Title : Expanding diagnostic criteria for Hospital-Acquired Pneumonia (HAP): A quality improvement initiative
Abstract:
Background: Hospital-Acquired Pneumonia (HAP) is a significant source of morbidity and mortality in hospitalized patients. Prior to this quality improvement (QI) project, the HAP diagnosis was limited to patients with hospital stays longer than 5 days or those with recent intravenous (IV) antibiotic exposure within the last 6 weeks. This restrictive definition missed at-risk patients who had recent hospitalizations but did not receive IV antibiotics. The goal of this project was to revise the criteria to include patients hospitalized in the previous 6 weeks, regardless of antibiotic exposure.
Methods: A retrospective re-audit was conducted in May 2024 at Our Lady’s Hospital Navan (OLHN), assessing 16 patients diagnosed with HAP under the new criteria. The updated definition removed the IV antibiotic condition for HAP criteria and included any patient who had been hospitalized within the previous 6 weeks. Key performance indicators—such as diagnostic accuracy, antibiotic choice, treatment duration, and adherence to local guidelines—were compared to an earlier audit conducted in 2023, which used the traditional definition.
Results: The revised definition captured more patients at risk for HAP. Under the new criteria, 88% of cases had the correct HAP indications documented, and 81% of patients received the correct antibiotic treatment. Adherence to the 5-7 day antibiotic duration guideline was achieved in 69% of cases. Importantly, expanding the definition allowed for earlier and more accurate treatment in patients who would have been excluded by the previous definition.
Conclusion: This QI project successfully expanded the diagnostic criteria for HAP, improving the identification and treatment of at-risk patients. Removing the IV antibiotic requirement increased the inclusivity of the diagnosis, ensuring more comprehensive care for vulnerable patient populations. Future initiatives will focus on optimizing antibiotic duration and IV to oral switches.
Keywords: Hospital-Acquired Pneumonia, Quality Improvement, HAP Definition, Antibiotic Stewardship, Recent Hospitalization.
