Health & Medicine

Sacramento study finds oral hygiene to be a factor in hospital pneumonia cases

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

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.

The study puts a spotlight on non-ventilator hospital-acquired pneumonia (NV-HAP), which has been largely unreported due to a focus on ventilated patients, who are more likely to contract pneumonia because their airways are more exposed. Barbara Quinn, a clinical nurse specialist at Sutter, initiated the study after noticing a prevalence of hospital-acquired pneumonia among patients not on ventilators.

Quinn contacted Dian Baker, a CSUS nursing professor and researcher, to investigate the scope of the problem. During a yearlong study funded by the medical center, the duo 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.

While some causes of NV-HAP such as age and a patient’s diagnosis cannot be changed, researchers saw an opportunity in oral hygiene factors.

By merely breathing, patients with compromised immune systems and limited mobility risk bringing bacteria from their mouths into their lungs, leading to more serious conditions, including pneumonia, Quinn said. Patients often become lax about brushing and flossing when they are tired and sick, Baker added, leaving them susceptible to sometimes life-threatening bacterial buildup.

“Once people are in the hospital for a day or two, the bacteria in their mouth changes and becomes more like the bacteria in the hospital environment,” Quinn said. “Unfortunately, hospitals have bad germs. Bacteria replicates so quickly in the mouth that it can take a matter of hours.”

As part of a pilot program between spring 2012 and 2013, Sutter 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.

A year’s supply of oral products for all of the adult patients in the two Sutter hospitals costs a total of $117,600. The supplies, combined with additional staff training focused on oral hygiene, 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.

“Not only are hospitals not paying attention to this, but we as a nursing profession were not aware that oral hygiene was so important for patients not on ventilators,” Baker said. “I tell all my friends now before they go to the hospital to see the dentist before they go, and brush their teeth four times a day.”

Other partners in the research included Kaiser Permanente South Sacramento and the Department of Veterans Affairs Medical Center in Salem, Va.

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.

“We provide oral care for patients at least twice a day and educate them about the importance oral care,” said Jennifer Stewart, a clinical educator at Kaiser Pemanente South Sacramento.