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DQA’s drive to reduce incidence of hospital-acquired pneumonia picks up steam

October 30, 2019

By David Burger

Scottsdale, Ariz. — The Dental Quality Alliance has a long-standing history of championing promising initiatives that are designed to raise awareness around quality improvement in oral health.

An example of this is the relationship they have established with researchers and medical professionals to support efforts to reduce the incidence of nonventilator associated hospital-acquired pneumonia in hospital inpatient units and long-term care facilities.

There has been a groundswell of awareness of how oral health care — and how the simple act of brushing at least two times per day throughout the hospital stay — can help reduce the incidence of hospital-acquired pneumonia, said Dian Baker, Ph.D., a professor and researcher at California State University, Sacramento, who is considered one of the nation’s foremost experts on hospital-acquired pneumonia and how to help prevent it.

“The DQA is pleased that this improvement initiative is yielding favorable results, and we are glad that the ADA is raising awareness around the importance of oral health being used as a strategy to help reduce the incidence of nonventilator hospital-acquired pneumonia,” said Dr. Allen Moffitt, chair of the DQA. “We are also glad to see that efforts to implement this proven strategy are spreading across states such as Arizona, California and Michigan. We believe this is an important issue to address, and collaborating with stakeholders such as Dr. Dian Baker, and her team, further underscores the importance of integrating oral health into the medical delivery system.”

Arizona’s push

While attending the DQA conference in May, Kevin Earle, Arizona Dental Association executive director, became aware of Dr. Baker’s project and developed an interest in addressing this issue within the state.

To date, the AZDA has taken early steps to embark on implementing a similar initiative in collaboration with the Arizona Hospital and Healthcare Association.
In support of this effort, the AZDA has scheduled a webinar during which Dr. Baker and Katharine Martinez, an oral health educator at Phoenix Children’s Hospital in Arizona, will present on this topic.

The webinar, entitled “Hospital-Acquired Pneumonia and Oral Care: Using Data to Change Practice and Improve Outcomes” is being held at 1 p.m. PT Nov. 18. Interested members can register for the webinar here.

The webinar will be recorded and available to view after Nov. 18 by contacting the Arizona Dental Association at 1-480-344-5777 or by going to their website at

“We are looking to start the conversation and begin the process of developing relationships between the dental and hospital communities across the state to gain a more complete understanding about the system-level oral health-medical connection to prevent infections and improve the lives of our patients,” said Dr. Nafys Samandari, a Scottsdale, Arizona, dentist and member of the Arizona Dental Association’s board of trustees. “This is only the beginning.”

Dentists should proactively involve the patient’s caregivers and work collaboratively with physicians to discuss the benefits of consistent oral care in preventing hospital-acquired pneumonia, said Dr. Baker.

Even though the pneumonia virus is transmitted in hospitals and long-term care facilities, dentists can best communicate the importance of maintaining oral health when talking to their patients who are going to be admitted to the hospital or long-term care facility for an extended period of time.

The dentist should educate the patient on how important it is to continue their oral health practices, Dr. Baker said.

‘A perfect storm of risk’

Brushing is important, Dr. Baker said during her presentation at the May DQA conference, because the mouth is the gateway to the internal body and a healthy mouth is necessary for overall good health.

This also applies to preventing pneumonia in the hospital.

The mouth has over 200 billion microbes of all types — but primarily bacteria and viruses, although protozoa and fungi are also part of the oral flora.

When patients come into the hospital, the health care team and medical interventions significantly disrupt a patient’s normal oral microbiome.

In addition, many medications are prescribed that cause patients to experience dry mouth and decrease their lungs’ normal defenses by suppressing their ability to cough. This is a significant concern because patients are at increased risk for missing basic daily oral care when in the hospital, which can result in an overgrowth of the bacteria and viruses.

Within 48 hours of hospitalization, gram-negative bacteria, the source of many infections, may start to dominate the oral flora.

“All of this adds up to a perfect storm of risk for our patients to develop acquired pneumonia during their hospital stay,” Dr. Baker told the assembled crowd.

The protocol for reducing the chances of patients contracting hospital pneumonia, Dr. Baker said, includes the use of:

• A soft-bristled, effective tooth brush.
• Toothpaste with dentifrice that removes biofilm.
• Alcohol-free antiseptic mouth rinse.
• Petroleum-free moisturizer for mouth and lips.
• Denture care equipment that includes a storage cup, denture cleanser, denture brush and adhesive, if needed.

The communication and collaboration between dentists and physicians is crucial, said Dr. Samandari.

“Doctors, nurses and infection control specialists in hospitals haven’t completely understood the association between the mouth and the propensity to develop infections, especially in the lungs,” said Dr. Samandari. “Therefore, dentists and dental teams can play essential roles by educating our medical colleagues and collaborating on a plan to address hospital-acquired pneumonia. Now we are starting to see some data that shows that most hospital-acquired pneumonia starts in the mouth. In fact, the Centers for Disease Control and Prevention notes that pneumonia accounts for one out of four hospital infections. These infections lead to longer lengths of stays, additional health care costs and could result in patient deaths. That should lead us to the conclusion that implementing inexpensive oral health protocols can help address this problem.”

Other states’ efforts

Michigan is another state where oral health and its effects on hospital-acquired pneumonia are being addressed. 

The Delta Dental Foundation awarded Sparrow Health System, a member of the Mayo Clinic Care Network and a mid-Michigan health care organization, a $400,000 grant to expand research focused on how good oral health care can improve overall health.

Sparrow’s original improvement project centered on providing all Sparrow Hospital patients with a high-quality toothbrush, toothpaste with sodium bicarbonate, alcohol-free antiseptic mouthwash and a suction toothbrush kit for those with difficulty swallowing or spitting. Through this project, the hospital observed a noticeable decrease in hospital-acquired pneumonia cases, said Chastity Warren, an assistant professor at Michigan State University’s College of Nursing who led the program at Sparrow.

“Our initial project reduced nonventilated hospital-acquired pneumonia by 50%,” Ms. Warren said. “Reach out to your local hospitals to see if partnerships can be made to begin bridging the gap.”

To further underscore the importance of this issue, the Michigan Dental Association also featured an article on the role of oral health in preventing nonventilator hospital-acquired pneumonia in the July 2019 MDA journal, “Integrating Oral Health Care into Patient Management to Prevent Hospital Acquired Pneumonia: A Team Approach.”

California health care system Sutter Heath has been a leader in using data to demonstrate that reducing hospital-acquired pneumonia is directly linked to increasing the quality and frequency of oral care during patients’ hospitalization.  Sutter Health has been recognized for this work, which was summarized in the Hospital Quality Institute’s C. Duane Dauner Quality Award overview entitled “Preventing the No. 1 Hospital-Acquired Infection and Saving Lives: One Clean Mouth at a Time.”

“Hospital-acquired pneumonia is now the most common hospital-associated infection in the U.S., according to the Centers for Disease Control of Prevention, and we need to begin putting our energy and resources into prevention as we have with other hospital-associated infections,” said Barbara Quinn, director of professional practice and nursing excellence for Sutter Health. “Improving oral health care is just the first step.”

For more information on the DQA, visit