Authors (including presenting author) :
Ng KC(1), Cheng YH(1), Ho WF(1), Sum HK(1), Ngai KH(2)
Affiliation :
(1)Department of Nursing, Cheshire Home, Chung Hom Kok, (2)Department of Psychiatry, Hong Kong East Cluster, Hospital Authority
Keyword 2: :
Suction toothbrush
Keyword 4: :
Dependent patient
Keyword 5: :
Long-term care
Keyword 6: :
Long Term Care
Introduction :
Oral health is crucial for hospitalized patients, as compromised oral hygiene diminishes quality of life and is strongly associated with hospital-acquired pneumonia (HAP) and increased mortality, placing a substantial financial burden on the healthcare system [1–2]. Routine clinical observation identified suboptimal oral health among functionally dependent patients in the Central Infirmary Waiting List (CIWL) wards at Cheshire Home, Chung Hom Kok (CCH). Common findings included plaque, gingivitis, xerostomia, and halitosis. Glycerin swabsticks—the usual oral care practice at CCH—are considered convenient and relatively safe for dependent patients who are unable to spit or are at risk of aspiration, as they do not require rinsing. However, current literature [3] indicates that swabsticks provide inadequate mechanical friction for plaque removal and may exacerbate oral dryness; therefore, they are not a sufficient alternative to toothbrushing. Suction toothbrushes, used in intensive care settings to help prevent ventilator-associated pneumonia (VAP), allow simultaneous brushing and removal of oral debris, bacteria, and secretions when connected to suction equipment. Previous studies [4–5] have demonstrated their effectiveness in improving oral health among dependent patients. This project implemented an oral care protocol using suction toothbrushes and sodium lauryl sulfate (SLS)-free toothpaste, in line with recommendations from the Centers for Disease Control and Prevention (CDC) [6], the American Dental Association (ADA) [7], and NHS England [8].
Objectives :
To improve the oral health status of functionally dependent patients through the implementation of an oral care protocol utilizing suction toothbrushes and SLS-free toothpaste.
Methodology :
A pilot quasi-experimental study was conducted with 14 functionally dependent patients recruited via convenience sampling. An oral care protocol was developed through literature review and expert consultation. The intervention comprised twice-daily brushing with suction toothbrushes and SLS-free toothpaste delivered by trained ward nurses. Oral health status was the primary outcome and was assessed using the Oral Health Assessment Tool (OHAT) at baseline (T0), two-week (T1) and four-week (T2) follow-up.
Result & Outcome :
Changes in OHAT scores were analyzed by Wilcoxon signed-rank test. Following implementation, OHAT scores demonstrated a statistically significant reduction from T0 to T1 (p = 0.014) and from T0 to T2 (p = 0.007), indicating a significant improvement in oral health status and achievement of the project’s objective. Word count: 399 words (including abstract title and name of authors; excluding references) References: [1] Baker D, Quinn B. Hospital acquired pneumonia prevention initiative-2: incidence of nonventilator hospital-acquired pneumonia in the United States. American Journal of Infection Control. 2018;46(1):2-7. [2] Silva Jerônimo L, Guimarães Abreu L, Araújo Cunha F, Esteves Lima RP, Jerônimo LS, Abreu LG, Cunha FA. Association Between Periodontitis and Nosocomial Pneumonia: A Systematic Review and Meta-analysis of Observational Studies. Oral Health & Preventive Dentistry. 2020;18(1):11–17. [3] Berry AM, Davidson PM, Masters J, Rolls K. Systematic literature review of oral hygiene practices for intensive care patients receiving mechanical ventilation. American journal of critical care : an official publication. American Association of Critical-Care Nurses. 2007;16(6):552–563. [4] Ferozali F, Johnson G, Cavagnaro A. Health benefits and reductions in bacteria from enhanced oral care. Special Care in Dentistry. 2007;27(5):168-76. [5] Yakiwchuk C-A, Bertone M, Ghiabi E, Brown S, Liarakos M, Brothwell DJ. Suction toothbrush use for dependent adults with dysphagia: A pilot examiner blind randomized clinical trial. Canadian Journal of Dental Hygiene. 2013;47(1):15–23. [6] Centers for Disease Control and Prevention. Oral Health in Healthcare Settings to Prevent Pneumonia Toolkit [online]. [cited 2024 Mar 27]. Available from: https://www.cdc.gov/healthcare-associated-infections/hcp/prevention-healthcare/oral-health-pneumonia-toolkit.html [7] Quinn B, Giuliano KK, Baker D. Non-ventilator health care-associated pneumonia (NV-HAP): best practices for prevention of NV-HAP. American journal of infection control. 2020;48(5):A23-A27. [8] Health Education England, National Health Service England. Mouth Care Matters: A guide for hospital healthcare professionals [pdf]. 2016 [cited 2016 Nov 11]. Available from: https://www.wyccn.org/uploads/6/5/1/9/65199375/mcm-guide-2016_100pp_oct-16_v121.pdf
