HAP prevention for nonventilated adults in acute care: Can a structured oral care program reduce infection incidence?

ospital-acquired pneumonia (HAP) has become a costly and dangerous healthcare issue. An estimated 200,000 cases of aspiration pneumonia occur every year in the United States, resulting in more than 15,000 deaths.1 HAP causes unnecessary patient suffering, mortality as high as 20% to 30%, and significantly increased length and cost of hospital stay.2,3 As reported by the American Thoracic Society and the Infectious Diseases Society of America, treatment of HAP costs approximately $40,000 per patient.4 Most of this incidence and outcome information is collected from patients with ventilatorassociated pneumonia (VAP). By deduction, information regarding VAP can be applied to patients with HAP.4 Given that HAP is one of the most common hospital-acquired infections, evidence-based prevention could save the healthcare industry several billion dollars annually.5 Relation between HAP and dental health Considerable evidence supports a relation between poor oral health and bacterial pneumonia. In a systematic review of evidence for an association between oral health and pneumonia, experts found that cariogenic and periodontal pathogens, dental decay, and poor oral hygiene are potential risk factors for pneumonia.6 In addition, poor oral hygiene has been linked to significant increases in the numbers of febrile days and cases of pneumonia.7 Specifically, dental plaque is composed of a complex population of more than 700 different bacterial species.8 Poor dental hygiene can result in continual bacterial cell growth and increased bacterial diversity within dental plaque. Without proper dental hygiene, dental plaque may serve as a reservoir for respiratory pathogens in hospitalized patients. Matching organisms have been found in dental plaque and bronchoalveolar lavage fluid from patients with HAP, implicating aspiration of organisms within dental plaque as the etiology of HAP in these patients.9 This is thought to occur via a mechanism in which aspirated respiratory pathogens shed HAP prevention for nonventilated adults in acute care Can a structured oral care program reduce infection incidence?