This clinical practice guideline (CPG) was developed by
an Alberta CPG Working Group.
EXCLUSIONS
♦ Hospital acquired pneumonia (onset within 14
days of discharge from an acute care facility)
♦ Aspiration pneumonia (see Appendix 1)
♦ Patients with cystic fibrosis, tuberculosis, or
bronchiectasis
DEFINITIONS
♦ Pneumonia in a patient residing in a nursing
home*
* This applies to any congrgate residential setting for
older and disabled patients that have high personal and
professional care needs. These are sometimes known as
long term care facilities, auxiliary hospitals, chronic
care centres, or continuing care centres.
ISSUES
♦ Treatment for NHAP should take into account
the individual’s personal directives
♦ There is a lack of well designed studies in this
patient population
♦ Chest radiography is not widely available or
practical in many locations
♦ Microbiologic diagnosis of NHAP has
significant limitations and as such, treatment
of NHAP is usually empiric
♦ Delay in administration of antibiotics for the
empiric treatment of NHAP may lead to in-
creased patient morbidity and mortality
♦ Inappropriate use of antibiotics may adversely
affect patient outcomes and may increase anti-
microbial resistance
Guideline for
The Diagnosis and Management of
Nursing Home Acquired Pneumonia (NHAP)
Administered by the Alberta
Medical Association
GOALS
♦ To enhance an earlier detection and treatment of
NHAP
♦ To increase the accuracy of the clinical diagnosis
of NHAP
♦ To optimise the appropriate use of laboratory and
diagnostic imaging services
♦ To optimise the use of antibiotics in the treatment
of NHAP
♦ To foster teamwork in the evaluation and manage-
ment of patients with NHAP
♦ To optimise the decision for patient transfer to
hospital
♦ To improve patient outcomes through decreased
morbidity and mortality.
PrEvENTION
♦ Limit the spread of infections (e.g., hand washing
and attention to outbreak management guidelines)
♦ Influenza and pneumococcal vaccines are recom-
mended (see Appendix 2)
♦ Smoking cessation and avoidance of environ-
mental tobacco smoke
DIAGNOSIS
Although a new infiltrate seen on chest X-ray with
compatible clinical signs is the gold standard for the
diagnosis of NHAP, in nursing home settings the
diagnosis must often be made on clinical grounds
alone. The physical examination must include blood
pressure, heart rate, respiratory rate and auscultation
of the respiratory system.
The above recommendations are systematically developed statements to assist practitioner and
patient decisions about appropriate health care for specific clinical circumstances.
They should be used as an adjunct to sound clinical decision making.
2008 Update
