VA Maryland Health Care System

VA is using a surprisingly simple life-saving weapon, and it’s not new nor is it high-tech. It’s a toothbrush, and along with good oral hygiene, it can prevent deaths from pneumonia.

Poor oral hygiene while hospitalized is associated with an increased chance of developing pneumonia. “That’s because not taking care of teeth can lead to plaque which creates a bacteria-friendly environment in the mouth. That bacteria can easily travel down the throat and into the lungs, causing a pneumonia infection. And pneumonia can lead to sepsis, which is nearly always fatal to vulnerable patients,” explains Suzanne Hook, RN, MSN, Chief Nurse Administration/Operations at the VA Maryland Health Care System. “Providing consistent oral care to hospitalized Veterans and long-term care residents, however, has been shown to cut the risk of developing hospital-acquired pneumonia in half, thus saving lives.”

Hook is leading nurses at the VA Maryland Health Care System, in collaboration with Dental and other services, in an initiative aimed at achieving zero hospital acquired pneumonias related to mouth care. They are modeling Project HAPPEN, (Hospital Acquired Pneumonia Prevention by Engaging Nurses to provide oral care), which was first implemented at the Salem VA Medical Center in 2016. Project HAPPEN was shown to significantly reduce rates of pneumonia in hospitalized patients and is now considered a best practice throughout VA for its ability to save lives.

While oral care is not new at the VA Maryland Health Care System, documenting it daily in a patient’s records—a practice already established with intensive care patients—is being rolled out to all levels of care, starting with Veterans residing in Community Living Centers and acute care patients. Eventually, efforts to raise awareness about the link between daily basic oral care and pneumonia will extend to all staff and Veterans receiving outpatient care throughout the health care system.

“In terms of money and time, the investment per hospitalized patient is minimal,” Hook says. “Just a few dollars for supplies—toothbrushes, toothpaste, denture cleaner, lip moisturizers—and a few minutes per nursing shift to perform oral care for each patient or to remind those who are able to, to do it themselves.”

“We like to say, we’re making things HAPPEN. And we’re excited about the positive impact Project HAPPEN can have for our Veteran patients.”