Impact of Oral Hygiene Management through a Multidisciplinary Approach on Patients with Acute Stroke: Building a Pneumonia-Prevention System by Dentistry

Abstract

Objective:　Our hospital constructed a pneumonia-prevention system in which ward nurses, dental staff and rehabilitation staff participate in acute wards. We aimed to examine the effect of a multidisciplinary approach for the management of acute stroke on the incidence of pneumonia and the inability to eat.　Methods:　The pneumonia-prevention system for all inpatients consists of oral assessment, oral care, dental request procedure, and sharing the status of swallowing assessment by the rehabilitation department. A total of 234 patients (127 men, 107 women, mean age 72±13 years) were selected from those who were hospitalized for a clinical presentation of stroke between April 2012 and March 2013 before the system was introduced, and 203 patients (107 men, 96 women, mean age 74±11 years) were selected from those hospitalized between April 2014 and March 2015 after the system was established. Their attributes during hospital admission and later (outcome) were assessed retrospectively by reviewing the medical records, a diagnosis procedure combination (DPC) database, and a patient clinical database operated by the rehabilitation and dental departments. These were then analyzed before the introduction and after the establishment of the system.　Results:　Subjects after establishment of the system could be interpreted as more severe than those before intervention. The incidence of pneumonia was 15% before introduction and 8% after establishment. The odds ratio for pneumonia onset comparing those before introduction with those after establishment was 2.70 (95% CI 1.17―6.21, p＝0.020). In addition, the Japan Coma Scale grade and initial dysphagia severity scale score were significantly associated with pneumonia onset. There was no change in the rate of oral intake at discharge, but it was considered significant that it did not reduce the proportion in the more severe group.　Conclusions:　Our system is effective in the prevention of pneumonia and continuation of oral intake. This is thought to be the result of cooperation among ward nurses, dental staff and rehabilitation staff.