Oral care measures for preventing nursing home-acquired pneumonia

Liu, Chang; Cao, Yubin; Lin, Jen‐Der; Ng, Linda; Needleman, Ian; Walsh, Tanya; Li, Chunjie

doi:10.1002/14651858.cd012416.pub2

Cited by 55 publications

(65 citation statements)

References 84 publications

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“…As mentioned in the introduction, previous studies suggested that oral hygiene including denture cleaning was associated with the incidence of pneumonia among nursing homes residents 11 ; the present study showed a similar association among the community-dwelling older adults. A study conducted in nursing home reported a reduction of death due to pneumonia among older residents by oral care including denture cleaning 23 .…”

Section: Discussionsupporting

confidence: 82%

“…In addition, because a substantial proportion of older adults are affected by dysphagia 7,8 , the risk of pneumonia through aspiration may increase 4 . To reduce the risk of aspiration pneumonia, oral care has been implemented in nursing homes and has successfully decreased the incidence of pneumonia among the nursing home residents 9–11 .…”

Section: Introductionmentioning

confidence: 99%

“…There is a possibility that the denture plaque may reach the lungs by aspiration, causing aspiration pneumonia. Although generally included as a part of oral care 11 , previous studies have not focused on denture cleaning alone. In addition, most of the previous studies on the relationship between oral hygiene and pneumonia were carried out in nursing homes and hospitals 14,15 .…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Infrequent Denture Cleaning Increased the Risk of Pneumonia among Community-dwelling Older Adults: A Population-based Cross-sectional Study

Kusama

Aida

Yamamoto

et al. 2019

Sci Rep

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Pneumonia is a leading cause of death among older adults. The effectiveness of oral care in preventing pneumonia in nursing homes and hospitals has been reported. However, in community-dwelling older adults, the role of denture cleaning in preventing pneumonia remains unknown. We aimed to investigate the association between infrequent denture cleaning and the risk of pneumonia in community-dwelling older adults. This cross-sectional study was based on the self-reported questionnaire targeting towards community-dwelling older adults aged ≥65 years. Responses of 71,227 removable full/partial denture users were included. The incidence of pneumonia within the last one-year and the frequency of denture cleaning (daily/non-daily) were treated as dependent and independent variables, respectively. The odds ratio (OR) and 95% confidence interval (CI) were calculated by the inverse probability weighting (IPW) method based on the logistic regression model. The mean age of the participants was 75.2 ± 6.5 years; 48.3% were male. Overall, 4.6% of the participants did not clean their dentures daily; 2.3% and 3.0% who did and did not clean their dentures daily, respectively, experienced pneumonia. After IPW, infrequent denture cleaning was significantly associated with pneumonia incidence (OR = 1.30, 95% CI = 1.01–1.68)). This study suggests that denture cleaning could prevent pneumonia among community-dwelling older adults.

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Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Infrequent Denture Cleaning Increased the Risk of Pneumonia among Community-dwelling Older Adults: A Population-based Cross-sectional Study

Kusama

Aida

Yamamoto

et al. 2019

Sci Rep

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“…It is therefore reasonable to presume that the antibiotic treatment was ineffective, but mechanical POHC was effective, in the recovery from aspiration pneumonia in this case. Currently, POHC is recommended for the prevention of fever and aspiration pneumonia in older adults; however, no clear evidence exists that it can suppress the exacerbation of aspiration pneumonia [1][2][3][4][5][6]. There is some evidence that POHC can contribute to a better quality of life by improving oral complications such as halitosis, xerostomia, and oral infectious diseases in the terminal stages of systemic diseases [15].…”

Section: Case Reports In Dentistrymentioning

confidence: 99%

“…Professional oral health care (POHC) prevents aspiration pneumonia caused by aspiration in older adults, especially when it is associated with dysphagia [1][2][3][4][5][6]. However, there is little evidence that POHC intervention after illness improves severe aspiration pneumonia.…”

Section: Introductionmentioning

confidence: 99%

Continuous Professional Oral Health Care Intervention Improves Severe Aspiration Pneumonia

Nawata

Umezaki

Yamaguchi

et al. 2019

Case Reports in Dentistry

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Professional oral health care (POHC) is known to prevent aspiration pneumonia in patients with dysphagia and/or those at the perioperative stage of surgery. However, the effect of POHC on patients suffering from aspiration pneumonia remains unknown. Here, we report a case where continual POHC intervention improved severe aspiration pneumonia. A 74-year-old male patient with a brain infarction suffered from severe aspiration pneumonia (PSI: IV, A-DROP: 3) complicated by vascular dementia and severe dysphagia. Because an antimicrobial approach following the treatment guidelines for pneumonia was not effective, we started a POHC intervention to improve his poor oral condition at the request of the attending doctor and the patient's family. The severe pneumonia markedly improved after continual POHC by the dental team. This case suggests that continual POHC intervention by a dental hygienist may improve severe aspiration pneumonia.

