ACQ Vol 11 No 1 2009

MULTICULTURALISM AND DYSPHAGIA

Table 2. 2005 Survey of facilities using a free water protocol (continued) Facility

Started Modified Notes on participants and Who they

Is it

More

protocol? program

exclude

working? pneumonia?

Archibold Memorial Sept. 2004 Yes, oral Eliminated all thickened

Exclude those with excessive discomfort/ coughing Trached or vent patients with history of pul- monary disease

Yes

No

Hospital, Thomasville,

care

liquids. Insist on strict oral care. Use ice chips if patient has marked coughing

Georgia

Kindred HealthCare, Sept. 2004 Yes, oral As above

Yes

No

Atlanta, Georgia (trach/vent) Cape Fear Valley Health System, Fayetteville, North Carolina

care

1999

Yes,

Strict oral care mandatory.

Significant coughing, decreased or history of aspiration

Yes

No

limited Increased compliance, improved hydration, the

amount 3x/day and oral

increased patient satisfaction pulmonary status

care

pneumonia; also very poor oral care Non-compliant, “super-coughers”

San Antonio, Texas (long-term acute

2000

Yes, case Strict oral care – written by case orders for staff compliance; mentation of improvement, cognitive imple-

Yes

No

hospital)

have noted increased speed or those who demonstrate no improvement and decreased real pleasure from dehydration free water protocol

Moncton Hospital, New Brunswick, Canada (acute &

2003

Yes

Use neon yellow signs at COPD patients carefully; patients are much happier; most tolerate protocol well

Compromised Yes

No

bedside and in chart; watch respiratory status

or immune suppression; those

rehab)

with severe coughing

Missouri Rehab Centre, Mount

2002

Yes, oral Use antibacterial mouthwash Significant

Yes

No

care

in addition to oral care. ICU respiratory issues,

Vernon

patients watched carefully. Improvement noted in pneumonia incidence, dehydration, cognition, speed of improvement; people much more compliant

non-ambulatory, bedridden

Caulfield General Medical Centre, Melbourne, Australia

2003

Yes, oral Strict oral hygiene; include Unstable patients Yes

No

care

medically stable patients –

mainly in residential care; no negative outcomes thus far Note. Compiled by Janis Lorman, MA CCC/S&A, Senior Lecturer, The University of Akron, Ohio.

defences may be overwhelmed and pneumonia develops (Cassiere, 1998; Finucane et al., 1999; Mojon, 2002). If the aspirate is large in volume, but small in contagion, then pneumonia results only if the aspirated organisms are highly virulent or host defences severely compromised (Cassiere, 1998). A direct association between pulmonary infection and oral diseases seems to only occur in patients with severely compromised health, such as frail elderly and patients with chronic pulmonary diseases (Mojon, 2002), with pneumonia occurring due to the inability of lung defences to clear or kill aspirated challenge (Gibson & Barrett, 1992). Risk factors Tube feeding Tube feeding in elderly patients is associated with pathogenic colonisation of the oropharynx. A study of 215 patients demonstrated oropharyngeal colonisation rates of 81% in nasogastric tube-fed patients, 51% of patients fed by

be particularly important in maintaining residents’ health, due to a link between poor oral health and increased risk of stroke (Joshipura, Hung, Rimm, Willett, & Ascherio, 2003). In a case-control study comparing residents of a chronic care facility with age-, race- and gender-matched dental clinic outpatients, chronic care patients had fewer teeth, but much higher plaque levels than outpatients. Chronic care patients took a greater number of medications, were more often cur­ rent or ex-smokers and were more likely to have COPD. Twenty five percent of chronic care subjects carried respiratory pathogens in their dental plaque, and 57% of these subjects were found to be colonised. While a similar percentage of the control group carried respiratory pathogens in plaque, none of the controls were colonised (Russell, Boylan, Kaslick, Scannapieco & Katz, 1999). If the aspirated material is small in volume, but highly contaminated with bacteria, even relatively strong host

ACQ uiring knowledge in sp eech , language and hearing , Volume 11, Number 1 2009

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