[Fwd: [Fwd: [DYSPHAGIA] glucose oxidase test strips & aspiration]-Reply]

[eripley@yahoo.com (Irene Campbell-Taylor)]

> 
> I would be interested to learn more about the
> documented frequency of the 
> various causes of aspiration. Do you know specific
> studies that I could 
> research to find the numbers? I am hoping that a
> written study shown to the 
> administrators might facilitate a change (however
> slight it may be) in my 
> facility to ensure better patient oral hygiene.
Dear Lauren,

There are multiple studies, from areas such as
respirology, (obviously), dentistry, infectious
diseases etc. A good place to start is with the
article and references in 
http://www.medscape.com/Medscape/RespiratoryCare/journal/1998/v02.n01/mrc3075.cassiere/mrc3075.cassiere.html
See also:
Limeback H. Implications of oral infections on
systemic diseases in the institutionalized elderly
with a special focus on pneumonia.Ann Periodontol,
3:262-275.1998.
A likely and common route of systemic infection by
oral microorganisms is through aspiration of
oropharyngeal fluids containing oral pathogenic
microorganisms, which colonize the lower respiratory
tract and cause pneumonia. Respiratory pathogens
emerge in the dental plaque of elderly patients with
very poor oral hygiene and severe periodontal disease.
In the chronic care setting, aspiration of
oropharyngeal fluids contaminated with these bacteria
occurs in patients with diminished host defenses,
resulting in bacterial pneumonia. This is also a
problem in intensive care units in the hospital
setting. In one study, pre-rinsing with a 0.12%
chlorhexidine gluconate mouthwash significantly
lowered the mortality rate from postsurgical pneumonia
in patients undergoing open heart surgery. Selective
digestive decontamination, a technique involving the
topical application of antimicrobials to reduce the
risk of colonization of the respiratory tract, has
been used to reduce the incidence of nosocomial
pneumonia in the acute care setting of hospitals. This
technique has not been employed in the nursing home
setting. 

Langmore SE; Terpenning MS; Schork A; Chen Y; Murray
JT; Lopatin D; Loesche WJ. Predictors of aspiration
pneumonia: how important is dysphagia? Dysphagia,
13:69-81  1998 
189 elderly subjects were followed for up to 4 years
for an outcome of verified aspiration pneumonia. The
best predictors of development of  pneumonia were, 
dependent for feeding, dependent for oral care, number
of decayed teeth, tube feeding, more than one medical
diagnosis, number of medications, and smoking.

The early studies of aspiration pneumonia that one
sees constantly cited as evidence of the lethal
effects of aspiration ( e.g. Bartlett, Cameron &
Zuidema) were referring to aspiration of gastric
contents and/or aspiration of saliva from mouths with
severe gum disease.

Perhaps if every clinician involved with dysphagic
patients were to insist that mouths be kept clean, or
their intervention is essentially undermined, we might
 see a change. To try to head off the development of
pneumonia in a patient at high risk because of
malnutrition, dehydration, general frailty, trauma
etc. is like pushing a rope up a hill if the patient's
mouth isn't kept scrupulously clean.
Irene.


> 


=====
Irene Campbell-Taylor, PhD
Clinical Neuroscientist

If one tells the truth, one is sure, sooner or later, to be found out.
Oscar Wilde.

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