Abstract 2666: Oral Care Protocol Reduces Risk of Aspiration Pneumonia in Acute Stroke Patients
Background: Swallowing is a complex process. Dysphagia, or impaired swallowing, may result in aspiration and can significantly contribute to morbidity and mortality. Approximately 25-70% of patients with stroke have dysphagia. Dysphagia and dependency for feeding/oral care are important risk factors in the development of aspiration pneumonia, which can delay patient functional recovery. Hospital acquired pneumonia (HAP) prevention studies have focused on critical care environments with intubated patients. Far fewer studies have investigated non-intubated patients, however the same physiologic principles apply.
Purpose: The purpose of this program is to present an evidence-based practice initiative implemented utilizing ventilator-associated pneumonia (VAP) oral care techniques in the non-intubated, at risk stroke population.
Methods: A multidisciplinary educational approach was utilized to implement a comprehensive oral care program recommended by the Centers for Disease Control and Prevention (CDC). Care practices include all patients, regardless of mental status, have their teeth brushed at least twice daily. Additionally, patients at risk who are eating, have their teeth brushed prior to meals and then mouth cleansed and moisturized after meals. Patients with altered mental status who are NPO receive oral care every 2-4 hours using swabs/cleanser and moisturizer.
Results: Aspiration pneumonia rate of stroke patients on the neuro/stroke unit was tracked. Pre-implementation aspiration pneumonia rates were 4% (128 patients). Post implementation aspiration pneumonia rates were reduced to 1.4% (268 patients).
Conclusion: Prevention of hospital acquired pneumonia is essential and has been shown to improve outcomes. A team approach is vital in providing oral care and preventing potential aspiration pneumonia. A nursing-led research study will be undertaken to further explore this topic.
- © 2012 by American Heart Association, Inc.