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

描述（由申请人提供）：每年，美国养老院（NH）的居民中有近200万例肺炎发作，导致的死亡人数超过任何其他感染。此外，NH居民患肺炎的比率比社区老年人高6-10倍，这表明这些人的特征和/或NH环境使他们患肺炎的风险增加。肺炎是一种炎症性疾病，通常是由细菌进入肺部引起的，比如通过吸入。在吸入法中，从口腔、喉咙或胃中被致病菌定植的内容物被吸入肺部。因此，不良的口腔卫生是一个严重的风险

DESCRIPTION (provided by applicant): 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. Evidece 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.