Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Preventing Pneumonia in the Hospital


Hospital-acquired pneumonia (HAP) is an infection in your lungs. It develops during your hospital stay. HAP is a serious illness that may become life-threatening. 

Many different types of germs (bacteria and fungi) cause pneumonia. The germs that are in hospitals tend to be harder to treat than germs you are exposed to in your daily life. Also, your immune system may be weaker and less able to fight the germs when you need hospital care. 

HAP symptoms include:

  • Cough that produces greenish mucus.
  • Fever.
  • Sweats that drench you.
  • Chills.
  • Shortness of breath.

HAP is treated with antibiotics, oxygen therapy, and lung treatments. To reduce your risk, follow the instructions we give you before, during, and after your hospital stay.


The best treatment for HAP is to try to avoid getting it in the first place. HAP can be prevented. 

Follow the instructions that we give you before, during, and after your surgery and hospitalization to significantly reduce your risk of getting HAP.

For example, to reduce your risk:

  • Use an incentive spirometer to keep your lungs active and strong.
  • Brush your teeth regularly.
  • Keep your hands washed.
  • Stay physically active.
  • Sit upright in a chair for meals.
  • Remain upright for 30 minutes after eating.

Step 1

This is your Incentive Spirometer. We recommend you begin to use it at home before your surgery and hospitalization.

Before Your Hospital Stay

Before your scheduled surgery or hospital stay, lower your risk of developing HAP. 

Use your incentive spirometer to exercise your lungs. This device tells us how well your lungs are working. It’s important that you use it as instructed to lower your risk of HAP. 

Stop smoking and avoid using alcohol and drugs. If you, smoke, ask us about resources to help you quit.

Get regular physical activity. Begin by walking a short distance 3 times a day. Slowly increase the distance and how often you walk.

Brush your teeth at least 2 times each day, and use mouthwash on the morning of your surgery or hospitalization. The bacteria in your mouth can move into your lungs and cause pneumonia. 

Wash your hands for at least 20 seconds each time to remove germs that can cause HAP.

During Your Hospital Stay

During your hospital stay, you can lower your risk of HAP with these steps. 

Use your incentive spirometer as instructed. Use it every 2 hours while you’re awake to keep your lungs strong. 

Manage your pain. When you have pain, it can be difficult to move or take deep breaths. Taking deep breaths helps open your airways and prevent fluid from building up in your lungs. Ask for pain medications before your pain becomes stronger. 

Oral care. Brush your teeth to reduce the number of bacteria in your mouth that might move to your lungs. Brush your teeth at least 2 times each day before, during, and after your hospital stay. You may be given a special mouthwash to use. 

If you have dentures or partials, bring them to use when you start eating during your hospital stay. 

Move and walk. Moving encourages faster healing and helps prevent HAP and other complications. If you’re not able to walk, change your position often and do exercises in bed. 

Sit up during meals. After you eat, sit upright for at least 30 minutes. This reduces the risk of inhaling food or liquid into your lungs. 

Raise the head of your bed. Keep the head of your hospital bed raised at least 30 degrees. This helps you breathe better and reduces your risk of HAP. 

Wash your hands with warm water and soap for at least 60 seconds each time.

After Your Hospital Stay

To prevent pneumonia, continue to follow the discharge instructions when you go home from the hospital. 

Use your spirometer as instructed. Be sure to breathe in deeply and hold your breath for 5 seconds before exhaling. Use the spirometer at least 10 times during every 2 hours that you are awake. 

Practice good hygiene. Continue to wash your hands thoroughly. Brush your teeth well at least 2 times each day. 

Avoid smoking and using alcohol or drugs. 

Move or walk. Sit up during meals, and get regular movement and gentle exercise during each day. When you continue to lie flat in bed for long periods of time, you’re at greater risk of developing pneumonia. Regular activity helps you heal. 

Raise the head of your bed. If possible, have someone raise the head of your bed up by 30 degrees so you’re not lying flat when sleeping. Otherwise, use several pillows to prop up your head, shoulders, and chest when resting or sleeping.

Raise the head of your bed about 6 to 8 inches. Try putting sturdy blocks under the bed frame legs.

Symptoms and Diagnosis

Let us know if you develop any symptoms of pneumonia. The most common signs of HAP include:

  • High fever and chills.
  • Difficulty breathing or shortness of breath.
  • Cough that produces mucus or a greenish-colored phlegm (sputum).
  • Profuse sweating that may drench your clothing.
  • Loss of appetite.
  • Nausea or vomiting.
  • Sharp pain in your chest when you breathe in deeply. 

If we suspect that you have HAP, we may test a sample of your mucus from your cough (sputum) to identify the germs causing the infection. 

We might also order tests to measure the oxygen level in your blood (and other blood tests) to see if the infection has spread. 

A CT scan or chest X-ray might also be used to check your lungs for pneumonia.

Causes and Risk Factors

When we breathe, a small number of germs naturally enter our lungs. The types of germs in hospitals tend to be harder to treat than the usual causes of pneumonia. 

When you’re sick or recovering from surgery, your body also can’t fight off germs as easily. For these reasons, HAP tends to be more severe and may become life-threatening. 

Your risk for getting HAP increases when you:

  • Are using a breathing machine (ventilator).
  • Have substance abuse problems (alcohol or drugs).
  • Recently had chest or another type of major surgery.
  • Have a chronic illness (such as cancer) or a severe injury.
  • Are an older adult.
  • Are not able to chew or swallow well and inhale food or liquid into your lungs.
  • Have general anesthesia during surgery, which decreases your ability to breathe deeply. 

We have many safety rules in place to avoid spreading germs in hospitals, such as wearing gowns and washing hands before and after examining each person. However, nurses, doctors, and other hospital workers may unintentionally pass germs to you from their hands or clothing. 

While we’re well-trained to maintain good hygiene, we encourage you to ask hospital staff if we have washed our hands before we examine you.


HAP is treated with medication, oxygen, and lung exercises. You may need to remain in the hospital during treatment. We must closely monitor you during treatment because HAP is a serious illness. 

Treatment usually includes:

  • Antibiotics through a vein (IV) or as pills that you swallow. You may be given more than one type of antibiotic.
  • Oxygen therapy, until you can breathe more easily on your own.
  • Lung treatments with the incentive spirometer to increase your lung activity, open your airways, and strengthen your lungs. We may use other lung treatments to break up and remove the mucus in your lungs. 

The best treatment for HAP is to try to avoid getting it in the first place. 

HAP can be prevented. Follow the instructions we give you before, during, and after your surgery to significantly reduce your risk of getting HAP.

Additional References:

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If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.

This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.