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Bronchopneumonia and oral health

NV-HAP pathogenesis and prevention
During a hospital stay, significant changes occur in a patient’s microbial flora and ability to maintain basic hygiene functions, such as daily oral care. Three key factors predisposed Mrs. Grossman to HAP—changes in oral microbes, micro­aspiration (subclinical aspiration of small droplets), and a weakened host.

Studies show that within 48 hours of admission, critically ill patients experience changes in oral bacterial colonization, including more virulent gram-negative organisms. Moreover, even healthy adults microaspirate while sleeping, from such causes as supine positioning and drugs that suppress the central nervous system. Microaspirations typically don’t lead to disease. But in hospital patients, microaspirations combined with decreased mobility and changes in the oral flora create an ideal environment for microbes to flourish in the pulmonary tract.

Also, hospitalization itself can weaken a patient’s natural defenses and typically disrupts daily care patterns. Patients may lack the energy or desire to perform basic care, such as effective oral hygiene, unless caregivers encourage it and teach them about its importance. This happened with Mrs. Grossman; she was exhausted after surgery and no oral care was recorded.