Rush to Brush: Oral hygiene as a novel weapon against infection

Preparing for surgery can be a frightening and often overwhelming experience. We worry about our health, our family and the many responsibilities we must navigate before and after an operation.

Packing a toothbrush, toothpaste and mouthwash may be at the bottom of the “to-do” list, but it could prove to be the difference between a smooth recovery and serious complications.

Surgery creates a perfect storm of conditions to wreak havoc on a patient’s oral health, and subsequently their overall health. Surgical patients often lie on their backs for hours, sometimes heavily medicated, allowing bacterial overgrowth to occur in their mouths. These bacteria can lead to medical complications elsewhere in the body, including the lungs. Numerous studiesPedersen PU, Larsen P, Hakonsen SJ. The effectiveness of systematic perioperative oral hygiene in reduction of postoperative respiratory tract infections after elective thoracic surgery in adults: a systematic review. JBI database of systematic reviews and implementation reports 2016;14(1):140-73. doi: 10.11124/jbisrir-2016-2180. https://www.ncbi.nlm.nih.gov/pubmed/26878926Pássaro L, Harbarth S, Landelle C. Prevention of hospital-acquired pneumonia in non-ventilated adult patients: a narrative review. Antimicrobial Resistance and Infection Control 2016;5 doi: 10.1186/s13756-016-0150-3. https://www.ncbi.nlm.nih.gov/pubmed/27895901Quinn, B., D.L. Baker, S. Cohen, J.L. et al. Basic nursing care to prevent nonventilator hospital‐acquired pneumonia. J Nursing Scholarship 2014; 46(1):11-19. https://www.ncbi.nlm.nih.gov/pubmed/24119253 have found that a focus on oral hygiene can play a big role in preventing pneumonia, the leading hospital-associated infection (HAI) in the United States.

“It just seemed too simple that a toothbrush could make such an impact…we couldn’t believe it,” said Dian Baker, PhD, nurse-researcher and Professor at Sacramento State University. “But of course, now we know it works and we just need to get the word out. By helping people have better oral hygiene in the hospital, we can make a significant difference in patient outcomes”

Oral care is not generally a priority in hospitals today. The dental products and education that patients receive during their stays—if they get any at all—may be low-quality.

Aetna is leading the charge by launching an oral care initiative, Rush to Brush, in collaboration with Dr. Baker, Johnson & Johnson and Colgate-Palmolive.

”We will be identifying members with upcoming inpatient surgeries via pre-certification data, and mailing them oral hygiene kits before their procedure,” said Dan Knecht, M.D., Aetna Vice President of Clinical Strategy & Policy.

The personalized kits include a high-quality soft-bristled toothbrush, Colgate Total toothpaste and Listerine Zero Alcohol Cool Mint packaged in a travel pouch, as well as a personalized ‘Get Well Soon’ card with easy-to-follow oral hygiene tips for patients’ hospital stays.

Pneumonia occurs in approximately 2-5% of all surgeries and almost always originates in the mouth.https://www.cdc.gov/hai/surveillance/index.html Once a patient contracts pneumonia, it is life threatening—the mortality rate has varied between 20-40% over the past several decades.https://www.journal-surgery.net/article/S1743-9191(16)00052-2/pdfhttp://annals.org/aim/fullarticle/714929/who-gets-pneumonia-after-surgery A recent study published in the New England Journal of Medicine found no significant reduction in hospital-acquired pneumonia cases over the past several years, despite encouraging reductions in other HAIs in that same timeframe.N Engl J Med 2018; 379:1732-1744DOI: 10.1056/NEJMoa180155

“Having made rounds in hospitals for years, I can attest to the fact that oral hygiene is frequently on the backburner of acute inpatient health care,” said Dr. Knecht. “This program offers resources and actionable insights for our members. We hope this initiative will also raise the visibility of this important health issue within the medical community.”

The program, launching in late 2018, will reach 36,000 Aetna members across the country over the course of about one year.“We want to shift the paradigm around oral health in hospitals. It’s actually more important to take care of your teeth and mouth when you go in for surgery, not less,” said Mary Lee Conicella, DMD, Chief Dental Officer at Aetna. “We’re leveraging data to contact patients with critical information and resources at a point in their health journey that can make a real difference in their recovery.”