Brushing your teeth in hospital could prevent catching a bad infection

Brushing your teeth during hospital treatment can significantly reduce your chances of getting pneumonia.

Many hospitalized patients do not brush their teeth during their stay, probably for a variety of reasons. Some may have forgotten to bring a toothbrush, while others don’t think to do it, feel unmotivated or physically unable to do so. Medical staff often do not include routine oral hygiene care in their services to patients.

But in the largest randomized controlled trial of its kind, patients provided with a toothbrush, toothpaste and dental care advice in hospitals were 60% less likely to develop a common form of hospital-acquired pneumonia, says Brett Mitchell of Avondale University in Australia.

“It really reinforces the need to communicate with patients about the risk of pneumonia and the importance of oral care and tooth brushing during their hospital stay,” he says.

It is widely accepted that patients on ventilators often develop pneumonia, in part due to the interference of medical equipment with the natural respiratory system. But many unventilated hospitalized patients also get pneumonia at least 48 hours after being admitted to the hospital. Researchers are still trying to understand why this happens and how to prevent it — especially since hospital-acquired pneumonia is linked to longer hospital stays, higher costs and increased mortality.

“This is a big problem,” says Michael Klompas of Harvard University, who was not involved in the study. “Nosocomial pneumonia is one of the most common and deadly hospital-acquired infections, and rigorous data on how best to prevent it is scarce. »

Mitchell suspected the illness might be linked to bacteria in people’s mouths. The oral microbiome can affect respiratory health because people breathe bacteria-laden droplets into their lungs. And the oral microbiome changes when people are hospitalized, Mitchell says. “I thought it was important that we try to do something about this problem.”

So he and his colleagues developed a year-long randomized controlled trial involving 8,870 patients in three Australian hospitals to test the effects of oral care on pneumonia risks. He is presenting results from this part of the team’s Nosocomial Pneumonia Prevention (“HAPPEN”) study today at the European Society for Clinical Microbiology and Infectious Diseases (ESCMID Global) Congress in Munich, Germany.

Each participating hospital divided its study participants into three groups. None of the groups received any intervention during the first three months of the study. After three months, patients in one group were given toothpaste and a toothbrush, labeled “Brushing your teeth helps prevent pneumonia” on one side and “Brushing pneumonia!” » on the other. The brushes have been designed with a special handle for people with reduced dexterity. Patients also received a QR code linking them to educational materials on the HAPPEN website.

After six months, the second group also received the toothbrushes, and the third group received toothbrushes after nine months, meaning that all study participants had the opportunity to brush their teeth during the last three months of the study.

As for nursing staff, the research team organized oral care training for ward nurses and provided them with links to professional advice on their website. They also encouraged nurses to remind patients to brush and floss their teeth and to help those who had difficulty doing so themselves.

Outside of intervention periods, only 15.9 percent of patients brushed their teeth once a day. During the intervention periods, 61.5 percent of patients attended to their oral care at least once a day – with patients doing so an average of 1.5 times a day. Web statistics revealed that patients and nurses frequently accessed information on HAPPEN pages during intervention periods, Mitchell says.

This coincided with a dramatic decline in the number of cases of non-ventilator-associated hospital-acquired pneumonia, Mitchell says. Specifically, the incidence increased from 1 case per 100 days of admission in the control group to 0.41 in the intervention group.

“This study is fascinating,” says Klompas, who points to the study’s large size and randomized design. “The message is that brushing your teeth in hospital is not only good for oral hygiene and feelings of well-being, but it can also literally save lives.”

Pyry Sipilä, from the University of Helsinki, Finland, says he appreciates the importance of such a significant improvement in risk based on such a simple intervention. “Basically, patients were just given toothbrushes, toothpaste and advice,” he explains. However, results may vary depending on the reasons for hospitalization and the patients’ usual oral hygiene habits.