Improved Oral Hygiene in Tube-Fed Patients Reduces Pneumonia, Fever, Antibiotics

Is routine oral care required for patients who are receiving nothing by mouth?

Background: Aspiration pneumonia is a serious problem in populations of patients receiving medical care. Aspiration pneumonia is encountered in intubated patients, patients with neurologic injury, patients with head and neck cancer, and in the frail. Efforts to reduce the incidence of aspiration-related morbidity improved quality of life and reduced incidence of pneumonia.

Study design: This retrospective study was undertaken over the course of two years. The oral care protocol was introduced in the second year. A total of 63 patients with a mean age of 81.7 years were enrolled. No special oral care was afforded in the first year to 32 patients. During the second year, 31 patients received the oral care protocol. The mean period of observation was 130 days.

Setting: Long-term care hospital.

Synopsis: The incidence of pneumonia, the number of days with recorded fever, and the need for antibiotic administration were significantly reduced in the subgroup of patients receiving the oral care protocol. The oral care protocol included daily tooth and tongue brushing using a sponge brush with 0.2% chlorhexidine solution. It also included moisturizing the mouth with glycerol and salivary gland massage.

Bottom line: The volume of bacteria in the oral cavity expands exponentially in patients unable to clean their mouths and consume an oral diet. Routine oral care reduces the potential for aspiration of a highly virulent quantity of oral material.

Citation: Maeda K, Akagi J. Oral care may reduce pneumonia in the tube-fed elderly: a preliminary study. Dysphagia. 2014;29:616-621.