Study: Dental care in ICU reduces pneumonia risk

Wednesday, December 3, 2008 | 3:31 p.m. CST

ST. LOUIS — A simple and inexpensive way to reduce the risk of potentially deadly pneumonia in intensive care patients is to keep their teeth clean, researchers at Barnes-Jewish Hospital in St. Louis said Wednesday.

A yearlong study at the hospital was led by nurse specialists in the intensive care unit in conjunction with Washington University physicians. It is scheduled to be published in an upcoming issue of the Journal of Intensive Care Medicine.

The study involved ICU patients on breathing machines. It found that a strict regimen of brushing the patients' teeth twice a day reduced the risk of ventilator-associated pneumonia, or VAP, by 46 percent.

The hospital said VAP is the most common hospital-acquired infection in critically ill patients and is a leading cause of complications and death. Development of the ailment can often add weeks — and up to $40,000 in patient costs — to a hospital stay. Nationally, about 300,000 patients each year develop VAP.

"The longer a patient is on a ventilator, the more potential there is for other complications to occur," said Lynn Schallom, a nurse specialist and co-author of the study with another registered nurse, Carrie Sona.

Sona said a review showed a wide disparity in nursing practices across the country in handling oral care for ventilator patients. So in 2004, nurses in the 24-bed unit brushed the teeth of patients twice a day and applied mouthwash to the inside of the mouth. The regimen went on until the patient was off the ventilator and breathing on his or her own.

The study found that the incidence of VAP dropped from 5.2 percent (24 cases) in 2003 to 2.4 percent (10 cases) in 2004. In the years since, nurses at Barnes-Jewish have continued the regimen, and the VAP rate has remained at 2.4 percent or lower.

Nurses used regular hospital toothbrushes that cost about 7 cents each. In fact, the total cost of the tooth-brushing regimen through the entire study was $2,187. Because the typical cost for treating a VAP infection ranges from $10,000 to $40,000 per patient, investigators said the treatment saved patients from $140,000 to $560,000 in combined hospital costs in 2004.

State University of New York at Buffalo oral biology professor Frank Scannapieco has also performed research showing a link between poor oral hygiene and an increased risk of bacterial pneumonia. He said the St. Louis study is consistent with his and other findings.

"There's bacteria that cause pneumonia, and it seems the teeth may be an important reservoir for those bacteria to establish in the mouth," Scannapieco said. "The idea is if you minimize the numbers of bacteria in the teeth, you might reduce the risk of lung infection."

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