atelectasis, malignancy, chronic obstructive pulmonary disease, hyaline membrane disease, bronchopulmonary dysplasia, etc. Also, care must be taken when assessing intubated patients to distinguish between tracheal colonization, upper respiratory tract infections (eg, tracheobronchitis), and early onset pneumonia. Finally, it should be recognized that it may be difficult to determine health care– associated pneumonia in the elderly, infants, and immunocompromised patients because such conditions may mask typical signs or symptoms associated with pneumonia. Alternate specific criteria for the elderly, infants and immunocompromised patients have been included in this definition of health care–associated pneumonia. Health care–associated pneumonia can be characterized by its onset: early or late. Early onset pneumonia occurs during the first 4 days of hospitalization and is often caused by Moraxella catarrhalis, H influenzae, and S pneumoniae. Causative agents of late onset pneumonia are frequently gram negative bacilli or S aureus, including methicillin-resistant S aureus. Viruses (eg, influenza A and B or respiratory syncytial virus) can cause early and late onset nosocomial pneumonia, whereas yeasts, fungi, legionellae, and Pneumocystis carinii are usually pathogens of late onset pneumonia. Pneumonia due to gross aspiration (for example, in the setting of intubation in the emergency room or operating room) is considered health care associated if it meets any specific criteria and was not clearly present or incubating at the time of admission to the hospital. Multiple episodes of health care–associated pneumonia may occur in critically ill patients with lengthy hospital stays. When determining whether to report multiple episodes of health care–associated pneumonia in a single patient, look for evidence of resolution of the initial infection. The addition of or change in pathogen alone is not indicative of a new episode of pneumonia. The combination of new signs and symptoms and radiographic evidence or other diagnostic testing is required. Positive Gram stain for bacteria and positive KOH (potassium hydroxide) mount for elastin fibers and/or fungal hyphae from appropriately collected sputum specimens are important clues that point toward the etiology of the infection. However, sputum samples are frequently contaminated with airway colonizers and therefore must be interpreted cautiously. In particular, Candida is commonly seen on stain, but infrequently causes healthcare-associated pneumonia. Home Health Agency Nursing Care & Procedures K-148