One Weird Thing About Brushing Your Teeth

[Solitaire]

Hospital-Acquired Pneumonia Is Killing Patients,
Yet There Is a Simple Way to Stop It by Brett Kelman

Hospital patients not getting their teeth brushed, or not brushing
their teeth themselves, is believed to be a leading cause of hundreds
of thousands of cases of pneumonia a year in patients who have not
been put on a ventilator. Pneumonia is among the most common
infections that occur in health care facilities, and a majority of cases
are non-ventilator hospital-acquired pneumonia, or NVHAP, which
kills up to 30% of those infected, Giuliano and other experts said.

But unlike many infections that strike within hospitals, the federal
government doesn’t require hospitals to report cases of NVHAP.
As a result, few hospitals understand the origin of the illness, track
its occurrence, or actively work to prevent it, the experts said.

Many cases of NVHAP could be avoided if hospital staffers more dutifully
brushed the teeth of bedridden patients, according to a growing body of
peer-reviewed research papers. Instead, many hospitals often skip teeth
brushing to prioritize other tasks and provide only cheap, ineffective
toothbrushes, often unaware of the consequences, said Dian Baker,
a Sacramento State nursing professor who has spent more than
a decade studying NVHAP.

How do the bacteria know you're in the hospital?
Good thing this doesn't happen in the wild.
It's just like the five second rule.

 

[Skeptic Ginger]

Weird.

 

[Dr.Sid]

How do the bacteria know you're in the hospital?
Good thing this doesn't happen in the wild.
It's just like the five second rule.

I guess it can be place where people susceptible to it concentrate. The fuel might simply be too sparse in the wild. There are other hospital related infections, and often the resistant ones.

 

[Bob001]

From the link:

NVHAP, a risk for virtually all hospital patients, is often caused by bacteria from the mouth that gathers in the scummy biofilm on unbrushed teeth and is aspirated into the lungs. Patients face a higher risk if they lie flat or remain immobile for long periods, so NVHAP can also be prevented by elevating their heads and getting them out of bed more often.

According to the National Organization for NV-HAP Prevention, which was founded in 2020, this pneumonia infects about 1 in every 100 hospital patients and kills 15% to 30% of them. For those who survive, the illness often extends their hospital stay by up to 15 days and makes it much more likely they will be readmitted within a month or transferred to an intensive care unit.

Toothbrushing in the hospital might be too labor-intensive and inconvenient in many cases, but I wonder if the same end could be accomplished by rinsing with an anti-microbial mouthwash, maybe even something formulated for that specific purpose?

 

[Mojo]

“It is very few sicknesses that are not from the teeth.” - Flann O’Brien

 

[casebro]

Pneumo vax?

 

[Darat]

From the link:


Toothbrushing in the hospital might be too labor-intensive and inconvenient in many cases, but I wonder if the same end could be accomplished by rinsing with an anti-microbial mouthwash, maybe even something formulated for that specific purpose?

Probably not practical to brush peoples' teeth who are on ventilators (depending where the ventilator is plugged in) so something like you suggest that could be wiped over the teeth and the gums on a small sponge would be a promising idea.

 

[Planigale]

Pneumo vax?

Pneumovax (PPV23) is routinely given to older persons and those with impaired immunity, and in any case Pneumococcus is not a cause of HAP (strictly speaking this stands for Healthcare Associated Pneumonia not Hospital Acquired Pneumonia).

 

[casebro]

Pneumovax (PPV23) is routinely given to older persons and those with impaired immunity, and in any case Pneumococcus is not a cause of HAP (strictly speaking this stands for Healthcare Associated Pneumonia not Hospital Acquired Pneumonia).

Bacteria vs virus?

 

[Planigale]

Probably not practical to brush peoples' teeth who are on ventilators (depending where the ventilator is plugged in) so something like you suggest that could be wiped over the teeth and the gums on a small sponge would be a promising idea.

Not very easy in confused elderly people either!

 

[Planigale]

Bacteria vs virus?

?

Not sure what you mean?

 

[Bob001]

?

Not sure what you mean?

