Healthcare News & Insights

One surprising way to reduce pneumonia rates

Trying to decrease your hospital’s pneumonia rates? One facility tried an unconventional method to much success: focusing on oral hygiene.

464409951At first, there doesn’t seem to be a direct link between dental hygiene and hospital-acquired pneumonia. However, the observations of one nurse specialist led to a study that suggests otherwise.

After implementing a comprehensive oral-care program at Sutter Medical Center, rates of one type of hospital-acquired pneumonia dropped by over a third.

According to an article in the Sacramento Bee, Barbara Quinn, the nurse specialist at Sutter, started noticing that several patients who weren’t on ventilators were still contracting pneumonia while in the hospital.

Quinn reached out to Dian Baker, a nursing professor and researcher at California State University, Sacramento, to see if they could get to the bottom of the problem.

Together, they conducted a yearlong study to see if they could decrease non-ventilator hospital-acquired pneumonia rates, and the results were highlighted in the Journal of Nursing Scholarship.

Shifting the focus

While ventilator-associated pneumonia is more prevalent, and gets more attention from the feds, non-ventilator associated pneumonia also has consequences for hospitals.

Per data from the study, patients that acquire any kind of pneumonia in the hospital face longer hospital stays (seven to nine extra days on average) and incur higher costs ($40,000-$60,000).

In looking at cases of non-ventilator hospital-acquired pneumonia at Sutter, Baker and Quinn found there were about 10 a month on average.

While many factors leading patients to get pneumonia were out of their control, they decided to focus on something they could influence: patients’ dental hygiene.

Importance of oral hygiene

Poor dental hygiene has been linked to other illnesses, from heart disease to arthritis, according to an article from Live Science. So it’s not surprising that it could be a contributor to pneumonia, as well.

Several other studies cited in Baker and Quinn’s research have mentioned that there may be a link between dental health and pneumonia, including one conducted by the Centers for Disease Control and Prevention (CDC) in 2013.

How can oral health cause this condition? Hospital patients with compromised immune systems may be breathing in bacteria, which can settle in their mouths. And dental plaque also harbors bacteria. If germs aren’t removed ASAP via regular brushing, they could find their way into patients’ lungs, leading to illness.

Making changes

To try and control the risk of non-ventilator hospital-acquired pneumonia, staff at Sutter Hospital implemented a full oral care program. At first, it was only in the ICU, but it soon spread to the entire hospital.

As part of the program, the hospital purchased higher-quality toothbrushes for patients, including large ones with suction so critically ill patients wouldn’t aspirate when their teeth were brushed. Staff also began using toothpaste with sodium bicarbonate to more effectively remove plaque and alcohol-free antiseptic mouth rinse to kill more oral germs.

The protocol for giving patients oral care also changed.  All adult patients who weren’t on ventilators were scheduled for oral care at least four times a day, either after meals and before bedtime, or at a six-hour interval. And staff could more easily document patients’ oral hygiene throughout the day, thanks to revised encounter forms.

In addition, staff received regular training in oral care, getting info from self-guided courses and from actual dentists themselves. And they passed this info on to patients and their families so they could be more involved in the process.

Better dental care = success

The extra work to keep patients’ mouths healthy paid off.

By the end of the study, cases of non-ventilator hospital-acquired pneumonia decreased to an average of six or seven a month in the ICU. In fact, at one point toward the end of the study, there was one month with no cases at all.

Overall, rates of non-ventilator hospital-acquired pneumonia at Sutter dropped by 37% over the course of the year.

Even better: The researchers estimated that the program led to a $1.72 million cost savings. The investment the hospital made for its revamped oral care program was $117,600. This means the approximate ROI for the hospital was over $1.6 million.

So if you’re looking to make a significant dent in hospital-acquired pneumonia rates, you may need to start with a toothbrush.

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