Many care-dependent clients in acute surgical settings are at risk for hospital-acquired pneumonia (HAP). A concern about high HAP rates on the neurosurgical ward at Royal Columbian Hospital (RCH) was identified by the Clinical Nurse Specialist (CNS). A multidisciplinary team was formed, led by the CNS and a Speech Language Pathologist (SLP). A review of the literature led to the hypothesis that enhanced oral care would reduce HAP rates.
The team successfully won seed grant funding, through the Fraser Health (FH) Department of Evaluation and Research Services’ Point of Care Research Challenge (POCR). The comparative quantitative POCRC study in 2012 investigated whether an enhanced oral hygiene protocol could prevent HAP in care-dependent adult inpatients on the neurosurgical ward at RCH. The study compared HAP rates in controls, who had received “prn” oral care, with study subjects, who received oral care in accordance with a formal evidence-based oral hygiene protocol.
The study was very successful with a statistically significant decrease in HAP rate. A statistically significant reduction in pneumonia rate (from 25.5% in controls to 6.3%) occurred with the enhanced oral hygiene protocol in place during the study period at RCH on the neurosurgical ward. Other research evidence supports the practice of enhanced oral hygiene or oral hygiene protocols in pneumonia prevention in other settings (critical care, residential).
Through recognition of the study’s success, a new team was formed to develop clinical tools and documentation standards to spread the protocol across the FH region for all acute, care-dependent, adult inpatients in relevant clinical programs (e.g. Surgery, Medicine, Older Adult, Trauma).
The link between oral hygiene and pneumonia has been well established in the literature of some fields for many years. Promotion of enhanced oral care in preventing pneumonia has been adopted by some professions (e.g. SLP as part of dysphagia management recommendations to reduce aspiration pneumonia risk) and by some clinical programs (e.g. critical care in their efforts to reduce ventilator-associated pneumonia).
This quality-improvement initiative recognizes the importance and efficacy of oral hygiene for non-ventilator-associated-HAP prevention. It provides evidence-based protocols and standardization of clinical decision support tools in this area that have not been previously developed in Surgery and other acute care programs that provide service to care-dependent adult inpatients.