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M. Patil S. Hospital-Acquired Pneumonia. Infect Dis (Lond) 2022. [DOI: 10.5772/intechopen.101236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Pneumonia acquired during hospitalization is called nosocomial pneumonia (NP). Nosocomial pneumonia is divided into two types. Hospital-acquired pneumonia (HAP) refers to hospital-acquired pneumonia, whereas ventilator-associated pneumonia (VAP) refers to ventilator-associated pneumonia. Most clinical literature stresses VAP’s importance and associated mortality and morbidity, whereas HAP is not given enough attention even while being the most common cause of NP. HAP, like VAP, carries a high mortality and morbidity. HAP is the commonest cause of mortality from hospital-acquired infections. HAP is a common determinant for intensive care unit (ICU) admits with respiratory failure. Recent research has identified definite risk factors responsible for HAP. If these are prevented or modified, the HAP incidence can be significantly decreased with improved clinical outcomes and lesser utilization of the health care resources. The prevention approach will need multiple strategies to address the issues. Precise epidemiological data on HAP is deficient due to limitations of the commonly used diagnostic measures. The diagnostic modalities available in HAP are less invasive than VAP. Recent infectious disease society guidelines have stressed the importance of HAP by removing healthcare-associated pneumonia as a diagnosis. Specific differences exist between HAP and VAP, which are gleaned over in this chapter.
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Izumi M, Isobe A, Akifusa S. Posterior teeth occlusion is related independently to onset of fever in residents of aged person welfare facility: Perspective cohort study. Gerodontology 2021; 39:170-176. [PMID: 33749006 DOI: 10.1111/ger.12551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/08/2021] [Accepted: 03/08/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Onset of fever is a common presentation of symptoms in older adults. Loss of posterior teeth occlusion provokes dysphagia, which is commonly related to infectious diseases of the respiratory tract. However, a correlation between posterior teeth occlusion and the onset of fever has not been studied. The aim of the present study was to investigate whether posterior teeth occlusion is correlated with the onset of fever in residents of aged person welfare facilities. METHODS This perspective cohort study was carried out from February 2019 to December 2019 in Kitakyushu, Japan. The follow-up period was 8 months. Overall, 141 residents aged ≥ 65 years from 10 aged person welfare facility were included. Dates when the body temperatures of participants were more than 37.2°C were recorded. Posterior teeth occlusion was evaluated by assessing functional tooth units (FTUs). RESULTS Data from 100 participants [median age, 89 (67-102)] were used for analysis. Total of 53 participants got a fever. The Kaplan-Meier analysis showed that the average period until onset of fever in participants with scores 0, 1-11 and 12 for FTU was 7.7 ± 0.6, 7.4 ± 1.0 and 3.9 ± 1.0, respectively. Cox's proportional hazards regression model revealed that participants with FTU = 0 were at higher risk of fever compared with those with FTU = 12 (hazards ratio: 3.2, 95% confidence interval: 1.4-7.7), adjusted for possible confounders. CONCLUSIONS Posterior teeth occlusion correlated with the risk of fever in older residents of nursing homes.
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Affiliation(s)
- Maya Izumi
- School of Oral Health Sciences, Faculty of Dentistry, Kyushu Dental University, Fukuoka, Japan
| | - Ayaka Isobe
- School of Oral Health Sciences, Faculty of Dentistry, Kyushu Dental University, Fukuoka, Japan
| | - Sumio Akifusa
- School of Oral Health Sciences, Faculty of Dentistry, Kyushu Dental University, Fukuoka, Japan
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Saito M, Shimazaki Y, Nonoyama T, Tadokoro Y. Association of oral health factors related to oral function with mortality in older Japanese. Gerodontology 2020; 38:166-173. [PMID: 33184952 DOI: 10.1111/ger.12508] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 10/17/2020] [Accepted: 10/24/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To examine the effects of oral health factors related to oral function and their combination on mortality in older people. BACKGROUND Recent studies have reported that oral factors, including oral function, are associated with mortality. MATERIALS AND METHODS The participants were 4765 community-dwelling individuals aged 75 and 80 years. The follow-up period for survival or death was 3.5 years, and the date of death was defined based on data managed by the insurer. A Cox proportional hazard model was applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality as dependent variables for oral health factors, including the number of teeth, swallowing disability, oral dryness and oral hygiene and the combinations of oral health factors as independent variables. RESULTS In univariate analyses, all four oral health factors were significantly associated with mortality. After adjusting for age, sex, smoking, body mass index and medical history, and analysing the oral health factors separately, swallowing difficulty had the highest HR for mortality (adjusted HR, 2.12; 95% CI, 1.35-3.33). In the analysis using combinations of oral health factors as the independent variable, the participants with swallowing disability, oral dryness and poor oral hygiene had the highest HR for mortality (adjusted HR, 8.35; 95% CI, 3.45-21.08). CONCLUSION Oral health factors related to oral function appear to be associated with mortality risk and an accumulation of oral health factors increases mortality risk among older people.
