Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2009 Jul;57(7):1226-31.
doi: 10.1111/j.1532-5415.2009.02311.x. Epub 2009 Jun 3.

Pilot testing of intervention protocols to prevent pneumonia in nursing home residents

Vincent Quagliarello  1 , Manisha Juthani-Mehta, Sandra Ginter, Virginia Towle, Heather Allore, Mary Tinetti
Affiliations
Randomized Controlled Trial

Pilot testing of intervention protocols to prevent pneumonia in nursing home residents

Vincent Quagliarello et al. J Am Geriatr Soc. 2009 Jul.

Abstract

Objectives: To test intervention protocols for feasibility, staff adherence, and effectiveness in reducing pneumonia risk factors (impaired oral hygiene, swallowing difficulty) in nursing home residents.

Design: Prospective study.

Setting: Two nursing homes.

Participants: Fifty-two nursing home residents.

Intervention: Thirty residents with impaired oral hygiene were randomly assigned to manual oral brushing plus 0.12% chlorhexidine oral rinse at different frequencies daily. Twenty-two residents with swallowing difficulty were randomly assigned to upright feeding positioning, teaching swallowing techniques, or manual oral brushing. All protocols were administered over 3 months.

Measurements: Feasibility was assessed monthly and defined as high if the protocol took less than 10 minutes to administer. Adherence was assessed weekly and defined as high if full staff adherence was demonstrated in more than 75% of assessments. Effectiveness for improved oral hygiene (reduction in oral plaque score) and swallowing (reduction in cough during swallowing) was compared at baseline and 3 months.

Results: Daily manual oral brushing plus 0.12% chlorhexidine rinse demonstrated high feasibility, high staff adherence, and effectiveness in improving oral hygiene (P<.001 vs baseline); this combination administered twice per day showed the highest plaque score reduction. Daily manual oral brushing and upright feeding positioning demonstrated high feasibility, high staff adherence, and effectiveness in improving swallowing.

Conclusion: Manual oral brushing, 0.12% chlorhexidine oral rinse, and upright feeding positioning demonstrated high feasibility, high staff adherence, and effectiveness in pneumonia risk factor reduction. A protocol combining these components warrants testing for its ability to reduce pneumonia in nursing home residents.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest: Vincent Quagliarello, M.D. – No financial conflicts regarding employment or affiliation, grants or funding, honoraria, speaker forum membership, consultant, stock ownership or options, royalties, expert testimony, advisory board, or patents as they relate to the sponsoring agent, products, technology and/or methodologies involved in the submitted paper. No personal conflicts regarding close family or personal relationship with owners or employees of the sponsoring agent or company associated with product, technology or methodology described in the submitted paper.

Manisha Juthani-Mehta, M.D. - No financial conflicts regarding employment or affiliation, grants or funding, honoraria, speaker forum membership, consultant, stock ownership or options, royalties, expert testimony, advisory board, or patents as they relate to the sponsoring agent, products, technology and/or methodologies involved in the submitted paper. No personal conflicts regarding close family or personal relationship with owners or employees of the sponsoring agent or company associated with product, technology or methodology described in the submitted paper.

Sandra Ginter, R.N. - No financial conflicts regarding employment or affiliation, grants or funding, honoraria, speaker forum membership, consultant, stock ownership or options, royalties, expert testimony, advisory board, or patents as they relate to the sponsoring agent, products, technology and/or methodologies involved in the submitted paper. No personal conflicts regarding close family or personal relationship with owners or employees of the sponsoring agent or company associated with product, technology or methodology described in the submitted paper.

Virginia Towle, M.Phil. - No financial conflicts regarding employment or affiliation, grants or funding, honoraria, speaker forum membership, consultant, stock ownership or options, royalties, expert testimony, advisory board, or patents as they relate to the sponsoring agent, products, technology and/or methodologies involved in the submitted paper. No personal conflicts regarding close family or personal relationship with owners or employees of the sponsoring agent or company associated with product, technology or methodology described in the submitted paper.

Heather Allore, Ph.D. - No financial conflicts regarding employment or affiliation, grants or funding, honoraria, speaker forum membership, consultant, stock ownership or options, royalties, expert testimony, advisory board, or patents as they relate to the sponsoring agent, products, technology and/or methodologies involved in the submitted paper. No personal conflicts regarding close family or personal relationship with owners or employees of the sponsoring agent or company associated with product, technology or methodology described in the submitted paper.

Mary Tinetti, M.D. - No financial conflicts regarding employment or affiliation, grants or funding, honoraria, speaker forum membership, consultant, stock ownership or options, royalties, expert testimony, advisory board, or patents as they relate to the sponsoring agent, products, technology and/or methodologies involved in the submitted paper. No personal conflicts regarding close family or personal relationship with owners or employees of the sponsoring agent or company associated with product, technology or methodology described in the submitted paper.

Comment in

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Fry AM, Shay DK, Holman RC, et al. Trends in hospitalizations for pneumonia among persons aged 65 years or older in the United States, 1988–2002. JAMA. 2005;294:2712–2719. - PubMed
    1. Muder R. Management of nursing home acquired pneumonia: unresolved issues and priorities for future investigation. J Am Geriatr Soc. 2000;48:95–96. - PubMed
    1. Yende S, Angus DC, Somes G, et al. Influence of comorbid conditions on long-term mortality after pneumonia in older people. J Amer Geriatr Soc. 2007;55:518–525. - PubMed
    1. Mody L, Rongjun S, Bradley SF. Assessment of pneumonia in older adults: effect of functional status. J Amer Geriatr Soc. 2006;54:1062–1067. - PMC - PubMed
    1. Garb JL, Brown R, Garb JR, et al. Differences in etiology of pneumonias in nursing home and community patients. JAMA. 1978;240:2169–2172. - PubMed

Publication types