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Q&A: The importance of oral care

In January, Trina Crow, RN, MJ, associate project director at The Joint Commission, wrote in a blog post that long-term care facilities need to pursue oral care policies more intently. While neither The Joint Commission nor CMS cite hospitals or critical access hospitals for oral care deficiencies, Crow writes that it’s still an essential part of care.

 “The statistics on this are alarming,” she wrote. “According to a study published in the Journal of American Geriatrics Society, on any given day, 84%–100% of [long-term care] residents don’t receive any oral care. Furthermore, only 27% of the long-term care organizations in the study had oral care supplies and the average tooth brushing duration was only 60 seconds. Many care providers didn’t even change their gloves between helping the resident use the restroom and brush teeth.”

Along with tooth and gum disease, poor oral care is linked to pneumonia and endocarditis (an infection of the heart's inner lining). Barbara Quinn, MSN, RN, ACNS-BC, a clinical nurse specialist with Integrated Quality Services at Sutter Medical Center, Sacramento (SMCS), and co-author of one of the few studies and articles on oral care programs and pneumonia prevention in hospital settings. Her research showed that by putting an oral care program in place, hospitals can prevent 40%–60% of non-ventilator hospital-acquired pneumonia (NV-HAP), which accounts for 62% of all hospital-acquired pneumonia. 

BOAQ: Do most facilities have an oral health program or policy in place? Is there any regulation or guidance that says that they should?

Quinn: I’ve done quite a bit of speaking and traveling across the country and internationally the past three years speaking on this particular subject. And I always ask, “Show me your oral care program. What’s your policy?” And almost always (if they have one at all), it’s barely relegated to patients on ventilator. And that was the case at [SMCS] too when we went to look at it.

There is no regulation that says every hospital has to have an oral care policy, nor is there any guidance or guidelines out there for what oral care should look like for the hospitalized patient. It’s specifically for things like the ventilator bundle, but there’s no other regulation. The Joint Commission doesn’t say, “as a [National Patient Safety Goal], everybody should have an oral care policy in place.” The Centers for Disease Control and Prevention (CDC) has a general recommendation for pneumonia prevention, and the first thing they say is “comprehensive oral care program.” But it’s not regulated at all.

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