Daily Mouth Care to Prevent Pneumonia in Nursing Homes: A Systems-Level Approach

项目总结/摘要 每年，全国各地的养老院（NH）居民都会遭受近200万次肺炎发作。 在美国，死亡人数超过任何其他感染。此外，NH居民获得 肺炎的发病率比社区中的老年人高6-10倍，表明 这些个体和/或NH环境使他们处于增加的肺炎风险中。 肺炎是一种炎症性疾病，通常由细菌进入肺部引起，如 通过渴望。在吸入中，来自口腔、喉咙或胃的内容物被细菌定殖， 致病菌被吸入肺部。因此，口腔卫生不良是一个关键的风险因素， 肺炎，因为它增加了口腔和喉咙分泌物的体积和传染性。 考虑到NHS中肺炎的高发病率及其与口腔卫生的关系， 令人惊讶的是，保健中心提供的口腔护理很差。几乎90%的居民需要帮助刷牙， 但只有16%的人定期刷牙。护理不足的原因包括时间，其他优先事项， 现有的程序，口腔健康对整体健康并不重要的看法，以及对抵抗居民的恐惧。 有证据表明，改善口腔护理可以预防肺炎。然而，没有研究表明， 并测试了一个专门为广泛采用和可持续性而设计的程序。我们的研究团队 开发和试点测试这样一个程序，称为“口腔护理没有一个战斗”。它的方法是模仿 在“不战而浴”之后，这已经成为全国NHS的护理标准。口腔护理 没有一场战斗显着增加了工作人员的知识和态度有关的口腔护理;改善牙齿 刷牙和使用牙线;最重要的是，减少牙菌斑和牙龈炎，这些细菌 会导致肺炎此外，护理和结果持续改善。 如果口腔护理没有战斗是有效的减少肺炎，这将构成一个重大进展， 预防因此，本项循证、经检验、配对的整群随机试验的目的是 确定是否以及在多大程度上可以通过培训降低NH居民的肺炎发病率 护理助理和监督护理人员提供务实，系统级，全面的口 护理计划的所有NH居民，包括使用专门的口腔护理助手。在这样做时，研究将 实现以下具体目标：（1）比较七个口腔护理NHS与 肺炎发病率在七个控制NHs两年;（2）检查的实施和可持续性 口腔护理计划;以及，其次，（3）比较住院率和死亡率的差异， 并评估干预措施节省成本的可能性。 我们希望这个项目能产生一个务实的，系统级的，全面的口腔护理计划， 这将减少肺炎发病率并节省相关费用。

Project Summary/Abstract Every year, almost two million episodes of pneumonia are suffered by nursing home (NH) residents across the United States, resulting in more deaths than from any other infection. Further, NH residents acquire pneumonia at a rate 6-10 times higher than older adults in the community, indicating that characteristics of these individuals and/or the NH setting put them at increased pneumonia risk. Pneumonia is an inflammatory condition usually initiated by the introduction of bacteria into the lung, such as through aspiration. In aspiration, contents from the mouth, throat, or stomach that are colonized with pathogenic bacteria are inhaled into the lungs. Poor oral hygiene is therefore a critical risk factor for pneumonia because it increases the volume and infectious nature of secretions from the mouth and throat. Considering the high rate of the pneumonia in NHs and its relationship to oral hygiene, it should come as no surprise that mouth care provided in NHs is poor. Almost 90% of residents require help with tooth brushing, yet only 16% have their teeth brushed regularly. Reasons for insufficient care include time, other priorities, existing procedures, perceptions that oral health is not vital to overall health, and fear of resistant residents. Evidence is emerging that improved oral care can prevent pneumonia. However, no studies have developed and tested a program designed specifically for widespread adoption and sustainability. Our research team has developed and pilot-tested such a program, called "Mouth Care Without a Battle". Its approach is modeled after "Bathing Without a Battle," which has become the standard of care in NHs across the nation. Mouth Care Without a Battle significantly increased staff knowledge and attitudes related to mouth care; improved tooth brushing and flossing; and most importantly, reduced dental plaque and gingivitis that harbor the bacteria that can cause pneumonia. Further, improved care and outcomes persisted. If Mouth Care Without a Battle is effective in reducing pneumonia, it would constitute a major advance in prevention. Therefore, the objective of this evidence-based, tested, matched pairs cluster randomized trial is to determine whether and to what extent pneumonia incidence in NH residents can be reduced by training nursing assistants and supervisory nursing staff to provide a pragmatic, system-level, comprehensive mouth care program to all NH residents, including use of a dedicated oral care aide. In doing so, the study will achieve the following specific aims: (1) compare the incidence of pneumonia in seven mouth care NHs to the incidence of pneumonia in seven control NHs for two years; (2) examine the implementation and sustainability of the mouth care program; and, secondarily, (3) compare differences in hospitalization and mortality rates, and assess the likelihood that the intervention is cost-saving. We expect this project to result in a pragmatic, system-level, comprehensive mouth care program that can be widely adopted and sustained and which will result in fewer episodes of pneumonia and related cost savings.