Could the Answer to Preventing Hospital-Acquired Pneumonia Be as Simple as Better Oral Care? This Nurse Thinks So

Would you believe that lowering the number of hospital-acquired pneumonia cases has a lot to do with ... a toothbrush?​

It's a creative—and potentially lifesaving—discovery that Dian Baker, Ph.D., and a team of nurses made after observing patients and then delving into research behind the problem.

Truth be told, Baker's story isn't unique—every day nurses just like her work to solve problems, improve on existing processes and figure out new ways of approaching challenges. In other words, they're always innovating.

And that's something Johnson & Johnson has long celebrated, with its 120-year history of supporting nurses. This year, to commemorate the Year of the Nurse and the Midwife, Johnson & Johnson and the American Nurses Association teamed up to launch See You Now, a podcast hosted by nurse economist Shawna Butler that features stories from pioneering nurses like Baker.

Before the debut of Baker's episode, we sat down with her to learn more about this game-changing medical discovery.

Q: You’ve worked in a few different capacities as a nurse throughout your career. What has that been like?

A: I’ve been a nurse and nurse practitioner for more than 45 years. One of the things I’m most grateful for about this profession is that you can do so many things!

There are thousands of different types of careers a nurse can have. I’ve worked in hospital settings, in emergency rooms and in public health. I’ve opened up school-based health centers, and taught nursing. Currently, I’m working on quality improvement at hospitals.

For most people, their image of a nurse involves being at someone’s bedside. Yet many of us are doing so many other things that are helping communities and families—and we’re constantly being innovative in our approach to care.

Q: Why is it so essential that nurses be innovators?

A: Everywhere I’ve worked has required me to be innovative. Early on in my career, I remember ventilating tiny babies in the neonatal intensive care unit and realizing that we needed a better system than the one provided us.

So my fellow nurses and I took rubber tubes and placed buckets of water on the floor, and tried to figure out how we could redesign those chest tubes to improve the equipment, process and patient outcomes.

I believe reflection leads to innovation. I try to instill this in my nursing students and suggest that, at the end of every shift, they take five minutes to ask themselves: What are the things I accomplished that were meaningful? What are the things I can improve next time?

Q: You’ve become a champion for finding solutions to non-ventilator, hospital-acquired pneumonia (NV-HAP). Can you tell us more about this?

A: About a decade ago, hospitals had essentially been put on notice by the Centers for Disease Control and Prevention (CDC) to do something about reducing hospital-acquired pneumonia.

After meeting with different organizations and working with graduate students on research about NV-HAP, it started to become clear to me that what we were originally looking at as the cause of hospital-acquired pneumonia—ventilators—wasn’t the problem. There were more patients getting pneumonia in the hospital who weren’t on ventilators.

Someone came to me and said, “We have an issue, but we don’t have data,” and that launched me down a path toward finding that data by working with multiple hospitals and countless researchers.

Once we realized we’d opened Pandora’s box, we started looking at ways to help address the issue.

Q: How did you come up with a dental care approach to this problem?

A: We started by looking at what causes pneumonia—specifically, how those bugs get into the lungs to begin with. What we realized is that the lungs are part of a respiratory system that includes the nose and mouth, which means germs get into the lungs through the mouth.

It’s like trying to rewind a domino effect: So if the germs causing NV-HAP are originating in the mouth, what’s happening with the mouth in the hospital? We realized oral care wasn’t being done routinely or regularly because the tools were poor—from foul-tasting mouthwash to toothbrushes with hard bristles that would fall out during use.

And nurses, who are responsible for patients' oral care, were reporting that they didn’t want to do it because it meant picking toothbrush bristles out of patients’ mouths. Many nurses don’t even know that germs in the mouth are related to pneumonia, and that hospital-acquired pneumonia can be prevented.

So the solution sounds simple: get basic oral care into the mindset of nurses. But it’s actually a complex problem with a number of challenges.

Q: What have been some of the biggest challenges?

A: As we've talked with various hospitals interested in addressing this patient safety issue, it has been difficult for them to implement a new hospital-wide change in nursing practice. There’s a list of nearly 400 mandates hospitals need to follow, so when we tell them they should add one more to that, well, it’s a tough sell.

Kaiser Permanente just published a study that found good oral care during a hospital stay can help reduce antibiotic usage, and we know pneumonia is the #1 reason why antibiotics are prescribed in the hospital. So there are many reasons why preventing NV-HAP should be front and center, but it’s hard for hospitals to do that without an external push.

Nurses already have a lot to do. How are they ever going to prioritize patient oral care if they have crummy toothbrushes, and no tracking or accountability proving why it’s important?

For the last decade, I’ve been thinking it’s crazy we don’t have a solution for this challenge. And I’m not going to retire until there’s a national standard on this.

Q: How can nurses help change the world—and medicine—as we know it?

A: It gets back to what I learned in my very first nursing course: Your role as a nurse is to maintain the homeostasis of patients; to be fully present and to understand what they need.

When you put the fundamental care of the patient first, that’s when you’re able to come up with solutions and truly start to innovate.