Pneumonia arising in a hospitalised patient who is not ventilated is usually seeded from the mouth and pharynx. Dysphagia, reduced consciousness, poor dentition, dry mouth, sedating drugs and lying flat all raise the risk, and patients who are frail or recovering from stroke carry several at once.
Simple measures that reduce aspiration and oral bacterial load are established ward practice: screening swallowing before oral intake after a stroke, sitting patients up for meals and after them, and keeping the mouth and teeth clean. They cost little and are often the first things to slip on a busy ward.
- Screen swallowing before oral intake in patients after a stroke or with reduced consciousness.
- Sit patients upright for meals and for a period afterwards.
- Review sedatives and anticholinergics that dry the mouth or dull the cough reflex.
- Include tooth brushing in the daily care plan of dependent patients.
Why it matters
The patients at highest risk of ward pneumonia are the ones least able to care for their own mouths.
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