Something most of us take for granted could become a national standard for when we need to be hospitalized.
A nursing researcher at a veterans’ hospital in Virginia helped start a national study – that could one day become hospital policy. It suggests using a toothbrush could become an easy way to reduce the risk of serious illness.
After months of radiation treatment for prostate cancer, John Hopkins says he feels okay given all he’s been through.
“(I've had) Hepatitis C, I had an ulcer, I’ve got prostate cancer, and a little bit of emphysema,” said the 75-year old Army veteran, who did two tours in Vietnam, and later overcame PTSD and drug addiction.
He admits oral care was never high on the priority list.
“I’m missing so many teeth – I’ve got two at the top, and five down at the bottom.”
But now, his daily regimen at the VA Medical Center in Salem, Virginia also includes regularly brushing his teeth. Hopkins and others at the VA may not realize they’re compiling statistics that could save the lives of others by preventing the most common hospital-acquired infection.
Shannon Munro is a nurse researcher there.
“Health care systems across the nation have focused on ventilator-associated pneumonia for many years – and they know that oral care works,” she said. “But they have been leaving out this entire other population of patients.”
This study targets those not on a ventilator who contract the illness. Nurses working under Munro started having their patients brush twice daily for just over a year – and the rate of those cases fell 92-percent, saving lives as well as more than $2-million in required treatment.
“Just simply brushing patients’ teeth – reduces the number of bacteria in their mouths, so they are not swallowing this into their lungs while they sleep,” Munro said.
Her work started six years ago, when nursing professor and researcher Dian Baker shared her study in northern California’s 24-hospital Sutter Hospital system.
She says the records revealed patients, both young and old, were contracting pneumonia within a couple days of being admitted.
“Because we went back to the fundamentals of how you prevent pneumonia, and pneumonia comes from germs in the mouth,” said Baker, who says having a patient use a toothbrush is just the start.
The work of Munro and Baker, whose work was recently profiled in the Wall Street Journal, want to include other logical steps, like early mobility of a patient, and keeping them warm during surgery.
But with no alerts from groups like the Centers for Disease Control, Baker says there’s nothing requiring hospitals elsewhere to pay attention.
“Trying to raise awareness so that hospitals will launch their own investigations so that the CDC and the National Institutes of Health will issue grant funding to hospitals, so that we can get some of those clinical control trials that will help us all learn more about pneumonia prevention," she said.
"The systematic review says we need more data,” said physician David Baker, with the Chicago-area based Joint Commission, which helps dictate hospital policy.
No relation to Dian Baker, he heads the Commission’s Health Care Quality Evaluation Division. He says no one’s opposed to such a study, but says the sample size now is just too small.
“And I think for us, for the Joint Commission to really be able to do anything, and say we’re going to establish national requirements – we just need some more hospitals to be able to reproduce their findings,” he said. “And I know that there are multiple ones that are working on this now.”
The Veterans Health Administration has started a campaign of online public service announcements – with hopes of boosting this sample size.
Speaking from personal experience, the Salem VA’s Shannon Munro says she understands changing hospital policy won’t be easy. She herself had surgery a few months back – and asked beforehand if she could brush her teeth.
“The nurse said ‘yes- go ahead,” she said. “And I said ‘well, I’m kind of tethered to the bed here, I’ve got an IV, and oxygen, and I can’t get out of bed’ - could you hand me the materials?,” she said. “I had to talk them through what exactly I needed them do to help me, I was just blown away. So I’ve been on both sides of it, and I can see how easily this could be missed.”
Munro’s research has led to new practices at other VA hospitals in Virginia, North Carolina, and Houston.
And in about a month, Baker, study co-author Barbara Quinn, and Munro will give a webinar on oral care for about 1,500 hospitals for the American Hospital Association. Their work has also been shared with hospitals in Canada, Australia, Brazil, Spain, and New Zealand.
