Toothbrushing to Prevent Pneumonia
Pneumonia in vent patients reduced by oral hygiene
February 1, 2024 3 minutes read
Oral care, including time-honored toothbrushing, may save a patient’s life from pneumonia of all stripes.
A new meta-analysis of 15 randomized clinical trials with an effective population size of 2,786 patients found that hospital-acquired pneumonia (HAP) rates were lower among patients randomized to daily toothbrushing, particularly among patients receiving invasive mechanical ventilation. “Toothbrushing was also associated with shorter duration of mechanical ventilation, shorter intensive care unit (ICU) length of stay, and lower ICU mortality, whereas hospital length of stay and use of antibiotics showed no differences,” the authors reported.1
Regular toothbrushing is an alternative strategy to decrease microbial burden in the mouth without the potential risk associated with oral chlorhexidine, the researchers noted. “Indeed, toothbrushing may be more effective than antiseptics at reducing microbial burden since mechanical scrubbing may better disrupt plaque and other biofilms compared with antiseptics,” they noted.
The researchers found a greater reduction effect of toothbrushing in ventilated patients. “These findings suggest that routine toothbrushing should be considered an essential component of standard care in hospitalized patients, particularly in patients receiving invasive mechanical ventilation, for whom the evidence is strongest, to prevent pneumonia and lower mortality rates,” the researchers concluded.
Ventilator-associated pneumonia (VAP) and HAP are ubiquitous in hospitals. Indeed, non-ventilator pneumonia (NV-HAP) is the leading healthcare-associated infection, yet it has no reporting requirements nor any well-understood incentives to adopt evidence-based prevention practices.
“It is the number one hospital-acquired infection, but it’s not a required infection to report to The Joint Commission or with [the] Centers for Medicare and Medicaid Services [CMS] reporting,” says JoAnn Brooks, RN, PhD, FCCP, FAAN, a leading non-ventilator NV-HAP researcher, who was not part of the study.
A Joint Commission call to action on this issue stated that “strategies to improve the prevention, recognition, and treatment of NV-HAP are currently limited by gaps in understanding of the pathogenesis of NV-HAP. Also, surveillance is challenging because the clinical criteria for NV-HAP are subjective, often inaccurate, variably documented, and labor-intensive to apply.”2
The Joint Commission recommends routine oral care, elevating the head of the bed and other common-sense measures to prevent NV-HAP. Numerous studies have shown that toothbrushing and other oral care components have proven to be an effective prevention tool for this type of HAP as well.3-5
REFERENCES
- Ehrenzeller A, Klompas M. Association between daily toothbrushing and hospital-acquired pneumonia: A systematic review and meta-analysis. JAMA Intern Med 2023; Dec 18. doi:10.1001/jamainternmed.2023.663. [Online ahead of print].
- Warren C, Medei MK, Wood B, Schutte D. A nurse-driven oral care protocol to reduce hospital-acquired pneumonia. Am J Nurs 2019;119;44-51.
- Munro S, Haile-Mariam A, Greenwell C, et al. Implementation and dissemination of a Department of Veterans Affairs oral care initiative to prevent hospital-acquired pneumonia among nonventilated patients. Nurs Adm Q 2018;42:363-372.
- Lacerna CC, Patey D, Block L, et al. A successful program preventing nonventilator hospital-acquired pneumonia in a large hospital system. Infect Control Hosp Epidemiol 2020;41:547-552.
- The Joint Commission. Preventing non-ventilator hospital-acquired pneumonia. Quick Safety, Issue 61. Published September 2021. https://www.jointcommission.org/-/media/tjc/newsletters/quick-safety-61-nvha-pneumonia-final-9-3-21.pdf
Oral care, including time-honored toothbrushing, may save a patient’s life from pneumonia of all stripes.
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