Pneumonia intensifies as a critical issue in hospital settings, primarily due to its primary role in healthcare-acquired infections (HAI). Notably, pneumonia accounts for almost a quarter of all HAI, as found in a point prevalence study. Within these pneumonia cases, nonventilator hospital-acquired pneumonia (NV-HAP) plays a substantial part, representing 65%, while ventilator-associated pneumonia (VAP) contributes to 35%. These statistics indicate a pressing need to focus on NV-HAP as diligently as VAP in healthcare strategies.
From a historical perspective, the link between oral health and pneumonia was first discovered by Augustus Wadsworth, MD, over a century ago. Over time, prolific research has confirmed this connection, showcasing how the oral microbiome and dental health directly influence the development of pneumonia, for both VAP and NV-HAP. Hospitalization tends to alter the oral microbiome dramatically and enable rapid bacteria colonization in the oropharyngeal area within dental plaque. Once ingested, these bacteria can instigate pneumonia, underlining oral care’s significance in preventing this disease.
VAP has been acknowledged as a complication in critical care due to mechanical ventilation (MV), often leading to extended hospital stays and higher healthcare costs. The incidence of VAP can range from 5% to 40% in patients receiving MV for more than 48 hours, and in-hospital mortality varies widely based on the study and type of outcome.
Improvements in preventing VAP have been noted over the past two decades, largely attributed to the implementation of a VAP bundle — a combination of multiple interventions designed to enhance prevention. The most common VAP bundle practices include oral care, semi-recumbent positioning, sedation and weaning protocols, and prophylaxis for peptic ulcer disease and deep venous thrombosis, among others.
Despite the focus on VAP, the visibility around NV-HAP is significantly lower. However, given its prevalence, it poses a serious threat to healthcare. The best preventative method for NV-HAP continues to be oral care. Implementing preventative bundles for NV-HAP, which includes oral care along with other interventions like bed positioning, dysphagia management, nasal hygiene, and sedation restrictions, has been found to lower NV-HAP rates.
The emphasis on oral health as a straightforward intervention holds substantial importance as it can significantly decrease the bacterial load, thereby reducing the risk of pneumonia. Companies like Stryker Sage contribute to this strategy by developing oral care systems that address HAP risk factors. The focus on clinical outcomes and user-friendly tools fosters oral hygiene across care continuums for both ventilator and non-ventilator spaces.
As healthcare providers, we must champion patient-centered practices like regular oral care to significantly reduce HAI like pneumonia.
Source: https://www.infectioncontroltoday.com/view/back-future-focus-oral-care-preventing-pneumonia