Four years ago, when Karen Giuliano was admitted to a Boston hospital for hip replacement surgery, she received a pink box of cosmetics: tissue, soap, deodorant, toothpaste and hands down, the worst toothbrush I have ever seen. His life.
“I can’t believe it. I had a toothbrush that didn’t have bristles,” he said. “It was just a toothpick.”
For most patients, a useless hospital toothbrush will be a secondary problem. But for Giuliano, a professor of nursing at the University of Massachusetts-Amherst, it was a reminder of a “neglected problem” in a U.S. hospital: the dire consequences of not brushing your teeth.
Among patients who have not been placed on a ventilator, failure to brush their teeth, themselves or their nurses, is thought to be the leading cause of thousands of pneumonia each year. Pneumonia is one of the most common infections that occurs in healthcare settings, mostly non-ventilator hospital-acquired pneumonia (NVHAP), a condition that kills up to 30% of sufferers, Giuliano said. And other experts.
But unlike many infections that occur inside the hospital, the federal government is not required to report to the hospital’s NVHAP. As a result, very few hospitals understand the origin of the disease, track its onset, or work actively to prevent it, experts say.
According to a growing body of peer-reviewed research articles, many cases of NVHAP can be prevented if hospital staff brush the teeth of bedridden patients well. Instead, many hospitals typically avoid brushing their teeth to prioritize other tasks and often provide cheap, ineffective toothbrushes without realizing the results, says Diane Baker, a Sacramento state nursing professor who has spent more than a decade studying NVHAP.
“I’ll tell you, most of the thousands of nurses in hospitals today have no idea that pneumonia comes from oral germs,” Baker said.
Pneumonia occurs when a bacterium infects the lungs. Although NVHAP is responsible for most healthcare-related cases, it has historically not received the same attention as ventilator-related pneumonia, which is easier to detect and study because it occurs in a smaller subset of patients.
A risk for virtually all hospital patients, NVHAP is often caused by oral bacteria that accumulate in the unfolded tooth foamy biofilm and are excreted in the lungs.
Patients are at higher risk if they lie down or are immobile for long periods of time, so NVHAP can be prevented by raising their heads and getting them out of bed more frequently.
According to the National Organization for NV-HAP Prevention, founded in 2020, this pneumonia infects 1 in 100 hospitalized patients and 15% to 30% of them die. For survivors, the illness often extends their hospital stay to 15 days, making it much more likely that they will need to be re-admitted within a month of discharge, or transferred to an intensive care unit.
Milinochet, Maine’s John McClary, 83, was involved in a possible NVHAP case in 2008 when he fell and broke an ankle and spent 12 days in hospital, his daughter, Kathy Day, a retired nurse and patient safety action network advocate said.
McCleary has recovered from the fracture, but not from pneumonia. Two days after returning home, an infection in her lungs prompted her to be rushed to hospital, where she contracted sepsis and spent several weeks in treatment before moving to an isolated unit in a nursing home.
A few weeks later he died, mad, very deaf, unable to eat and “too weak to drink water with straw,” his daughter said. He no longer walked after suffering from pneumonia.
“It was an amazing attack on her body, she met me here a week before her fall, until just a few months after her death,” Day said. “And it was all avoidable.”
Although experts have described NVHAP as a widely ignored threat, this seems to be changing.
Last year, a team of researchers, including Giuliano and Baker, as well as officials from the Center for Disease Control and Prevention (CDC), the Veterans Health Administration and the Joint Commission, published an investigative article as a “call to action.” Hoping to launch a “National Healthcare Dialogue on NVHAP Prevention”.
The Joint Commission, a non-profit organization whose recognition can build or dismantle hospitals, is considering expanding infection control standards to include more illnesses, such as NVHAP, said Sylvia Garcia-Houchins, chief prevention officer and infection control officer.
Separately this year, ECRI, a non-profit organization focused on healthcare protection, identified NVHAP as one of the top concerns for patient safety.
James Davis, an infection specialist at ECRI, said the spread of NVHAP, although already worrying, was probably “underestimated” and worsened as hospitals were admitted by patients during the coronavirus epidemic.
“We only know what is being reported,” Davis said. “Could this be the tip of the iceberg? In my opinion, I would say, probably.”
To better measure the situation, some researchers are calling for a standardized surveillance definition of NVHAP, which could eventually open the door for the federal government to make case reporting mandatory or to encourage prevention. With the growing urgency, researchers are pressuring hospitals not to wait for the federal government to act against NVHAP.
Baker says he has talked to hundreds of hospitals about how to prevent NVHAP, but there are thousands who have yet to get on board.
“We’re not asking for a দলের 300,000 large team,” Baker said. “The two things that show the best evidence to prevent this damage are the things that should be taken care of anyway: brushing teeth and removing patients.”
This evidence comes from multiple studies that show that these two strategies can significantly reduce the rate of infection.
In California, a study by Kaiser Permanente of 21 hospitals was used to prioritize oral care and reduce the rate of hospital-acquired pneumonia by removing patients from bed by about 70%. At Sutter Medical Center in Sacramento, improved dental care reduced NVHAP cases by an average of 35% annually.
At the Orlando Regional Medical Center in Florida, a medical unit and a surgical unit where patients receive enhanced oral care, NVHAP rates are reduced by 85% and 56%, respectively, compared to similar units receiving normal care. Similar research is underway at two Illinois hospitals.
And the most impressive results come from a veteran hospital in Salem, Virginia, where a 2016 oral care pilot program reduced the NVHAP rate by 92%, saving an estimated 13 lives in just 19 months. The program, the Happen Initiative, has been expanded to the Veterans Health Administration and experts say it could serve as a model for hospitals across the country.
Michelle Lucarto, a nursing officer who runs Happen, said the program trains nurses more effectively to brush patients’ teeth and educates patients and their families about the link between oral care and tooth decay prevention. NVHAP While it may seem like you don’t need any training to brush your teeth, Lucatorto compares it to how the coronavirus revealed that many Americans are doing a moderate job of doing another regular hygiene practice: washing their hands.
“Sometimes we look for the most complex interventions,” he said. “We are always looking for that new bypass surgery or some new technological equipment. And sometimes I think we fail to see the simple things we can do in our practice to save lives. “
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