A simple improvement in oral care for hospitalised patients reduced the risk of non-ventilator hospital-acquired pneumonia by 60 percent, a trial of 8870 patients in three Australian hospitals has found.
Patients with non-ventilator hospital-acquired pneumonia are eight times more likely to die in hospital than patients without it.
Toothbrush and toothpaste plus education on optimal oral care led to a 60 per cent reduction in NV-HAP.
Oral care reduces the bacterial load which lowers risk of aspirating bacteria into the lungs that can cause pneumonia.
Associate Professor Nicole White from QUT’s School of Public Health and Social Work who led the trial analysis—published in The Lancet Infectious Diseases—said patients who developed non-ventilator hospital-acquired pneumonia (NV-HAP), one of the most common healthcare-associated infections, stayed in hospital between 10 and 48 days longer.
“Prior research has found that patients with NV-HAP are eight times more likely to die in hospital than patients without NV-HAP,” Dr White said.
“Oral care is considered a key measure to prevent NV-HAP because reducing the oral bacterial load decreases the risk of aspirating these bacteria into the lungs that can cause pneumonia.
“Despite the risks of NV-HAP to patient safety and its heavy economic impact on the health system, NV-HAP is not routinely monitored. Our study is the first randomised-controlled trial in a hospital setting to demonstrate the importance of monitoring NV-HAP and that it can be prevented by improving oral care.”
The research team worked with consumers to design the simple intervention of providing a toothbrush and toothpaste, reinforced by patient and staff education on the importance of good mouth hygiene and how to perform it.
“Oral care, in the trial, included moisturising lips and cleaning of teeth or dentures and tongue with a suitable toothbrush and toothpaste containing sodium bicarbonate and fluoride,” Dr White said.
“The research nurses engaged participants as early as possible after their admission to the intervention ward.”
Dr White said that of the 8870 patients who participated, 4523 were in the control group and received the hospital’s usual oral care, and 4347 were in the intervention group.
“The results showed that NV-HAP was confirmed in 78 of the 8870 participants, with 46 cases occurring in the control and 32 cases in the intervention.
“Overall, we estimated that the intervention reduced the risk of NVHAP by about 60 per cent,” Dr White said.
“Over the same period, the proportion of participants who successfully completed oral care increased from 16 per cent in the control to 62 per cent in the intervention.
“This study reinforces the importance of prioritising oral care for hospitalised patients.”