Non-medical person here, but I wonder if some pneumonias are caused by bacteria and some by viruses, and the vaccines and treatments that prevent some don't affect others?

 

[casebro]

Non-medical person here, but I wonder if some pneumonias are caused by bacteria and some by viruses, and the vaccines and treatments that prevent some don't affect others?

Yeah dat. Was it too hard for a Medico to understand? I had mentioned Vax, you sauid nope, Phlemococcus....

 

[Planigale]

Non-medical person here, but I wonder if some pneumonias are caused by bacteria and some by viruses, and the vaccines and treatments that prevent some don't affect others?

Healthcare Associated* (hospital acquired) pneumonia is bacterial. It is thought to be mainly due to bacteria in your mouth and throat getting down into the lungs. The issues about being in hospital are that people may be less able to cough / swallow etc. so more likely to infect their lungs. Also because of antibiotic use the germs they are infected with if they get pneumonia are likely to be more resistant to antibiotics than if the same thing happened at home. Reducing bactertial load by good mouth care is thought to reduce the risk. In ventilated patients they tend to use mouthwash type antiseptics, this would probably be as good as toothbrushing.

HAP is not viral. Viral pneumonias are almost all person to person spread because there is not a carrier state for the viruses that cause pneumonia (excepting some like CMV that can cause pneumonia in very immunosuppressed persons e.g. post transplant). Even if you caught a viral pneumonia in hospital it would not be regarded as HAP because the process is the same as happens in the community.

The most common form of community acquired pneumonia is bacterial - pneumococcal pneumonia - this bacteria can also cause meningitis and sepsis. In the UK at risk (immunocompromised adults) and everyone over 65 are given the vaccine casebro mentioned - pneumovax (PPV23). In contrast to in the community pneumococcus is rarely a cause of pneumonia in hospital, possibly in part due to older people being vaccinated and in part to the fact that pneumococcus is still sensitive to penicillin in most cases. FWIW children under one receive a different vaccine Prevenar (PCV13) since pneumovax doesn't work in infants. The object of the vaccine is more to prevent meningitis and sepsis in children than prevent pneumonia. Viral pneumonias are (in non-pandemic times) a minority of community acquired pneumonias probably around a third. Influenza would be the most common viral pneumonia.


ETA Healthcare Associated Pneumonia is the prefered term because it is not just being physically in hospital that is important but the issues around healthcare, healthcare associated pneumonia also occurs in residents of nursing homes or long term care facillities and in those who acquire the pneumonia at home but have recently been in hospital.

 

[Skeptic Ginger]

From the link:


Toothbrushing in the hospital might be too labor-intensive and inconvenient in many cases, but I wonder if the same end could be accomplished by rinsing with an anti-microbial mouthwash, maybe even something formulated for that specific purpose?

If it's strong enough to actually kill germs it almost certainly would kill the cells in you mouth.

And the biofilms bacteria form on teeth protect the organisms.

And Listerine does not kill germs. The amount of alcohol in it doesn't meet the EPA's designation of the weakest disinfectant level. Next time you look at a bottle of Listerine notice 'alcohol' is listed under 'other ingredients' and notice they bury that fact in the middle of a paragraph of active ingredients so it is hard to see.

 

[Skeptic Ginger]

RSV and influenza are two viruses that can cause nosocomial (hospital acquired) pneumonia in some debilitated hospital patients. But viruses don't multiply outside of the host cell so they wouldn't be growing in one's mouth.

 

[Skeptic Ginger]

...Reducing bactertial load by good mouth care is thought to reduce the risk. In ventilated patients they tend to use mouthwash type antiseptics, this would probably be as good as toothbrushing.

There is a prescription only mouth rinse: chlorhexidine gluconate oral rinse that can be used on intubated persons. Probably needs to be monitored since it can be quite harsh on oral tissues. And I would think you would still try to brush the person's teeth.

..HAP is not viral. Viral pneumonias are almost all person to person spread because there is not a carrier state for the viruses that cause pneumonia (excepting some like CMV that can cause pneumonia in very immunosuppressed persons e.g. post transplant). Even if you caught a viral pneumonia in hospital it would not be regarded as HAP because the process is the same as happens in the community.

