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periodontal disease and risk for nosocomial bacterial

Preventing HAP

Pneumonia risk can be reduced through basic care measures, including early and frequent mobilization, assessing the patient’s aspiration risk, elevating the head of the bed, and promoting lung expansion. However, except for ICU patients on mechanical ventilators, the link between basic oral care and pneumonia prevention hasn’t been well studied.

Because the 20 billion microbes in our mouths replicate every 4 to 6 hours and patients microaspirate these microbes, reducing oral microbes is crucial to HAP prevention. In one study, researchers found that oral care went undocumented in the 24 hours before NV-HAP diagnosis 73% of the time. This means missed nursing care may have contributed to NV-HAP caused by increased microbial load and oral flora changes. In our hospital, some nurses stated they avoided oral care for patients with known aspiration risk for fear they’d aspirate.

Nurses have been surveyed to analyze their understanding of the importance of oral care and knowledge of standards for oral care practices. The surveys found that although nurses understand that oral care increases patients’ comfort, they may not appreciate the pneumonia risk linked to missed oral care, especially in nonintubated patients. Thus, nurses should receive enhanced education on the importance of oral care, the need for increased access to effective oral-care supplies, and clear protocols that specify the required frequency of oral care and its documentation. (See Preventing hospital-acquired pneumonia.)