Pilot testing of intervention protocols to prevent pneumonia in nursing home residents.
OBJECTIVE
To test intervention protocols for feasibility, staff adherence, and effectiveness in reducing pneumonia risk factors (impaired oral hygiene, swallowing difficulty) in nursing home residents.


METHODS
Prospective study.


METHODS
Two nursing homes.


METHODS
Fifty-two nursing home residents.


METHODS
Thirty residents with impaired oral hygiene were randomly assigned to manual oral brushing plus 0.12% chlorhexidine oral rinse at different frequencies daily. Twenty-two residents with swallowing difficulty were randomly assigned to upright feeding positioning, teaching swallowing techniques, or manual oral brushing. All protocols were administered over 3 months.


METHODS
Feasibility was assessed monthly and defined as high if the protocol took less than 10 minutes to administer. Adherence was assessed weekly and defined as high if full staff adherence was demonstrated in more than 75% of assessments. Effectiveness for improved oral hygiene (reduction in oral plaque score) and swallowing (reduction in cough during swallowing) was compared at baseline and 3 months.


RESULTS
Daily manual oral brushing plus 0.12% chlorhexidine rinse demonstrated high feasibility, high staff adherence, and effectiveness in improving oral hygiene (P<.001 vs baseline); this combination administered twice per day showed the highest plaque score reduction. Daily manual oral brushing and upright feeding positioning demonstrated high feasibility, high staff adherence, and effectiveness in improving swallowing.


CONCLUSIONS
Manual oral brushing, 0.12% chlorhexidine oral rinse, and upright feeding positioning demonstrated high feasibility, high staff adherence, and effectiveness in pneumonia risk factor reduction. A protocol combining these components warrants testing for its ability to reduce pneumonia in nursing home residents.
Quagliarello
Vincent
V
Department of Internal Medicine, Infectious Diseases Section, School of Medicine, Yale University, New Haven, Connecticut 06520, USA. vincent.quagliarello@yale.edu
Juthani-Mehta
Manisha
M
Ginter
Sandra
S
Towle
Virginia
V
Allore
Heather
H
Tinetti
Mary
M
D000369:Aged, 80 and over; D002710:Chlorhexidine / Q000008:administration & dosage; D015897:Comorbidity; D003237:Connecticut; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D009067:Mouthwashes / Q000008:administration & dosage; D009735:Nursing Homes; D009911:Oral Hygiene Index; D010865:Pilot Projects; D011014:Pneumonia / Q000517:prevention & control*; D011187:Posture / Q000502:physiology; D011446:Prospective Studies; D012307:Risk Factors; D040242:Risk Reduction Behavior; D014099:Toothbrushing
D009067:Mouthwashes; D002710:Chlorhexidine