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Oral Care Clinical Trial to Reduce Non–Intensive Care Unit, Hospital-Acquired Pneumonia

Lessons for Future Research

McNally, Edel; Krisciunas, Gintas P.; Langmore, Susan E.; Crimlisk, Janet T.; Pisegna, Jessica M.; Massaro, Joseph

The Journal for Healthcare Quality (JHQ): January/February 2019 - Volume 41 - Issue 1 - p 1–9
doi: 10.1097/JHQ.0000000000000131
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ABSTRACT Hospital-acquired pneumonia (HAP) contributes greatly to patient mortality and healthcare costs. Studies have shown that aggressive oral care in intensive care units (ICUs) can significantly reduce pneumonia rates, and hospitals have implemented stringent protocols in this setting. However, little is known about the effectiveness of aggressive oral care in reducing HAP in non–intensive care wards, prompting us to conduct a nonrandomized controlled clinical trial. A structured toothbrushing program was provided to an experimental cohort of patients. A control group received usual care. Patient demographics, toothbrushing frequency, and pneumonia diagnosis were recorded over a 3.5-month period. Difference in pneumonia rates was computed using unadjusted and multivariate logistic regression analyses. No significant difference in pneumonia rates between control and experimental groups was found (1.7% versus 1.8%). Toothbrushing rates increased significantly in the experimental group (p = .002) but fell short of protocol frequency. It became apparent that aggressive toothbrushing program implementation requires nursing-led interdisciplinary involvement, more intensive training, a streamlined documentation system, and efficient compliance tracking. Lessons from this study should be used for future large-scale research. A secondary analysis of these data did, however, suggests that increasing toothbrushing rates may have the potential to reduce pneumonia in the non-ICU acute care setting.

For more information on this article, contact Edel McNally at edel.mcnally@bmc.org.

Supported in part by an unrestricted grant and in-kind donation of oral care products from Sage Products, Inc.

The authors declare no conflicts of interest.

This study was approved by our hospital's Institutional Review Board (IRB number H-3173).

© 2019 National Association for Healthcare Quality
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