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Good oral hygiene a factor in halting hospital pneumonia cases: Sacramento study

Good oral hygiene by patients is key to combating hospital-acquired pneumonia, a recent study from California State University, Sacramento, researchers and Sutter Medical Center staff found. You can read the abstract of the new Sacramento study, "Basic Nursing Care to Prevent Nonventilator Hospital-Acquired Pneumonia," published in the January 2014 issue of the Journal of Nursing Scholarship (See, Volume 46, Issue 1, pages 11–19, January 2014.) Sometimes, it may not be your physician, but a nurse that saves your life by making the connection between good oral hygiene and preventing bacterial pneumonia in your mouth from being inhaled into your lungs when you're in a hospital where the air may be full of germs. Also in another, unrelated study, many popular sedatives have been linked to fatal pneumonia risk.

Good oral hygiene a factor in halting hospital pneumonia cases: Sacramento study.
Photo by Dan Kitwood/Getty Images

See, "Sedative Linked To Pneumonia Risk, Research Suggests." The point of research on pneumonia risks in hospitals is to find out how many variables might be linked to getting pneumonia when you enter a hospital as a patient. The latest study links oral hygiene as a factor in lowering the risk of coming down with pneumonia when you enter a hospital. You don't want the bacteria in your mouth to change into the type of bacteria that causes pneumonia, and then you inhale the bacteria into your lungs.

The article on good oral hygiene for hospital patients first appeared online September 30, 2013

Nonventilator hospital-acquired pneumonia (NV-HAP) is an underreported and unstudied disease, with potential for measurable outcomes, fiscal savings, and improvement in quality of life. The purpose of this news Sacramento study at Sutter Hospital focused on identifying the incidence of bacteria-caused pneumonia, known as NV-HAP in non-ventilated hospital patients.

The researchers looked at a sample of U.S. hospitals. Researchers wanted to determine the effectiveness of reliably delivered basic oral nursing care in reducing NV-HAP. It takes nurses and clinical educators to inform the public how important oral hygiene is to prevent bacterial pneumonia if you're in a hospital as a patient (or for any other reason). It's one variable to brush your teeth as a patient not on a ventilator, where pneumonia can happen if you inhale hospital pneumonia bacteria into your lungs.

It's another issue when you can't brush your teeth when on a ventilator and you need someone coming in several times a day to floss and brush your teeth, someone who can floss your teeth when you can't and not tear your gums flossing you, so more bacteria gets under the gum and into your blood. And it costs money for hospitals to have supplies and staff. So who pays for the extra expense, the consumer, the insurance, or the hospital?

The new Sacramento research is a descriptive, quasi-experimental study using retrospective comparative outcomes to determine the incidence of this pneumonia bacteria infecting patients coming into hospitals

The bacterial causing pneumonia in hospital patients is known as NV-HAP. In the latest study with several Sacramento hospitals, researchers also wanted to find out more about the effectiveness of enhanced basic oral nursing care versus usual care to prevent NV-HAP after introduction of a basic oral nursing care initiative. In plain language, if patients frequently flossed and brushed their teeth each time they ate food while in the hospital, there would be fewer bacteria in their mouth to inhale into their lungs when they're patients in hospitals.

The Sacramento researchers used the International Statistical Classification of Diseases and Related Problems (ICD-9) codes for pneumonia not present on admission and verified NV-HAP diagnosis using the U.S. Centers for Disease Control and Prevention diagnostic criteria. They completed an evidence-based gap analysis and designed a site-specific oral care initiative designed to reduce NV-HAP. The intervention process was guided by the Influencer Model™ and participatory action research. You can check out the site, "ICD-10 - Centers for Medicare & Medicaid Services." What the researchers found focused on a substantial amount of unreported NV-HAP.

