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Cao Y, Liu C, Lin J, Ng L, Needleman I, Walsh T, Li C. Oral care measures for preventing nursing home-acquired pneumonia. Cochrane Database Syst Rev 2022; 11:CD012416. [PMID: 36383760 PMCID: PMC9668328 DOI: 10.1002/14651858.cd012416.pub3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pneumonia in residents of nursing homes can be termed nursing home-acquired pneumonia (NHAP). NHAP is one of the most common infections identified in nursing home residents and has the highest mortality of any infection in this population. NHAP is associated with poor oral hygiene and may be caused by aspiration of oropharyngeal flora into the lung. Oral care measures to remove or disrupt oral plaque might reduce the risk of NHAP. This is the first update of a review published in 2018. OBJECTIVES To assess effects of oral care measures for preventing nursing home-acquired pneumonia in residents of nursing homes and other long-term care facilities. SEARCH METHODS An information specialist searched CENTRAL, MEDLINE, Embase, one other database and three trials registers up to 12 May 2022. We also used additional search methods to identify published, unpublished and ongoing studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) that evaluated the effects of oral care measures (brushing, swabbing, denture cleaning mouthrinse, or combination) in residents of any age in nursing homes and other long-term care facilities. DATA COLLECTION AND ANALYSIS At least two review authors independently assessed search results, extracted data, and assessed risk of bias in the included studies. We contacted study authors for additional information. We pooled data from studies with similar interventions and outcomes. We reported risk ratios (RRs) for dichotomous outcomes, mean differences (MDs) for continuous outcomes, and hazard ratios (HRs) or incidence rate ratio (IRR) for time-to-event outcomes, using random-effects models. MAIN RESULTS We included six RCTs (6244 participants), all of which were at high risk of bias. Three studies were carried out in Japan, two in the USA, and one in France. The studies evaluated one comparison: professional oral care versus usual oral care. We did not include the results from one study (834 participants) because it had been stopped at interim analysis. Consistent results from five studies, with 5018 participants, provided insufficient evidence of a difference between professional oral care and usual (simple, self-administered) oral care in the incidence of pneumonia. Three studies reported HRs, one reported IRRs, and one reported RRs. Due to the variation in study design and follow-up duration, we decided not to pool the data. We downgraded the certainty of the evidence for this outcome by two levels to low: one level for study limitations (high risk of performance bias), and one level for imprecision. There was low-certainty evidence from meta-analysis of two individually randomised studies that professional oral care may reduce the risk of pneumonia-associated mortality compared with usual oral care at 24 months' follow-up (RR 0.43, 95% CI 0.25 to 0.76, 454 participants). Another study (2513 participants) reported insufficient evidence of a difference for this outcome at 18 months' follow-up. Three studies measured all-cause mortality and identified insufficient evidence of a difference between professional and usual oral care at 12 to 30 months' follow-up. Only one study (834 participants) measured the adverse effects of the interventions. The study identified no serious events and 64 non-serious events, the most common of which were oral cavity disturbances (not defined) and dental staining. No studies evaluated oral care versus no oral care. AUTHORS' CONCLUSIONS Although low-certainty evidence suggests that professional oral care may reduce mortality compared to usual care when measured at 24 months, the effect of professional oral care on preventing NHAP remains largely unclear. Low-certainty evidence was inconclusive about the effects of this intervention on incidence and number of first episodes of NHAP. Due to differences in study design, effect measures, follow-up duration, and composition of the interventions, we cannot determine the optimal oral care protocol from current evidence. Future trials will require larger samples, robust methods that ensure low risk of bias, and more practicable interventions for nursing home residents.