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Affiliation(s)
- Mizuki Saito
- Department of Preventive Dentistry and Dental Public Health, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Yoshihiro Shimazaki
- Department of Preventive Dentistry and Dental Public Health, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Toshiya Nonoyama
- Department of Preventive Dentistry and Dental Public Health, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
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Abstract
PURPOSE OF REVIEW Hospital-acquired pneumonia (HAP) is the leading cause of death from hospital-acquired infection. Little work has been done on strategies for prevention of HAP. This review aims to describe potential HAP prevention strategies and the evidence supporting them. Oral care and aspiration precautions may attenuate some risk for HAP. Oral and digestive decontamination with antibiotics may be effective but could increase risk for resistant organisms. Other preventive measures, including isolation practices, remain theoretical or experimental. RECENT FINDINGS Hospital-acquired pneumonia occurs because of pharyngeal colonization with pathogenic organisms and subsequent aspiration of these pathogens. SUMMARY Most potential HAP prevention strategies remain unproven.
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Affiliation(s)
- Virginia Prendergast
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ (V.P.); and Villanova University College of Nursing, PA (J.L.H.)
| | - Janice L. Hinkle
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ (V.P.); and Villanova University College of Nursing, PA (J.L.H.)
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Saensom D, Merchant AT, Wara-Aswapati N, Ruaisungnoen W, Pitiphat W. Oral health and ventilator-associated pneumonia among critically ill patients: a prospective study. Oral Dis 2016; 22:709-14. [PMID: 27388365 DOI: 10.1111/odi.12535] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 06/14/2016] [Accepted: 07/03/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate the association between oral health and ventilator-associated pneumonia (VAP) among critically ill patients. METHODS A prospective cohort study was conducted among 162 critically ill patients newly intubated and treated with mechanical ventilator in one tertiary hospital in Thailand. Oral health status was assessed using Oral Health Assessment Tool (OHAT), Plaque Index (PI), and number of teeth. VAP, defined as Clinical Pulmonary Infection Score >6, was assessed on Day 4 after intubation. Hazard ratios and 95% confidence intervals (CIs) were calculated using Cox proportional hazards regression adjusted for confounders. RESULTS Critically ill patients had deteriorating oral health status after intubation. Early-onset VAP developed in 69 patients (42.6%), with VAP incidence of 117 episodes per 1000 ventilator-days. Moderately unhealthy and unhealthy oral conditions based on OHAT scores were associated with a 2.92-fold (95% CI: 1.26-6.74) and 3.22-fold (95% CI: 1.34-7.76) increased risk of VAP. Patients with moderate-to-very poor oral hygiene assessed by PI had increased VAP risk of 1.66-folds (95% CI: 1.001-2.75). The number of teeth was not associated with VAP development. CONCLUSIONS There is a strong association between poor oral health and increased risk for early-onset VAP. Routine oral care possibly prevents VAP development among critically ill patients treated with mechanical ventilator.
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Affiliation(s)
- D Saensom
- Graduate School, Khon Kean University, Khon Kaen, Thailand.,Faculty of Nursing, Khon Kean University, Khon Kaen, Thailand
| | - A T Merchant
- School of Public Health, University of South Carolina, Columbia, SC, USA
| | - N Wara-Aswapati
- Faculty of Dentistry, Khon Kean University, Khon Kaen, Thailand.,Chronic Inflammatory and Systemic Diseases Associated with Oral Health Research Group, Khon Kean University, Khon Kaen, Thailand
| | - W Ruaisungnoen
- Faculty of Nursing, Khon Kean University, Khon Kaen, Thailand
| | - W Pitiphat
- Faculty of Dentistry, Khon Kean University, Khon Kaen, Thailand. .,Chronic Inflammatory and Systemic Diseases Associated with Oral Health Research Group, Khon Kean University, Khon Kaen, Thailand.