After the researchers initiated their oral care protocols, the rate of NV-HAP per 100 patient days decreased from 0.49 to 0.3 (38.8%)

The overall number of cases of NV-HAP was reduced by 37% during the 12-month intervention period. The avoidance of NV-HAP cases resulted in an estimated 8 lives saved, $1.72 million cost avoided, and 500 extra hospital days averted. The extra cost for therapeutic oral care equipment was $117,600 during the 12-month intervention period. Cost savings resulting from avoided NV-HAP was $1.72 million. Return on investment for the organization was $1.6 million in avoided costs.

It's also a good practice to get a cleaning from your dentist before you go into a hospital for elective surgery, a practice you can't predict or do if you suddenly take ill. Then again, if you get a cleaning from your dentist every six months or so, you're in better shape than if you didn't see a dentist for years.

Some patients are left wondering who's going to pay for the increased cost for therapeutic oral care equipment such as suction toothbrushes, dental floss, and mouth wash?

What this Sacramento study found is that hospital-acquired pneumonia bacteria needs more focus. The researchers noted in the study's abstract that NV-HAP should be elevated to the same level of concern, attention, and effort as prevention of ventilator-associated pneumonia in hospitals. Your health is in the care of nurses.

Think about it....Nurses started this study because nurses see how frequently someone enters a hospital and within a day or two develops pneumonia. The study showed how the bacteria in your mouth rapidly changes into pneumonia bacteria that you inhale into your lungs. And the pneumonia bacteria is floating around in the air of hospitals along with other types of germs in hospitals.

Nursing needs to lead the way in the design and implementation of policies that allow for adequate time, proper oral care supplies, ease of access to supplies, clear procedures, and outcome monitoring ensuring that patients are protected from NV-HAP.

Oral hygiene such as flossing and brushing can save your life if you're in the hospital even for a short time

You also may wish to check out the February 22, 2014 Sacramento Bee article by Sammy Caiola, "Sacramento study finds oral hygiene to be a factor in hospital pneumonia cases." If you've ever wondered why someone who's healthy and comes into a hospital to have a baby or an operation suddenly comes down with pneumonia that they caught in the hospital, it's most likely because within hours of entering a hospital as an in-patient, the bacteria in the person's mouth changes to the pneumonia bacteria found in almost all hospitals. And the only action that could prevent oral bacteria from rapidly changing into hospital pneumonia bacteria is frequent flossing and brushing the teeth--good oral hygiene.

Besides flossing, you need to brush with a baking-soda type of toothpaste frequently and use a mouthwash, even if you've read how mouthwashes aren't so great. You might try rinsing with salt water as your mouthwash instead of an alcohol-based mouthwash/rinse. See, "Johnson & Johnson sued over mouthwash cancer fears | Society."

Frequent flossing is not just a good habit for hospital patients – it’s a lifesaver

Dian Baker, a California State University, Sacramento (CSUS) nursing professor and researcher, investigated the relationship between hospital pneumonia acquired by patients not on ventilators. Barbara Quinn, a clinical nurse specialist at Sutter, initiated the study after noticing a prevalence of hospital-acquired pneumonia among patients not on ventilators.

A typical scenario in hospitals nationally and globally is that patients come into the hospital, and within a few hours, the bacteria already in their mouth rapidly changes to a different type of bacteria, the bacteria already in the hospital, which happens to be pneumonia bacteria. Too many patients were coming down with pneumonia, and the new study wanted to find out the reason why. It had to do with a patient's oral hygiene.

During a yearlong study funded by the medical center, the research team discovered that about 10 non-ventilated patients per month contract pneumonia while at the Sutter Medical Center, which includes Sutter General Hospital in midtown and Sutter Memorial in east Sacramento, according to the Sacramento Bee article.

The illness is known as non-ventilator hospital-acquired pneumonia (NV-HAP). In the past, hospitals focused studies on ventilated patients because when someone is sick enough to require ventilation, their immunity may be down and their airways are more exposed to the pneumonia bacteria floating around in most hospitals.