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Affiliation(s)
- Yubin Cao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Chang Liu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jie Lin
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Anaesthesiology and Intensive Care Unit, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Linda Ng
- School of Nursing and Midwifery, The University of Queensland, South Brisbane, Australia
| | - Ian Needleman
- Unit of Periodontology and International Centre for Evidence-Based Oral Health, UCL Eastman Dental Institute, London, UK
| | - Tanya Walsh
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Chunjie Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Schmidt N, Marujo V, Eckmanns T, Zacher B, Arvand M, Ruscher C. [Healthcare-associated infections and antimicrobial use in long-term care facilities. German results of the third European point prevalence survey HALT-3]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2022; 65:863-871. [PMID: 35951042 PMCID: PMC9366828 DOI: 10.1007/s00103-022-03566-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 07/08/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVE The essential role of infection prevention in long-term care facilities has become evident during the current SARS-CoV‑2 pandemic. In order to obtain a reliable database on nosocomial infections and antibiotic use, the European Centre for Disease Prevention and Control (ECDC) initiated the third point prevalence survey in European long-term care facilities from 2016 to 2017 (HALT-3). MATERIAL AND METHODS In Germany, 131 facilities with 10,565 residents participated voluntarily. On a single day in 2016, the number of nosocomial infections and/or uses of antibiotics as well as care characteristics and risk factors of the residents were recorded. Infections were documented based on symptoms using an algorithm in accordance with the McGeer surveillance criteria for long-term care facilities. RESULTS A nosocomial infection was documented in 177 residents, which corresponds to a prevalence of 1.7% (95% CI: 1.3-2.1), still low in comparison with the European prevalence (mean value 3.9%). Urinary tract infections were the most common infections at almost 50%, followed by respiratory, skin, and soft-tissue infections. The type of infection was consistent with the most common indications for antibiotic use. Antibiotic use was documented in 143 residents (prevalence of 1.4%, 95% CI: 1.1-1.7). The frequent use of fluoroquinolones with over 20% of all prescriptions was noticeable. CONCLUSIONS The establishment of facility-based surveillance of the most common infections and antibiotic consumption, together with the creation of guidelines specifically tailored to the geriatric population, could contribute to improving infection prevention and control as well as a more rational use of antibiotics, thus increasing the quality and safety of care.
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Affiliation(s)
- Nicole Schmidt
- Fachgebiet 37 - Nosokomiale Infektionen, Surveillance von Antibiotikaresistenz und -verbrauch, Robert Koch-Institut, Seestr. 10, 13353, Berlin, Deutschland.
| | - Vanda Marujo
- Fachgebiet 14 - Angewandte Infektions- und Krankenhaushygiene, Robert Koch-Institut, Berlin, Deutschland
| | - Tim Eckmanns
- Fachgebiet 37 - Nosokomiale Infektionen, Surveillance von Antibiotikaresistenz und -verbrauch, Robert Koch-Institut, Seestr. 10, 13353, Berlin, Deutschland
| | - Benedikt Zacher
- Fachgebiet 37 - Nosokomiale Infektionen, Surveillance von Antibiotikaresistenz und -verbrauch, Robert Koch-Institut, Seestr. 10, 13353, Berlin, Deutschland
| | - Mardjan Arvand
- Fachgebiet 14 - Angewandte Infektions- und Krankenhaushygiene, Robert Koch-Institut, Berlin, Deutschland
| | - Claudia Ruscher
- Fachgebiet 14 - Angewandte Infektions- und Krankenhaushygiene, Robert Koch-Institut, Berlin, Deutschland
- Landesamt für Gesundheit und Soziales (LAGeSo), Berlin, Deutschland
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Bavelaar L, Visser M, Schlicksupp P, Tilburgs B, van der Maaden T, Achterberg WP, van der Steen JT. Change in Advance Care Plans of Nursing Home Residents With Dementia and Pneumonia: Secondary Analysis of Randomized Controlled Trial Data. J Am Med Dir Assoc 2022; 23:1741.e19-1741.e26. [PMID: 35932798 DOI: 10.1016/j.jamda.2022.06.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 06/22/2022] [Accepted: 06/22/2022] [Indexed: 10/16/2022]
Abstract
OBJECTIVES To explore changes in advance care plans of nursing home residents with dementia following pneumonia, and factors associated with changes. Second, to explore factors associated with the person perceived by older adult care physicians as most influential in advance treatment decision making. DESIGN Secondary analysis of physician-reported PneuMonitor trial data. SETTING AND PARTICIPANTS The PneuMonitor trial took place between January 2012 and May 2015 in 32 nursing homes across the Netherlands; it involved 429 residents with dementia who developed pneumonia. METHODS We compared advance care plans before and after the first pneumonia episode. Generalized logistic linear mixed models were used to explore associations of advance care plan changes with the person most influential in decision making, with demographics and indicators of disease progression. Exploratory analyses assessed associations with the person most influential in decision making. RESULTS For >90% of the residents, advance care plans had been established before the pneumonia. After pneumonia, treatment goals were revised in 15.9% of residents; 72% of all changes entailed refinements of goals. Significant associations with treatment goal changes were not found. Treatment plans changed in 20.0% of residents. Changes in treatment decisions were more likely for residents who were more severely ill (odds ratio 1.5, 95% CI 1.2-1.9) and those estimated to live <3 months (odds ratio 3.3, 95% CI 1.9-5.8). Physicians reported that a family member was often (47.4%) most influential in decision making. Who is most influential was associated with the resident's dementia severity. CONCLUSIONS AND IMPLICATIONS Overall, changes in advance care plans after pneumonia diagnosis were small, suggesting stability of most preferences or limited dynamics in the advance care planning process. Advance care planning involving family is common for nursing home residents with dementia, but advance care planning with persons with dementia themselves is rare and requires more attention.