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Effectiveness of a Mouth Care Program Provided by Nursing Home Staff vs Standard Care on Reducing Pneumonia Incidence

et al. 2020

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IMPORTANCE Pneumonia affects more than 250 000 nursing home (NH) residents annually. A strategy to reduce pneumonia is to provide daily mouth care, especially to residents with dementia. OBJECTIVE To evaluate the effectiveness of Mouth Care Without a Battle, a program that increases staff knowledge and attitudes regarding oral hygiene, changes mouth care, and improves oral hygiene, in reducing the incidence of pneumonia among NH residents. DESIGN, SETTING, AND PARTICIPANTS This pragmatic cluster randomized trial observing 2152 NH residents for up to 2 years was conducted from September 2014 to May 2017. Data collectors were masked to study group. The study included 14 NHs from regions of North Carolina that evidenced proportionately high rehospitalization rates for pneumonia and long-term care residents. Nursing homes were pair matched and randomly assigned to intervention or control groups. INTERVENTION Mouth Care Without a Battle is a standardized program that teaches that mouth care is health care, provides instruction on individualized techniques and products for mouth care, and trains caregivers to provide care to residents who are resistant and in special situations. The control condition was standard mouth care. MAIN OUTCOMES AND MEASURES Pneumonia incidence (primary) and hospitalization and mortality (secondary), obtained from medical records. RESULTS Overall, the study enrolled 2152 residents (mean [SD] age, 79.4 [12.4] years; 1281 [66.2%] women; 1180 [62.2%] white residents). Participants included 1219 residents (56.6%) in 7 intervention NHs and 933 residents (43.4%) in 7 control NHs. During the 2-year study period, the incidence rate of pneumonia per 1000 resident-days was 0.67 and 0.72 in the intervention and control NHs, respectively. Neither the primary (unadjusted) nor secondary (covariate-adjusted) analyses found a significant reduction in pneumonia due to Mouth Care Without a Battle during 2 years (unadjusted incidence rate ratio, 0.90; upper bound of 1-sided 95% CI, 1.24; P = .27; adjusted incidence rate ratio, 0.92; upper bound of 1-sided 95% CI, 1.27; P = .30). In the second year, the rate of pneumonia was nonsignificantly higher in intervention NHs. Adjusted post hoc analyses limited to the first year found a significant reduction in pneumonia incidence in intervention NHs (IRR, 0.69; upper bound of 1-sided 95% CI, 0.94; P = .03). CONCLUSIONS AND RELEVANCE This matched-pairs cluster randomized trial of a mouth care program compared with standard care was not effective in reducing pneumonia incidence at 2 years, although reduction was found during the first year. The lack of significant results in the second year (continued) Key Points Question Can nursing home staff reduce pneumonia by providing mouth care to residents? Findings In this pragmatic cluster randomized trial including 2152 residents from 14 paired nursing homes during 2 years, there was no statistically significant difference in the primary outcome of pneumonia incidence during 2 years. Adjusted post hoc analyses indicated a stat...

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Oral care measures for preventing nursing home-acquired pneumonia

Abstract: Oral care measures for preventing nursing home-acquired pneumonia.

Cited by 55 publications

References 84 publications

Infrequent Denture Cleaning Increased the Risk of Pneumonia among Community-dwelling Older Adults: A Population-based Cross-sectional Study

Infrequent Denture Cleaning Increased the Risk of Pneumonia among Community-dwelling Older Adults: A Population-based Cross-sectional Study

Continuous Professional Oral Health Care Intervention Improves Severe Aspiration Pneumonia

Effectiveness of a Mouth Care Program Provided by Nursing Home Staff vs Standard Care on Reducing Pneumonia Incidence

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