CMV in immunocompromised patients usually comes from latent infection that becomes active when the person's immune system breaks down. It can be hospital acquired if a susceptible person gets a blood transfusion that carries the virus.

RSV most definitely causes pneumonia outbreaks in hospitals. It's especially a hazard in the NICU but also anywhere kids under 5 or so are hospitalized. The elderly as well are especially susceptible to pneumonia with RSV. While RSV is a big risk of spreading in hospitals, we don't label the strains hospital associated. But the pneumonia RSV causes can most definitely be hospital acquired.

As for influenza, it's droplet spread which means it can spread on hands and other fomites to hospitalized patients. If the patient is susceptible to their viral respiratory infection involving the lung, then you could see hospital acquired influenza pneumonia especially during an influenza outbreak in the facility. But we wouldn't call the strain of flu "hospital associated".

ETA Healthcare Associated Pneumonia is the prefered term because it is not just being physically in hospital that is important but the issues around healthcare, healthcare associated pneumonia also occurs in residents of nursing homes or long term care facillities and in those who acquire the pneumonia at home but have recently been in hospital.

Hospital acquired vs hospital associated labels mostly matter with MRSA. Hospital associated MRSA tends to be resistant to most commonly used antibiotics but it is still treatable with vancomycin (it is developing resistance to vanco and there are some newer antibiotics that might work against it, I haven't checked lately).

Community associated MRSA, OTOH, is still susceptible to a number of oral antibiotics like Bactrim. To make it even more confusing you can get hospital associated MRSA in the community and you can get community associated MRSA in the hospital. Only infection control providers and the prescribing provider generally care. They would be looking at the 'sensitivity' result in a culture and sensitivity.

If you have something to add to this, I'm most interested.

 

[Bob001]

If it's strong enough to actually kill germs it almost certainly would kill the cells in you mouth.

And the biofilms bacteria form on teeth protect the organisms.

And Listerine does not kill germs. The amount of alcohol in it doesn't meet the EPA's designation of the weakest disinfectant level. Next time you look at a bottle of Listerine notice 'alcohol' is listed under 'other ingredients' and notice they bury that fact in the middle of a paragraph of active ingredients so it is hard to see.

Drugstore shelves are full of over-the-counter mouthwashes labeled "antibacterial," "kills 99% of germs," etc. Not all contain alcohol. So is that a lie, or just a different kind of bacteria, or what?
https://www.walgreens.com/store/c/c...i-protection-mouthwash/ID=prod6102313-product
https://www.walgreens.com/store/c/c...tiplaque-oral-rinse-mint/ID=300410999-product

 

[Planigale]

Drugstore shelves are full of over-the-counter mouthwashes labeled "antibacterial," "kills 99% of germs," etc. Not all contain alcohol. So is that a lie, or just a different kind of bacteria, or what?
https://www.walgreens.com/store/c/c...i-protection-mouthwash/ID=prod6102313-product
https://www.walgreens.com/store/c/c...tiplaque-oral-rinse-mint/ID=300410999-product

No not a lie. But the sort of bad bacteria that may be 'acquired' in hospital tend to be resistant to the chemicals in normal anti-bacterial mouthwashes. Some germs are very tough. TB like germs are isolated by shaking up sputum with bleach (10% NaOH) which kills 99% of germs but leaves the TB like ones sitting pretty.

 

[Darat]

Drugstore shelves are full of over-the-counter mouthwashes labeled "antibacterial," "kills 99% of germs," etc. Not all contain alcohol. So is that a lie, or just a different kind of bacteria, or what?
https://www.walgreens.com/store/c/c...i-protection-mouthwash/ID=prod6102313-product
https://www.walgreens.com/store/c/c...tiplaque-oral-rinse-mint/ID=300410999-product

Often the antibacterial or antiseptic property will have been tested in a lab rather than in the wild. I recall a paper linked from here many years ago that assessed many of the then OTC products and noted that they had very little or even no effect on the bacteria in your mouth when used as directed. (Sorry can't find a link to the paper.) The conclusion was they may taste nice and flush your mouth out but there was no significant benefit in terms of removing bacteria that caused plaque.