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Affiliation(s)
- Laura Bavelaar
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Mandy Visser
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Philine Schlicksupp
- Faculty of Behavioral and Social Sciences, Leiden University, Leiden, the Netherlands
| | - Bram Tilburgs
- Department of Intensive Care Medicine, Radboud university medical center, Nijmegen, the Netherlands
| | - Tessa van der Maaden
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Jenny T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands; Department of Primary and Community Care, Radboud university medical center, Nijmegen, the Netherlands.
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Hunt LJ, Morrison RS, Gan S, Espejo E, Ornstein KA, Boscardin WJ, Smith AK. Incidence of potentially disruptive medical and social events in older adults with and without dementia. J Am Geriatr Soc 2022; 70:1461-1470. [PMID: 35122662 PMCID: PMC9106866 DOI: 10.1111/jgs.17682] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 01/07/2022] [Accepted: 01/09/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Potentially disruptive medical, surgical, and social events-such as pneumonia, hip fracture, and widowhood-may accelerate the trajectory of decline and impact caregiving needs in older adults, especially among people with dementia (PWD). Prior research has focused primarily on nursing home residents with dementia. We sought to assess the incidence of potentially disruptive events in community-dwelling people with and without dementia. METHODS Retrospective cohort study of participants aged 65+ enrolled in the Health and Retirement Study between 2010 and 2018 (n = 9346), including a subset who were married-partnered at baseline (n = 5105). Dementia was defined with a previously validated algorithm. We calculated age-adjusted and gender-stratified incidence per 1000 person-years and incidence rate ratios of: 1) hospitalization for pneumonia, 2) hip fracture, and 3) widowhood in people with and without dementia. RESULTS PWD (n = 596) were older (mean age 84 vs. 75) and a higher proportion were female (67% vs. 57%) than people without dementia (PWoD) (n = 8750). Age-adjusted incidence rates (per 1000 person-years) of pneumonia were higher in PWD (113.1; 95% CI 94.3, 131.9) compared to PWoD (62.1; 95% CI 54.7, 69.5), as were hip fractures (12.3; 95% CI 9.1, 15.6 for PWD compared to 8.1; 95% CI 6.9, 9.2 in PWoD). Point estimates of widowhood incidence were slightly higher for PWD (25.3; 95% CI 20.1, 30.5) compared to PWoD (21.9; 95% CI 20.3, 23.5), but differences were not statistically significant. The association of dementia with hip fracture-but not pneumonia or widowhood-was modified by gender (male incidence rate ratio [IRR] 2.24, 95% CI 1.34, 3.75 versus female IRR 1.31 95% CI 0.92,1.86); interaction term p = 0.02). CONCLUSIONS Compared to PWoD, community-dwelling PWD had higher rates of pneumonia and hip fracture, but not widowhood. Knowing how often PWD experience these events can aid in anticipatory guidance and care planning for this growing population.