Researchers linked lack of good oral hygiene to catching pneumonia when you're a hospital patient. Other factors related to catching pneumonia from the pneumonia bacteria in the air of a hospital is known as NV-HAP. You're also more likely to catch pneumonia in a hospital from bacteria rather than a different pneumonia virus depending upon your age and your diagnosis. But if you've wondered what you can do to help your immunity, it's practice good oral hygiene by flossing, not just brushing, and rinsing your mouth.

In the new Sacramento study, researchers found the culprit to be a lack of good oral hygiene

What happens is when patients breathe into the air of a hospital, those patients with compromised immune systems and limited mobility risk bringing bacteria from their own mouths into their lungs. So it's your own bacteria from your mouth, not always from other people's mouths, that gets sucked into your own lungs, and that's how you develop pneumonia.

It can happen outside of a hospital if your mouth is breeding bacteria and you breath in the bacteria, and then do to your immunity and the air around you, the bacteria in your environment rapidly changes into pneumonia-causing bacteria. Other health problems can happen not just pneumonia from breathing into your lungs the bacteria around your gums.

Patients in a hospital bed or anywhere else where they're sick or too tired may stop flossing and brushing frequently, such as brushing four times a day, rinsing, and flossing after they've finished each meal.

The bacteria builds up and could become life-threatening when they inhale the bacteria into their lungs

In a hospital environment, if you're there for one or two days, the bacteria in your mouth changes and becomes more like the bacteria in the hospital environment, according to the Sacramento Bee article. Most people don't realize how many germs are in the air of hospitals. The bacteria reproduces quickly once in your mouth and gets into your lungs.

As part of a pilot program between spring 2012 and 2013, Sutter Hospital in Sacramento staff designed and funded a new oral-care protocol, which includes distribution of American Dental Association-recommended brushes, sodium bicarbonate toothpaste and antiseptic mouthwash. They also added special suction toothbrushes with larger, firmer handles, and lip moisturizer, for patients whose conditions make it difficult for them to brush, notes the Sacramento Bee article.

Hospitals need to have oral products for the adult patients. And those supplies cost money. The hospital also has to train the staff to practice oral hygiene. At least, the outcome of better oral hygiene for patients resulted in reduced the number of NV-HAP cases at Sutter to about six or seven a month – a 37 percent decrease over the one-year period. The results of the study were published in the January 2014 issue of the Journal of Nursing Scholarship.

U.S. hospitals are required to monitor only ventilated patients for pneumonia – a standard that Baker and Quinn hope to change by promoting their study at national conferences

The moral of this study is that oral hygiene is important for everyone, not just people on ventilators. You need to floss and brush each time you eat if you're in a hospital setting. Brush four times daily if you're eating meals and snacks. And floss when you've finished eating your final meal or snack of the day. Don't rely on a fresh apple to clean your teeth as people did centuries ago.

Kaiser Permanente’s involvement in the study reinforced its protocol in place to combat hospital-acquired pneumonia, including improving oral hygiene education and increasing distribution of mouthwash and getting patients walking early in their hospital stay, says the Sacramento Bee article. The point is that some Sacramento hospitals provide oral care for patients at least twice a day and educate them about the importance oral care.

And hospitals everywhere need to do the same oral hygiene regimens

If you're going into a hospital, take your oral care devices with you if you're at a hospital somewhere and you don't know whether oral hygiene care is provided at the level of frequent flossing and brushing followed by a type of mouthwash that works well. At least you know good oral hygiene practices are being done at Kaiser Permanente, South Sacramento and some other area hospitals.

Other partners in the research included Kaiser Permanente South Sacramento and the Department of Veterans Affairs Medical Center in Salem, Va. Researchers of the study include Barbara Quinn MSN, CNS, RN, Dian L. Baker PhD, APRN-BC, PNP Shannon Cohen PhD, APRN-BC, FNP, Jennifer L. Stewart MSN, RN, Christine A. Lima PhD, MN, RN, and Carol Parise PhD.