Also, poor hand-washing and inadequate disinfection of respiratory devices cause cross-infection and are important factors. Pathogenesis
Most nosocomial respiratory infections are caused by so-called microaspiration of upper airway secretions, through inapparent aspiration, into the lower respiratory tract. Also, "macroaspirations" of esophageal or gastric material is known to result in HAP. Since it results from aspiration either type is called aspiration pneumonia.Although gram-negative bacilli are a common cause they are rarely found in the respiratory tract of people without pneumonia, which has led to speculation of the mouth and throat as origin of the infection. Diagnosis
In hospitalised patients who develop respiratory symptoms and fever, one should consider the diagnosis. The likelihood increases when upon investigation symptoms are found of respiratory insufficiency, purulent secretions, newly developed infiltrate on the chest X-Ray, and increasing leucocyte count. If pneumonia is suspected material from sputum or tracheal aspirates are sent to the microbiology department for cultures. In case of pleural effusion, thoracentesis is performed for examination of pleural fluid. In suspected ventilator-associated pneumonia it has been suggested that bronchoscopy or bronchoalveolar lavage is necessary because of the risks of incorrect clinical diagnoses. Differential diagnosis
Atelectasis
Congestive heart failure
Pulmonary embolism

Treatment
Usually initial therapy is empirical. If sufficient reason to suspect influenza, one might consider oseltamivir. In case of legionellosis, erythromycin or fluoroquinolone.A third generation cephalosporin (ceftazidime) + carbapenems (imipenem) + beta lactam & beta lactamase inhibitors (piperacillin/tazobactam)

References
Further reading
Carratalà J, Garcia-Vidal C (2008). "What is healthcare-associated pneumonia and how is it managed?". Curr. Opin. Infect. Dis. 21 (2): 168–173. doi:10.1097/QCO.0b013e3282f4f248. PMID 18317041. S2CID 3060658.
Granuloma faciale  is an uncommon benign chronic skin disease of unknown origin characterized by single or multiple cutaneous nodules, usually occurring over the face. : 836  Occasionally, extrafacial involvement is noted, most often on sun-exposed areas. Diagnosis
Skin biopsy for histopathology: 
Focal LCV, diffuse dermal neutrophilia with leukocytoclasia, tissue eosinophilia & perivascular fibrosis. Differential diagnosis
The disease mimics many other dermatoses and can be confused with conditions, such as sarcoidosis, discoid lupus erythematosus, mycosis fungoides, and fixed drug eruption. Treatment
Topical corticosteroid,
Intralesional corticosteroid,
Dapsone,
Colchicine,
Antimalarial,
Pulse dye laser,
Carbon dioxide laser. History
GF was first described in 1945 by John Edwin Mackonochie Wigley (1892–1962). See also
Cutaneous small-vessel vasculitis
List of cutaneous conditions

References


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