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Kelly M. Pyrek

Kelly M. Pyrek has served as editor in chief of Infection Control Today magazine for the past seven years, and manages a number of ICT-affiliated print and online offerings, including the Infection Control Education Institute, the ICT Conference on Professional Development, the ICT Series of Webinars, and GermStop. Recognized by the Society of Professional Journalists as an award-winning practitioner, she has served as an editorial manager, editor, and writer for newspapers, magazines, wire services, and public information bureaus for 25 years. She is a graduate of the Universityof Southern California.

Giving VAP the Brush-Off

December 11, 2008 Comments
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A new study confirms what infection prevention and control professionals have known for some time – that toothbrushing can prevent hospital-acquired pneumonia in the form of ventilator-associated pneumonia (VAP), a lung infection that develops in about 15 percent of all people who are ventilated. With weakened immune systems and a higher resistance to antibiotics, patients who rely on a mechanical ventilator can easily develop serious infections — as 26,000 Americans do every year.

Thanks to a proven new clinical approach developed by Tel Aviv University nurses, though, there is a new tool for stopping the onset of VAP in hospitals. This new high-tech tool? An ordinary toothbrush.

“Pneumonia is a big problem in hospitals everywhere, even in the developed world,” says Ofra Raanan, the chief researcher in the new study and a lecturer at Tel Aviv University’s Department of Nursing. “Patients who are intubated can be contaminated with pneumonia only two or three days after the tube is put in place. But pneumonia can be effectively prevented if the right measures are taken.”

Raanan, who works at the Sheba Academic School of Nursing at The Chaim Sheba Medical Center, collaborated with a team of nurses at major medical centers around Israel. The nurses found that if patients — even unconscious ones — have their teeth brushed three times a day, the onset of pneumonia can be reduced by as much as 50 percent.

It’s difficult to quantify the effects precisely, the researchers say.  “While the research shows a definite improvement in reducing the incidence of hospital-borne pneumonia, it’s hard to say by exactly how much toothbrushing prevents VAP,” says Raanan, but the published evidence shows a direct correlation for intubated patients. “Sometimes, however, doctors and nurses do everything right and the patient still gets pneumonia.  But this approach will certainly improve the odds for survival.”

Normally, the teeth and oral cavity in a healthy mouth maintain a colony of otherwise harmless bacteria. Infection takes root when a breathing tube allows free passage of the “good” bacteria into the lower parts of the lung. The bacteria travel in small water droplets through the tube and colonize the lung. Once there, the bacteria take advantage of a patient’s weakened immune system and multiply. A regular toothbrushing kills the growth and subsequent spread of the bacterium that leads to VAP.

Toothbrushing, say TelAvivUniversity nurses, should be added to the routine. Although nurses in some U.S. hospitals already practice toothbrushing and oral care on ventilated patients, these new results may convince hospitals around the world to invest more resources in this common-sense, routine practice.

 

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