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Seo HY, Jeon JE, Chung WG, Kim NH. Activities of daily living and oral hygiene status of older Korean patients in a long-term care facility. Int J Dent Hyg 2016; 15:154-160. [DOI: 10.1111/idh.12194] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2015] [Indexed: 11/28/2022]
Affiliation(s)
- H-Y Seo
- Department of Dental Hygiene; Wonju College of Medicine; Yonsei University; Republic of Korea
- Department and Research Institute of Dental Biomaterials and Bioengineering; College of Dentistry; Yonsei University; Seoul Republic of Korea
| | - J-E Jeon
- Research Institute for Dental Care Policy; Korean Dental Association; Republic of Korea
- Health Policy Institute; Korean Dental Association; Seoul, Republic of Korea
| | - W-G Chung
- Department of Dental Hygiene; Wonju College of Medicine; Yonsei University; Republic of Korea
| | - N-H Kim
- Department of Dental Hygiene; Wonju College of Medicine; Yonsei University; Republic of Korea
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Huang YC, Chu CL, Ho CS, Lan SJ, Chen WY, Liang YW, Hsieh YP. Factors affecting institutionalized older peoples' self-perceived dry mouth. Qual Life Res 2014; 24:685-91. [PMID: 25150709 PMCID: PMC4349962 DOI: 10.1007/s11136-014-0792-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2014] [Indexed: 11/29/2022]
Abstract
Purpose The purpose of this study was to determine the factors affecting institutionalized older peoples’ self-perceived dry mouth. Methods This cross-sectional study was conducted on elderly residents at 22 long-term care facilities. A total of 165 questionnaires were returned from 13 senior citizen welfare institutions (SCWIs) and nine nursing homes. Multiple logistic regression analysis was used to analyze the data obtained. Results The results showed that the type of long-term care (LTC) facility, regular oral examinations, wearing dentures, and the ability to chew sticky foods affected self-perceived dry mouth. This study determined an association between the type of LTC facility where the participants lived and self-perceived dry mouth. Conclusions The results indicated the importance of providing oral care in order to improve and prevent dry mouth among institutionalized older people living in SCWIs who do not undergo regular oral examinations, wear dentures, and have difficulty chewing sticky foods.
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Affiliation(s)
- Ying-Chia Huang
- Department of Healthcare Administration, Asia University, Taichung City, Taiwan, ROC,
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Kakudate N, Muramatsu T, Endoh M, Satomura K, Koseki T, Sato Y, Ito K, Ogasawara T, Nakamura S, Kishimoto E, Kashiwazaki H, Yamashita Y, Uchiyama K, Nishihara T, Kiyohara Y, Kakinoki Y. Factors associated with dry mouth in dependent Japanese elderly. Gerodontology 2012; 31:11-8. [PMID: 22672112 DOI: 10.1111/j.1741-2358.2012.00685.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To identify factors associated with dry mouth. BACKGROUND Dry mouth adversely affects oropharyngeal health, particularly in elderly, and can lead to pneumonia. A better understanding of the epidemiology of dry mouth is therefore important in improving treatment strategies and oral health in high-risk elderly patients. METHODS We conducted a cross-sectional study involving 383 dependent Japanese elderly individuals (65-84 [n = 167] and ≥85 [n = 216] years) at eight long-term care facilities and hospitals. Thirty-four potential factors associated with dry mouth were examined by multiple logistic regression analysis. The primary outcome was dry mouth, as diagnosed by tongue dorsum moisture. RESULTS We identified that body mass index and severity of physical disability were identified as a potential factors associated with dry mouth in the super-elderly (≥85 years) group, whereas severity of physical disability, outcome measurement time, high daily water consumption, mouth breathing, use of antidepressants and diuretics, and high frequency of daily brushing (≥2 times per day; Odds ratio: 5.56; 95% Confidence Interval: 1.52-20.00) were associated with dry mouth in the 65- to 84-year-old group. CONCLUSION To our knowledge, this is the first study to identify a link between frequency of daily brushing and dry mouth and suggests that tooth brushing should be encouraged in high-risk dependent Japanese elderly (65-84 years), particularly those taking antidepressants and/or diuretics.
