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

描述(申请人提供)：每年，全美疗养院(NH)居民患上近200万次肺炎，死亡人数超过其他任何一种感染。此外，NH居民患肺炎的比率比社区中的老年人高6-10倍，这表明这些人的特征和/或NH环境使他们面临更高的肺炎风险。肺炎是一种炎症性疾病，通常由细菌进入肺部引起，例如通过吸入。吸入时，口腔、喉咙或胃中寄生有致病菌的物质被吸入肺部。因此，不良的口腔卫生是一个严重的风险。 肺炎的一个因素，因为它增加了口腔和喉咙分泌物的数量和传染性。考虑到NHS肺炎的高发病率及其与口腔卫生的关系，NHS提供的口腔护理很差也就不足为奇了。近90%的居民在刷牙方面需要帮助，但只有16%的居民定期刷牙。护理不足的原因包括时间、其他优先事项、现有程序、认为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。证据显示，改善口腔护理可以预防肺炎。然而，还没有研究开发和测试专门为广泛采用和可持续发展而设计的计划。我们的研究团队已经开发并中试了这样一个项目，名为“口腔护理无需战斗”。它的方法是模仿“洗澡不打仗”，这已经成为全国NHS的标准护理。无战口腔护理显著增加了工作人员关于口腔护理的知识和态度；改进了刷牙和使用牙线；最重要的是，减少了携带可导致肺炎的细菌的牙菌斑和牙周炎。此外，改善的护理和结果持续存在。如果没有战斗的口腔护理在减少肺炎方面是有效的，它将构成预防方面的重大进步。因此，这项循证、测试、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护理助理和监督护理人员来降低NH住院患者的肺炎发病率，以便为所有NH住院患者提供务实的、系统水平的、全面的口腔护理计划，包括使用专门的口腔护理助理。通过这样做，研究将达到以下具体目标：(1)比较 (2)检查口腔护理计划的实施情况和可持续性；(3)比较住院和死亡率方面的差异，并评估干预措施节约成本的可能性。我们期望这一项目将产生一个务实的、系统级的、全面的口腔护理计划，该计划可以被广泛采用和持续，并将导致较少的肺炎发作和相关的成本节约。

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.