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Affiliation(s)
- Lauren J Hunt
- Department of Physiological Nursing, University of California, San Francisco, California, USA.,Global Brain Health Institute, University of California, San Francisco, California, USA
| | - R Sean Morrison
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,James J. Peters VA Medical Center, Bronx, New York, USA
| | - Siqi Gan
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA
| | - Edie Espejo
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA
| | - Katherine A Ornstein
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - W John Boscardin
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA.,Department of Epidemiology & Biostatistics, University of California, San Francisco, California, USA
| | - Alexander K Smith
- James J. Peters VA Medical Center, Bronx, New York, USA.,Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA
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Pneumonia risk and its associated factors in Parkinson's disease: A National Database Study. J Neurol Sci 2020; 415:116949. [PMID: 32505011 DOI: 10.1016/j.jns.2020.116949] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 05/21/2020] [Accepted: 05/25/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Despite pneumonia being an emerging burden on Parkinson's disease patients, there is essentially nothing known on whether they are at an increased risk of pneumonia occurrence and their associated factors. OBJECTIVES To determine whether Parkinson's disease is associated with the risk of pneumonia and its associated factors. METHODS Using nationwide database that covers the whole population in South Korea from 2002 to 2017, we identified newly diagnosed Parkinson's disease patients in 2004-2006, and selected four age- and sex-matched controls for each patient from the general population. From these patients and controls, we identified pneumonia occurrence until the end of the study period, and plotted Kaplan-Meier curves and Cox proportional hazards model to determine its risk. RESULTS We identified 10,159 Parkinson's disease patients and matched 39,574 controls. These patients showed a higher incidence rate than controls (11.21 vs. 3.61 events/1000 person-years) throughout the study period, and were at an increased risk of pneumonia (hazard ratio = 2.26; 95% CI, 2.17-2.36) even after adjusting for confounders. Old age, male sex, region of residence, diabetes mellitus, congestive heart failure, tuberculosis, atrial fibrillation, chronic kidney disease, cerebrovascular disease, dementia, chronic obstructive pulmonary disease, seizure disorder and antidiabetic drug usage were all associated with a higher risk of pneumonia, while dyslipidemia and antihypertensive medication usage lowered the risk. CONCLUSIONS Parkinson's disease patients may be more likely to experience pneumonia compared to the general population throughout the disease course from diagnosis. Therefore, physicians should focus on the modifiable risk factors of pneumonia in such patients.
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Ricchizzi E, Latour K, Kärki T, Buttazzi R, Jans B, Moro ML, Nakitanda OA, Plachouras D, Monnet DL, Suetens C, Kinross P. Antimicrobial use in European long-term care facilities: results from the third point prevalence survey of healthcare-associated infections and antimicrobial use, 2016 to 2017. ACTA ACUST UNITED AC 2019; 23. [PMID: 30458913 PMCID: PMC6247460 DOI: 10.2807/1560-7917.es.2018.23.46.1800394] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Antimicrobials are commonly prescribed and contribute to the development of antimicrobial resistance in long-term care facilities (LTCFs). In 2010, the European Centre for Disease Prevention and Control initiated point prevalence surveys (PPS) of healthcare-associated infections and antimicrobial use in European LTCFs, performed by external contractors as the Healthcare-Associated infections in Long-Term care facilities (HALT) projects. Here, we investigated prevalence and characteristics of antimicrobial use and antimicrobial stewardship indicators in European LTCFs in 2016–17. Twenty-four European Union/European Economic Area (EU/EEA) countries, the former Yugoslav Republic of Macedonia and Serbia participated in the third PPS in European LTCFs. Overall, 4.9% (95% confidence interval: 4.8–5.1) of LTCF residents in the EU/EEA participating countries received at least one antimicrobial. The most commonly reported Anatomical Therapeutic Chemical (ATC) groups were beta-lactam antibacterials/penicillins (J01C), other antibacterials (J01X) (e.g. glycopeptide antibacterials, polymyxins), quinolones (J01M), sulfonamides and trimethoprim (J01E), and other beta-lactams (J01D). Urinary tract infections and respiratory tract infections were the main indications for antimicrobial prescription. This PPS provides updated and detailed information on antimicrobial use in LTCFs across the EU/EEA that can be used to identify targets for future interventions, follow-up of these interventions and promote prudent use of antimicrobials in European LTCFs.
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Affiliation(s)
- Enrico Ricchizzi
- Agenzia sanitaria e sociale regionale - Regione Emilia Romagna, Bologna, Italy
| | | | - Tommi Kärki
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Rossella Buttazzi
- Agenzia sanitaria e sociale regionale - Regione Emilia Romagna, Bologna, Italy
| | | | - Maria Luisa Moro
- Agenzia sanitaria e sociale regionale - Regione Emilia Romagna, Bologna, Italy
| | | | | | | | - Carl Suetens
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Pete Kinross
- European Centre for Disease Prevention and Control, Solna, Sweden
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