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P2 Mouth care and pneumonia: a clinician’s insight
  1. N Sehgal,
  2. J Hoyle
  1. North Manchester General Hospital, Manchester University NHS Foundation Trust, Manchester, UK

Abstract

Introduction Oral health is an important aspect of general health and well-being. Studies confirm a significant link between poor oral health and the risk of developing community acquired pneumonia and demonstrate that implementation of oral care protocols on wards can reduce the likelihood of hospital acquired pneumonia.

Embedding good oral care into patient care pathways is essential; in this review, we assessed clinicians’ awareness of mouth care.

Methods An online survey was sent to 39 medical consultants working at an acute Manchester Hospital reviewing current knowledge and utilisation of the oral assessment tool (OAT) and mouth care plan (MCP). All in-patients have an OAT completed on admission/transfer to the ward and every 7 days thereafter, triggering a patient-centred MCP which is signed off daily in the patients notes.

Results 25 consultants completed the survey. 76% confirmed they were aware of the association between poor mouth care and the risk of developing pneumonia, but only 36% routinely inspected a patient’s mouth as part of their daily clinical examination. 12% were aware of the OAT and 24% of the MCP. One fifth of consultants routinely checked whether daily mouth care had been received and only 3 checked whether the patient had a toothbrush or toothpaste.

At the time of discharge for patients admitted with pneumonia, whilst a significant number reviewed smoking status (88%), pneumococcal (48%) and flu vaccination status (52%), only 1 individual reviewed whether patients were able to independently perform mouth care.

Conclusion Despite awareness of links between poor mouth care and pneumonia, senior clinicians are not utilising available tools to assess care. Poor mouth care amongst hospitalised patients increases the risk of nosocomial pneumonia with significant impact on length of stay and mortality. Failure to identify those at risk who are unable to independently perform mouth care at the time of discharge, can lead to recurrent episodes of pneumonia, and needs to be a focus for secondary prevention particularly in vulnerable groups with frailty and learning difficulties where mortality rates remain unacceptably high. Pathways championing oral care need to be considered as part of pneumonia quality improvement measures.

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