Study Looks at Link Between Oral Health and Pneumonia in Patients on Ventilators
As an ICU surgical nurse practitioner, Gina Luciano has witnessed firsthand the impact of ventilator-associated pneumonia (VAP) on her patients. With the help of funding from the National Institutes of Health, the doctoral student at Case Western Reserve University's Frances Payne Bolton School of Nursing is investigating whether there is a link between poor oral health and the development of VAP.
While in the intensive-care unit, a patient's oral health can deteriorate due to a dry mouth from ventilator use. But Luciano suspects the pneumonia also results from reservoirs of bacteria in the dental plaque. As the patient breathes in small amounts of the bacteria, bacteria grow around the tubing and eventually are breathed into the lungs, which then progresses into pneumonia. If an evidence-based link is found to oral health, she hopes to develop an early intervention and screening to use prior to surgery to prevent or reduce the number of VAP cases in the ICU. Some 250,000 to 300,000 cases occur each year in the United States.
According to Luciano, for each day a patient is on a ventilator, the chance of developing VAP increases by 1 to 5 percent. Once VAP develops, it can prolong the hospital stay by six days in the ICU or as many as 12 days overall in the hospital-that is if the patient survives. The death rates range from 24 to 87 percent. The infection increases a patient's hospital bill by an average of $40,000.
As people age, Luciano said, their immune systems have a tougher time fighting off infections, which puts them at additional risks for VAP. Improvements in oral health care have helped more senior citizens arrive at old age with intact teeth. However, past epidemiological studies have shown that about 41 percent of older Americans have some dental problems.
The study will follow 126 patients, who are 59 or older. Each patient will receive a pre-surgical oral exam to assess the health of the teeth and gums. Then Luciano will continue to track them after surgery to see if they develop VAP after being on assisted breathing for three days or more in the ICU.
Luciano will also look at gender, race and health problems to see if these other factors have an impact on the development of VAP. She will also assess whether the patients had used antibiotics prior to surgery or are smokers.
Luciano will work with Aaron Weinberg, professor and chair of the department of biological sciences at the Case Western Reserve University School of Dental Medicine, and receive training in identifying and measuring dental plaque, a substance that develops on the teeth and promotes the growth of bacteria. Brushing and flossing remove this plaque.