Oral Care

SNF Patients Dependent on Staff for Oral Care Have Lower Oral Hygiene Scores

Angie Szumlinski Health, Studies

The Hospital Readmissions Reduction Program targets pneumonia as a critical disease because it has the highest mortality and morbidity rates of all hospital-acquired infections and a major threat to patients in long term care facilities. Many of the risk factors for pneumonia involve oral hygiene and oral care, including pathogens in the oral cavity and trouble swallowing properly. Aspiration pneumonia, which is caused by aspirating material into the lungs, has risk factors that include dependent feeding, smoking, multiple comorbidities, and using a high number of medications concurrently.           

Aspiration pneumonia can be caused by aspirating solid or liquid foodstuffs during feeding, but another significant risk is the aspiration of oropharyngeal secretions during sleep, which occurs in about half of the healthy population. The risk of nocturnal oropharyngeal secretion aspiration causing pneumonia is greatly increased when the inhaled material contains an elevated level of bacteria or if the body’s natural defense mechanisms are preternaturally weakened, such as the reduced cough reflex in many elder residents. Thus, the use of oral care to significantly reduce bacteria in the oral cavity is paramount when it comes to preventing cases of pneumonia in SNFs.

Unfortunately, the research found in the study suggests that dependent patients are not receiving the level of care that they should, as evidenced by their below par oral health care scores. This puts many residents at risk, especially considering some forms of pneumonia are contagious. Additionally, dysphagic patients are perhaps critically underinformed on their chances of developing aspiration, and how much proper oral hygiene could lower their risk, as they too have below average oral hygiene scores. Dysphagic residents should be employing aggressive oral care programs and hopefully be reporting oral health scores at levels equal to or higher to the standard population to offset their increased risk of aspirating bacteria-laden material.

The original study can be found here.