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VA research in action

Oral hygiene to fight pneumonia

May 7, 2019


After VA researchers showed that proper oral hygiene can help prevent pneumonia in hospitals and nursing homes, they created a program to disseminate the practice across VA and other medical settings. (Photo from “Healthy Teeth, Healthy You.”) 

VA researchers developed and implemented a program to increase oral hygiene in community living center and hospital patients. This simple initiative has greatly reduced cases of hospital-acquired pneumonia, saving Veterans’ lives and increasing their quality of life. Germs in the mouth multiply rapidly and often trickle down into the lungs during sleep. These germs can then cause pneumonia. Removing the biofilm from teeth with regular brushing can therefore help prevent pneumonia.

The program, which began in a single VA community living center, is simple. Through training and educational programs, it aims to ensure that nurses brush patients’ teeth twice daily in community living centers. The incidence of hospital-acquired pneumonia not associated with a ventilator decreased by 92% in the initial pilot program. By preventing hospital-acquired pneumonia—and its associated complications like sepsis—among non-ventilated patients, the program has saved a predicted 42 lives and $9.4 million as of July 2019. The electronic medical record now requires nurses to document whether teeth were brushed. It has also become standard practice at the community living center to have each new patient’s teeth and mouth evaluated, and to have problems corrected.

Project HAPPEN (Hospital-Acquired Pneumonia Prevention by Engaging Nurses to provide oral care) began in October 2016 at the Salem VA Medical Center’s community living center. With the program’s success, tooth-brushing has become a priority throughout the medical center, and is now being spread to other hospitals. Many VA medical centers have implemented the program. The team has worked with hospitals in all 50 states, six provinces in Canada, Australia, Brazil, New Zealand, Spain, and the United Kingdom to spread the word.

Watch a video about the program here.

Principal investigator: Shannon Munro, Ph.D., Salem VA Medical Center

Research partners: Sutter Medical Center, Kaiser Health Systems

Selected publications:

Implementation and dissemination of a Department of Veterans Affairs oral care initiative to prevent hospital-acquired pneumonia among nonventilated patients. Munro S, Haile-Mariam A, Greenwell C, Demirci S, Faroogi O, Vasudeva S. Nurs Adm Q. 2018 Oct/Dec;42(4):363-372.

Reducing missed oral care opportunities to prevent non-ventilator associated hospital acquired pneumonia at the Department of Veterans Affairs. Munro S, Baker D. Appl Nurs Res. 2018 Dec;44:48-53.

Salem VA leads national research: Tooth brushing each day keeps pneumonia at bay. Rife L. The Roanoke Times. 2018 Jan. 7.

Healthy teeth, healthy you! Robbins B. Salem VA Medical Center. 2018 Jan. 5.

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