ScienceDaily (Dec. 15, 2008) — Hospital-borne
infections are a serious risk of a long-term
hospital stay, and ventilator-associated
pneumonia (VAP), a lung infection that
develops in about 15% of all people who are
ventilated, is among the most dangerous.
With weakened immune systems and a higher
resistance to antibiotics, patients who rely
on a mechanical ventilator can easily develop
serious infections — as 26,000 Americans do
every year.

Thanks to a proven new clinical approach
developed by Tel Aviv University nurses,
though, there is a new tool for stopping the
onset of VAP in hospitals.

This new high-tech tool? An ordinary toothbrush.

Three Times a Day Keeps Pneumonia Away

“Pneumonia is a big problem in hospitals
everywhere, even in the developed world,”
says Nurse Ofra Raanan, the chief researcher
in the new study and a lecturer at Tel Aviv
University’s Department of Nursing. “Patients
who are intubated can be contaminated with
pneumonia only 2 or 3 days after the tube is
put in place. But pneumonia can be
effectively prevented if the right measures
are taken.”

Raanan, who works at the Sheba Academic
School of Nursing at The Chaim Sheba Medical
Center, collaborated with a team of nurses at
major medical centers around Israel. The
nurses found that if patients — even
unconscious ones — have their teeth brushed
three times a day, the onset of pneumonia can
be reduced by as much as 50%.

A Pioneering Study with Measurable Effects

It’s difficult to quantify the effects
precisely, the researchers say. “While the
research shows a definite improvement in
reducing the incidence of hospital-borne
pneumonia, it’s hard to say by exactly how
much toothbrushing prevents VAP,” says
Raanan, but the published evidence shows a
direct correlation for intubated patients.

“Sometimes, however, doctors and nurses do
everything right and the patient still gets
pneumonia. But this approach will certainly
improve the odds for survival.”

Normally, the teeth and oral cavity in a
healthy mouth maintain a colony of otherwise
harmless bacteria. Infection takes root when
a breathing tube allows free passage of the
“good” bacteria into the lower parts of the
lung. The bacteria travel in small water
droplets through the tube and colonize the
lung. Once there, the bacteria take
advantage of a patient’s weakened immune
system and multiply. A regular toothbrushing
kills the growth and subsequent spread of the
bacterium that leads to VAP.

Augmenting the Preventative Routine

There are additional steps for preventing the
onset of VAP. Today, nurses typically use a
mechanical suction device to remove
secretions from the mouth and throat. They
also put patients in a seated position and
change the position every few hours.
Toothbrushing, say Tel Aviv University
nurses, should be added to the routine.

Although nurses in some American hospitals
already practice toothbrushing on ventilated
patients, these new results may convince
medical centers around the world to invest
more resources in this routine practice,
thereby saving lives.


Oral hygiene curbs pneumonia risk in elderly

Reuters – Oct 23, 2008

NEW YORK (Reuters Health) – Among nursing home residents, having a nursing aide help them maintain good oral hygiene lowers the odds of them dying from pneumonia, a study suggests.

Pneumonia is the leading cause of death in elderly nursing home residents, Dr. Carol W. Bassim and colleagues point out in the Journal of the American Geriatrics Society. “Several studies have shown that poor oral hygiene or inadequate oral care are also associated with pneumonia,” they add.

Bassim, now at the National Institute of Dental and Craniofacial Research in Bethesda, Maryland, and her associates studied the impact of enhanced oral hygiene care for residents in two wards at a Florida nursing home compared with residents in two other wards.

Initially, there was no difference in the mortality rate from pneumonia between the two groups. However, patients in the oral care group were older and more disabled than those who did not receive oral care, and once this was taken into account the risk of dying from pneumonia was more than three times higher in patients who did not receive oral care.

Pneumonia in the elderly is often triggered by aspirating saliva or food. It is likely that the risk of pneumonia “depends on the quality and the quantity of the oropharyngeal contents of a patient at the time of respiratory inoculation or introduction,” Bassim and colleagues explain.

“The quantity of saliva inhaled and a predisposition to gross aspiration events may not be modified through oral care,” they add, “but this study indicates that oral care may be involved in significantly reducing the harmful quality of the intra-oral environment, reducing the risk of a patient dying from pneumonia.”

SOURCE: Journal of the American Geriatrics Society, September 2008.