A Virginia VA hospital’s simple solution to prevent pneumonia? Toothbrushes

Beginning in late 2016, nurses at the Salem Veterans Affairs Medical Center Community Living Centers began ensuring patients brushed their teeth twice a day. (Getty/CentralITAlliance)

A Virginia VA hospital found it could dramatically reduce its cases of pneumonia with a surprisingly simple and affordable change: Getting patients to brush their teeth. 

Beginning in late 2016, nurses at the Salem Veterans Affairs Medical Center Community Living Centers began ensuring patients brushed their teeth twice a day. 

Since then, the number of nonventilator cases of hospital-acquired pneumonia have decreased by 90%. 

“Toothbrushing is saving lives,” said Shannon Munro, Ph.D., a nurse researcher at the hospital speaking at the Veterans Health Administration’s Innovation Experience event in Washington, D.C., on Thursday.

Calling the program Project HAPPEN (Hospital-Acquired Pneumonia Prevention by Engaging Nurses), they have expanded the effort to eight VA hospitals so far and have to date prevented 117 cases of pneumonia—saving an estimated 21 lives and reducing costs by $4.69 million. 

Developing Project HAPPEN was a collaborative effort between nurses, infection control experts, physicians and dental professionals, Munro said.

“It’s very important to use and our nursing staff have taken on this challenge to help our patients.” 

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When there is a lot of plaque on a patient’s teeth, it acts like “sticky sandpaper,” irritating the mouth and producing bacteria, Munro said. That bacteria can easily then travel down the throat and into the lungs, causing a pneumonia infection. 

Hospital-acquired pneumonia can be a significant risk for patients—especially elderly ones, as are often seeking care in the VA—and a recent study found that cutting rates nationwide by even just half could save nearly 10,000 lives a year.

The HAPPEN program doesn’t require a significant investment in either time or money—Salem VA spent an additional $5 on patients for supplies and it added two minutes of face-to-face time to a nurse’s day. 

Munro and her team are working with the Department of Veterans Affairs Innovation Network and its Diffusion of Excellence initiative to spread Project HAPPEN to more facilities. They’re aiming for 40 additional hospitals to join to the program in 2019. 

“We plan on rippling this across the United States,” Munro said. 

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Other hospitals that implemented the program so far have also seen it pay off, with pneumonia rates decreasing by at least 40%. Most recoup the cost for oral care items within three months, as it costs an average of $40,000 to treat one case of pneumonia. 

Ryan Vega, M.D., Diffusion of Excellence lead, said that if the program was scaled to every VA Medical Center, an estimated 1,000 lives could have been saved over the two-year life of the pilot program.

“These are real numbers and real people,” Vega said. “The work that these individuals are doing every day is truly changing and saving lives.” 

Check out this video produced as part of the project: