An Israeli study found that brushing a ventilator patient’s teeth three times a day can help prevent pneumonia bacteria travelling down to the lungs.It happens far more than people might realize: ventilator-associated pneumonia, or VAP for short, is a leading hospital-borne infection in American hospitals, causing an unnecessary 26,000 deaths per year. The pneumonia afflicts mainly patients who are ventilated, when bacteria — innocuous in the mouth — travel down to the lungs where they wreck havoc.
A new study conducted by a team of Israeli nurses at medical centers throughout the country has proven what nurses around America, and the world, have known and been practising for some time. That brushing a ventilated patient’s teeth three times a day, can cut down the rate of VAP quite radically. The toothbrush is literally a lifesaver.
The pioneering study, published in an Israeli nursing journal, and about to be published in a leading international journal, was performed by a team of eight nurses at Israeli medical centers, including Hadassah-University Medical Center, The Chaim Sheba Medical Center at Tel Hashomer, and the Rabin Medical Center.
Julie Benbenishty, the study’s leader, is an American-born nurse who works at Hadassah-University Medical Center. She has been brushing patients’ teeth for several years and is convinced that it reduces up to 25 percent of all VAP infections in ventilated patients. Afflicting about 15% of all people who are ventilated, VAP can set in as early as two to three days after intubation.
A brush to lower infection
Nurse Ofra Raanan, the team leader at Sheba says the same, although the exact percentage is debatable, she notes, at least until more hard evidence is brought to the table. “Intubations are the main reason why people are getting pneumonia,” she tells ISRAEL21c.
“It’s also occurring in intubated people who are receiving tube feeding. It’s a problem because they are also aspirating some food. These are the two main reasons why people are getting pneumonia in hospitals,” she says. “If we brush the patients’ teeth we are lowering the percentage,” she adds.
If patients are not intubated it is most likely they would not get VAP on their own, Raanan, who has seen her fair share of sad stories in the hospital, explains. And it’s not just the old and the infirm that fall prey to VAP. Patients who are intubated during operations, even routines ones, are also at risk.
“This happens frequently in the hospitals and it is something we can reduce with the help of a standard kit,” says Raanan, who has been working with a team of volunteer researchers in Israel. Patients whose teeth are cleaned with the kit, which consists of a toothbrush, paste and a special suction component, can up their odds of survival when in the hospital. This is true for patients who are both conscious and unconscious.
Volunteer nurses working alone and together
The idea of examining the effects of teeth brushing on VAP, emerged three years ago. In discussions, the all female group decided to take a closer look at the effects of teeth brushing on ventilated patients. Meeting once a month on Fridays, their day off, the nurses who call themselves the Evidence Based Nursing Practice Group, planned the study. Two chief nurses are on the team and Raanan is one of them.
“We looked for an important subject of research that we nurses can do each alone and together,” explains Raanan.
The next research project the nurses are about to tackle is one that concerns nurses everywhere: the moral distress they experience in intensive care units. “We are already starting to think about how to plan the study,” says Raanan, who communicates with her study partners after a busy day or night shift at work, by phone or email.
While the Israeli nurses may be the first to have shown that teeth brushing can reduce VAP, they are yet to say by how much, and wait for new results to come in. In some cases, a nurse can do everything in his or her power to prevent pneumonia — using suction, teeth brushing and elevating the head and organs — but even then the patient can still get VAP, explains Raanan. Now, with clear-cut evidence that the practice works, however, the Israeli nursing research team expects hospitals everywhere to make a bigger investment in the toothbrush.