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Affiliation(s)
- Naoki Kakudate
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA; Department of Epidemiology and Healthcare Research, Kyoto University School of Medicine and Public Health, Kyoto, Japan
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Tada A, Miura H. Prevention of aspiration pneumonia (AP) with oral care. Arch Gerontol Geriatr 2011; 55:16-21. [PMID: 21764148 DOI: 10.1016/j.archger.2011.06.029] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Revised: 06/22/2011] [Accepted: 06/23/2011] [Indexed: 10/17/2022]
Abstract
AP is a major cause of morbidity and mortality in elderly patients, especially frail elderly patients. The aim of this article is to review effect of oral care, including oral hygiene and improvement of oral function, on the prevention of AP among elderly people in hospitals and nursing homes. There is now a substantial body of work studying the effect of oral care on the prevention of respiratory diseases. Oral hygiene, consisting of oral decontamination and mechanical cleaning by dental professionals, has resulted in significant clinical effects (decreased incidence of pneumonia and decreased mortality from respiratory diseases) in clinical randomized trials. Moreover, studies examining oral colonization by pneumonia pathogens have shown the effect of oral hygiene on eliminating these pathogens. In addition, swallowing training has been shown to improve the movement and function of swallowing-related muscles, also resulting in decreased incidence of pneumonia. These findings support the contention that oral care is effective in the prevention of AP.
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Affiliation(s)
- Akio Tada
- Department of Health Science, Hyogo University, 2301 Shinzaike Hiraoka-cyo, Kakogawa, Hyogo 675-0195, Japan.
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van der Maarel-Wierink CD, Vanobbergen JNO, Bronkhorst EM, Schols JMGA, de Baat C. Risk factors for aspiration pneumonia in frail older people: a systematic literature review. J Am Med Dir Assoc 2011; 12:344-54. [PMID: 21450240 DOI: 10.1016/j.jamda.2010.12.099] [Citation(s) in RCA: 173] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 12/28/2010] [Accepted: 12/28/2010] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To systematically review the risks for aspiration pneumonia in frail older people and the contribution of bad oral health among the risk factors. DESIGN Systematic literature review. SETTING PubMed (Medline), Web of Science, Cochrane Library, EMBASE, and CINAHL were searched for eligible studies, published in English in the period January 2000 to April 2009. PARTICIPANTS Frail older people. MEASUREMENTS Only publications with regard to hospitalized, institutionalized, or frail home-dwelling people of 60 years and older were eligible. Two authors independently assessed the publications for their methodological quality. Unadjusted and adjusted odds ratios and their corresponding 95% confidence intervals for respective risk factors related to aspiration pneumonia were extracted. The results were evaluated according to the levels of evidence of the Oxford Centre for Evidence-based Medicine. RESULTS A total of 21 publications fulfilled the quality criteria. Evidence level 2a (systematic review with homogeneity of cohort studies) was found for a positive relationship between aspiration pneumonia and age, male gender, lung diseases, dysphagia, and diabetes mellitus; 2b (individual cohort study) for severe dementia, angiotensin I-converting enzyme deletion/deletion genotype, and bad oral health; 3a (systematic review with homogeneity of case-control studies) for malnutrition; 3b (individual case-control study) for Parkinson's disease and the use of antipsychotic drugs, proton pump inhibitors, and angiotensin-converting enzyme inhibitors. The contribution of bad oral health among the risk factors seems limited. CONCLUSION Thirteen significant risk factors were identified: age, male gender, lung diseases, dysphagia, diabetes mellitus, severe dementia, angiotensin I-converting enzyme deletion/deletion genotype, bad oral health, malnutrition, Parkinson's disease, and the use of antipsychotic drugs, proton pump inhibitors, and angiotensin-converting enzyme inhibitors. The contribution of bad oral health seems limited.
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Takeshita T, Tomioka M, Shimazaki Y, Matsuyama M, Koyano K, Matsuda K, Yamashita Y. Microfloral Characterization of the Tongue Coating and Associated Risk for Pneumonia-Related Health Problems in Institutionalized Older Adults. J Am Geriatr Soc 2010; 58:1050-7. [DOI: 10.1111/j.1532-5415.2010.02867.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Saito T. Hyposalivation is Associated with High BMI Among Young Adults and is Associated with Medication in Older Adults in Sweden. J Evid Based Dent Pract 2009; 9:242-3. [PMID: 19913751 DOI: 10.1016/j.jebdp.2009.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Toshiyuki Saito
- Department of Oral Health, Unit of Social Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8588, Japan.
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