Healthy Mouths in Hospital

This project implemented a more effective method for cleaning dentures in hospital and delivered education session to staff and patients on the link between oral health and systemic infection.

Aim

To improve oral hygiene and associated health outcomes for inpatients at Bega District Hospital.

Benefits

• Improves oral hygiene, patient safety and health literacy in hospital.
• Reduces the risk of hospital-acquired infections and associated chronic diseases.
• Reduces length of stay (LoS) and associated costs.
• Reduces the risk of post-operative delirium which is linked to increased morbidity, mortality and LoS.
• Enhances collaboration between consumers, patients, carers and staff.
• Improves the productivity and efficiency of patient care.

Background

An operating theatre recovery room audit and three patient surveys were conducted at Bega District Hospital between October 2013 and March 2014. They found that 20% of dentures that required cleaning belonged to inpatients and that 95% of patients did not remove dentures overnight. These results showed that the oral health needs of these patients were not being met.

Insufficient oral hygiene can lead to oral and systemic candida infections, which is associated with decreased appetite, malnutrition, decreased wound healing and bloodstream infections. It has also been linked to cardiovascular disease, respiratory disease and osteoarthritis. A bi-directional relationship between periodontal disease and impaired metabolic control for Type 2 diabetes has also been established.

A literature review found that improving the oral health of inpatients with dentures would not only improve patient safety and health outcomes, but also reduce the risk of increased LoS and associated costs.

Implementation

• Information brochures were developed in collaboration with consumers and provided to patients at pre-admission. They highlight the link between chronic disease, infections and oral hygiene, as well as provide advice and support contacts. Brochures were also shared with neighbouring Pambula Hospital.
• Effective methods for cleaning dentures were identified and implemented within the hospital.
• Education on the link between oral hygiene and systemic infection was delivered to staff and patients in theatre, medical, surgical and children’s wards. It was also provided to assistants in nursing students at the Bega campus of Illawarra TAFE and new nurses on orientation.
• The project was presented to the Health and Education Training Institute (HETI) clinical team leadership group, the Southern Dental Conference and the NSW Agency for Clinical Innovation.
• Community dental clinics in Deniliquin and Young requested patient brochures and other materials, to implement this project in their facilities.

Project status

• Sustained - the initiative has been implemented and is sustained in standard business.

Key dates

Project start: August 2013

Implementation sites

• Bega District Hospital, Southern NSW Local Health District

Partnerships

• Health Education and Training Institute (HETI) Clinical Team Leadership Program
• Bega Valley Health Service

Results

• Prior to the project, 95% of patients did not remove dentures and store them in denture cups overnight. The patient pamphlet and staff education changed this practice by encouraging patients to ask for denture cups and cleaning materials.
• Denture cleaning tablets, toothbrushes and denture cups are now available on wards and in recovery rooms. Staff are encouraged to ask patients if they need assistance with oral health care and patients are encouraged to ask staff for assistance.
• Patient information brochures are provided at pre-admission and available in patient lockers, folders and wards.
• Dentures are now frequently inspected and cleaned prior to returning them to patients, with dentures returned to patients as soon as possible after surgery to aid in the recovery process.
• Post-implementation surveys indicate that education sessions provided staff with a better understanding of the link between oral health, infection and disease.
• Ad hoc audits of dentures in recovery are used to provide ongoing feedback to ward staff.

Awards

• 2015 NSW Health Awards Finalist – Harry Collins Award

Lessons learnt

The role of oral health in reducing infections and promoting positive health outcomes needs to be recognised throughout all clinical settings. Collaboration between nursing staff and patients is essential to achieve this outcome.

Further reading

• Maeda Y, Kenny F, Coulter W et al. Bactericidal activity of denture-cleaning formulations against planktonic health care-associated and community-associated methicillin-resistant Staphylococcus aureus. American Journal of Infection Control 2007; 35(9): 612-622.
• Coulthwaite L, Verran J. Potential pathogenic aspects of denture plaque. British Journal of Biomedical Science 2007; 64(2): 180-187.
• Dickinson, H. Maintaining oral health after stroke. Nursing Standard 2012; 26(49): 35-39.
• Frazer C, Frazer R, Byron R. Prevent infections with good denture care. Nursing 2009; 39(8): 50-53.
• Leite R, Marlow N, Fernandes J. Oral health and Type 2 diabetes. American Journal of Medical Sciences 2013; 345(44): 271-273.
• Astroth J. The links between oral and systemic health. The Clinical Advisor: For Nurse Practitioners 2009; 12(3): 19-23.
• Flinn D, Diehl K, Seyfried L et al. Prevention, diagnosis and management of postoperative delirium in older adults. American College of Surgeons 2009; 209(2): 261-267.

Contacts