infection prevention
infection prevention
By Barbara J . Quinn , DNP , RN , ACNS-BC , FCNS
Oral Hygiene in Hospitals Can Reduce Grim Statistics
Oral health is often equated with preventing cavities , but it encompasses much more than that . Maintaining good oral hygiene is vital for overall health , particularly in hospitals where patients are vulnerable to various complications and infections . The role of infection preventionists ( IPs ) in promoting comprehensive oral care cannot be overstated .
Good oral health is crucial for overall wellbeing . Without daily oral hygiene , bacteria from the mouth can lead to severe conditions such as endocarditis , cardiovascular disease , diabetes , and respiratory infections . 1 Good oral hygiene enhances quality of life and promotes nutrition , speech , and self-esteem . 2
Oral Health in the Hospital
Hospitalized patients face unique challenges that can compromise their oral health and lead to hospital-acquired infection , making oral hygiene during hospitalization even more critical . Limited mobility , medication effects , and medical devices such as ventilators can hurt the oral microbiome . Antibiotics may indiscriminately kill healthy oral microbes , allowing an overgrowth of secondary pathogens , and invasive procedures can bypass normal defenses . 3 Proper oral hygiene in these settings is critical to prevent further health complications , particularly healthcare-acquired pneumonia .
Maintaining good oral hygiene in the hospital can prevent pneumonia . Pathogens responsible for pneumonia originate in the mouth , so a lack of oral hygiene can lead to the development of harmful bacteria , causing inflammation and infection . 4-5
Pneumonia and Sepsis
Healthcare-acquired pneumonia ( HAP ) is the most common healthcare-acquired infection ( HAI ) in the U . S . It affects more patients than surgical site , central line , or urinary catheter infections . 6 Ventilator-associated pneumonia ( VAP ) makes up 35 percent of hospital-acquired pneumonia ( HAP ), while non-ventilator healthcare-acquired pneumonia ( NV-HAP ) accounts for 65 percent . 6 Although HAP is not a widely reported metric , it costs patients and healthcare organizations dearly .
HAP impacts several key quality metrics , such as mortality , length of stay , cost , intensive care unit ( ICU ) utilization ,
readmission rates , and post-discharge level of care . Mortality for HAP is one of the highest of HAIs , with VAP estimated at 30 percent to 50 percent , depending on the severity of the illness . 7 In a study conducted across 284 U . S . hospitals , mortality due to NV-HAP was 22.4 percent and made up 7.3 percent of all hospital deaths . 8 In another study looking at Medicare patients , length of stay in the hospital , one of the largest cost drivers , was also impacted by HAP , with NV-HAP leading to an extended stay of 13 days and $ 40,000 and VAP leading to 28 days and as high as $ 110,000 . 9 Additionally , HAP cases put a strain on resources , with 46 percent of NV-HAP requiring ICU-level care . 10 Patients who survive VAP or NV-HAP are likely to be readmitted to the hospital within 30 days and discharged to another healthcare facility instead of their home setting , 11-12 which is a burden to families .
Pneumonia can lead to other serious health problems , such as sepsis . Pneumonia is responsible for about half of all sepsis cases . It is the leading cause of death for hospitalized patients in the U . S . Additionally , it results in more than $ 14 billion in hospital spending annually . 13 Although the primary focus in reducing the impact of sepsis is on early recognition and treatment , it is important to note that preventing the most common source of infection , pneumonia , can also lead to significant benefits in saving lives and reducing healthcare costs .
Oral Hygiene as a Therapeutic Intervention
Daily oral hygiene for hospitalized patients addresses the chain of infection and is recommended by infection prevention experts . Research and professional position statements support oral hygiene as an intervention , an essential practice by the Society of Healthcare Epidemiology of America ( SHEA ), the Infectious Diseases Society of America ( IDSA ), and the Association for Professionals in Infection Control and Epidemiology ( APIC ) to prevent VAP , ventilator-associated events ( VAE ), and NV-HAP and is the only intervention to address source control . 14 Maintaining good oral hygiene in the hospital is not just nice ; it is necessary to prevent disease .
VAP bundles have been in place for over a decade , and recently NV-HAP has seen increased interest as the cause of two-thirds of HAP cases . 6 In 2019 ,
APIC published the first Practice Position Statement on NV-HAP , highlighting the incidence , poor outcomes , and preventability with basic care standards , including oral hygiene . 15 Subsequently , multiple publications were released regarding NV-HAP and the imperative of prevention programs ( See NV-HAP Resources ).
Studies show that implementing oral hygiene programs for hospital patients can prevent pneumonia and result in significant cost savings . For example , one hospital ’ s 12-month study successfully increased oral care frequency and reduced pneumonia cases by 37 percent , saving lives and cutting costs . 16 Another study over two years estimated 31 lives saved and $ 6.2 million in cost-avoidance due to incorporating oral care into pre-surgical routines . 10
Role of the Infection Preventionist
Infection preventionists play a crucial role in healthcare settings by focusing on preventing and controlling infections . Although IPs are not responsible for providing direct care , they are important care-team partners in practice and quality . 17 Just as IPs educate , develop policy , monitor , and report feedback on practices to prevent central line-associated infections or catheter-associated urinary infections , they can make a significant impact in promoting and ensuring compliance with oral hygiene practices and preventing pneumonia .
In conclusion , maintaining oral hygiene in hospitals is essential to preventing HAP , the No . 1 HAI in U . S . hospitals . This can also help reduce the occurrence of sepsis , a potentially fatal complication . Infection preventionists should include oral hygiene in their protocols and policies .
Barbara J . Quinn , DNP , RN , ACNS-BC , FCNS , is a board-certified adult clinical nursing specialist and has been a fellow of the National Association for Clinical Nurse Specialists since 2020 . Quinn has 30 years of experience as a registered nurse , and 16 years of experience as a clinical nurse specialist using evidence-based practice and the science of process improvement to impact patient outcomes . Quinn recently retired from her role as director of professional practice and nursing Excellence for Sutter Health System for 24 hospitals . She continues to research , educate , and consult , emphasizing nurse-sensitive outcomes such as the prevention on non-ventilator hospital-acquired pneumonia .
10 • www . healthcarehygienemagazine . com • july 2024