Michael Hunter, MD on Medika Life

Two Simple Ways to Lower Your Risk of Dying in the Hospital

Hospital-acquired pneumonia is not uncommon. Toothbrushing and mobilizing patients can dramatically lower the risk.

ONE IN EVERY 100 HOSPITAL PATIENTS in the USA develops pneumonia, with the infection then killing 15 to 30 percent of them.

For survivors, the infection extends hospital stays for up to 15 days and increases the chances of readmission within a month. The National Organization for NV-HAP Prevention offers these observations.

These disturbing figures are likely an underestimate of the incidence of hospital-acquired pneumonia. Now comes evidence that two simple maneuvers can significantly improve the statistics. Can you guess what they are?

Hospital-acquired pneumonia — improving the odds

The two things with the best evidence of preventing hospital-=acquired pneumonia are not particularly expensive or challenging to implement. Here they are:

  • Brushing teeth
  • Getting patients mobilized

Limited data suggest that it is that simple.

DVT of the right leg. Note the swelling and redness. Photo courtesy of Wikipedia (https://en.wikipedia.org/wiki/Deep_vein_thrombosis)

Dodging pneumonia: Brush your teeth.

Let’s look at the experience of Orlando Regional Medical Center in Florida (USA).

Patients in the medical unit who received enhanced oral care had an 85 percent reduction in the risk of developing hospital-acquired pneumonia. Those in the surgical unit saw their risk cut by more than half (56 percent) compared with those who received routine care.

Not convinced? Perhaps a study from a Veteran’s Administration Hospital in Salem, Virginia (USA) will bring you around. Following the introduction of an oral care pilot in 2016, the rates of hospital-acquired pneumonia dropped by a whopping 92 percent.

That improvement in pneumonia rates translated to saving an estimated 13 lives in only 19 months. The Veteran’s Health Administration has broadened the approach across its system. Learn more about the so-called HAPPEN Initiative here:VHA Innovation EcosystemHAPPEN (Hospital-Acquired Pneumonia Prevention by Engaging Nurses) began in October 2016 at the Salem VA Medical…www.va.gov

We should shout such outcomes from the rooftops. A simple and inexpensive maneuver can remarkably improve our patients’ outcomes.

Photo by Stephen Andrews on Unsplash

Dodging pneumonia: Move

I knew well the perils of not getting patients moving. Deep vein thrombosis (DVT) occurs when a blood clot — a thrombus — forms in one or more deep veins, typically in the legs. Patients may report leg pain or swelling, but sometimes there are no symptoms.

Certain medical conditions, including some cancers, raise the chances of DVT. Another cause is not moving for long periods of time. When I travel long distances by car, train, or air, I always make sure to get up regularly.

Here’s the problem with deep venous thrombosis: The blood clots in the veins can break loose, travel through the bloodstream, and get stuck in the lungs. This phenomenon can blood blood flow in the lungs, a condition known as pulmonary embolism (PE). If DVT and pulmonary embolism occur together, we have venous thromboembolism (VTE).

Dodging pneumonia: Brush your teeth and move

Let’s look at some compelling evidence that brushing your teeth and moving can dramatically lower your chances of developing hospital-acquired pneumonia. A Kaiser Permanente study of 21 hospitals in California (USA) focused on oral care and getting patients out of bed. The results are impressive:

This dual strategy of oral care and mobilization dropped the rates of hospital-acquired pneumonia by around 70 percent.

The Smithsonian Museum (USA) observes that you could die from a broken arm not very long ago — and many did. That all changed with the idea that seems obvious today: surgery needs to be sterile.

In 1867, Dr. Joseph Lister published an article in The Lancet that revolutionized medicine. “An Address on the Antiseptic System of Treatment in Surgery” described a new way of practicing operations that he first presented in Glasgow, Scotland.

The great innovation? Kill germs. Lister used a carbolic acid spray on wounds, dressings and surgical tools. He also washed his hands. The acid killed the germs before they had a chance to cause infection, and the hand-washing kept the surgeon from introducing new germs to the surgical field.

Sound familiar?

Thank you for joining me in this look at a simple, practical, and inexpensive way to save the lives of our hospitalized patients.

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Michael Hunter, MD
I received an undergraduate degree from Harvard, a medical degree from Yale, and trained in radiation oncology at the University of Pennsylvania. I practice radiation oncology in the Seattle area.

Michael Hunter, MD

I received an undergraduate degree from Harvard, a medical degree from Yale, and trained in radiation oncology at the University of Pennsylvania. I practice radiation oncology in the Seattle area.

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