Courtney Rodriguez-Cayro, a UF Health nurse and UF College of Nursing Doctor of Nursing Practice student, believed lax patient oral hygiene standards were responsible for an increase in cases of pneumonia. A study she helped design setting formal oral care protocols in one unit, saw a drop in cases and caught the attention of clinical leaders.
So much so, that the study recently won a nearly $20,000 UF award, allowing Rodriguez-Cayro to continue the research.
The 2024 W. Martin Smith Interdisciplinary Patient Safety Award went to just two projects submitted by UF Health faculty or staff. The projects had to be designed to improve patient safety and reduce adverse events in the hospital setting. The UF College of Medicine Continuing Medical Education and UF Self-Insurance cosponsor the awards.
“I was shocked when I got it. I only applied because my advisors encouraged me,” said Rodriguez-Cayro. “Most of the other projects seemed more sophisticated than mine.”
The project was part of her DNP studies[AH1] . Each student must complete a focused scholarly work on identifying, analyzing, and improving problems impacting patient care.
Rodriguez-Cayro, who recently graduated with her DNP and is currently working in that role at UF Health Shands, recalled how the project came about.
“I was familiar with studies showing that oral care in cardiac surgery patients was linked to hospital-acquired pneumonia,” she said. “I did a pre-study survey and found that the nurses were never given formalized training on oral health. Training varied from preceptor to preceptor. There was no concrete policy of how to do oral care.”
In fact, the survey showed patient oral hygiene participation was only about 4% at the time. During the study, participation jumped to more than 70%.
It turned out that Rodriguez-Cayro was not the only one who noticed the spike in pneumonia cases. Hospital clinical leaders also wanted answers and joined the effort. Rodriguez-Cayro developed the study with UF Health’s critical care medicine, the UF College of Dentistry, nurses, and occupational and speech therapy professionals.
UF Dentistry helped establish the protocol. Patients on ventilators would get oral care six times daily. Patients at high risk of developing pneumonia would receive oral care four times per day. Low-risk patients would get oral care twice per day. Oral care included tooth brushing twice per day for all patients. Ventilated and high-risk patients also had their mouths cleaned with swabs and lips moisturized several times daily.
Nurses were given education on the importance of oral health care and got hands-on training using dental mannequins. Low-risk patients received pamphlets on oral health and how it affects overall health.
“Courtney really put in a lot of hours. I’ve worked with Courtney for many years now. She’s a phenomenal nurse, and she’s very passionate about her patients. She deserves all the credit for all this,” said Elida Benitez, DNP, AG-ACNP, Rodriguez-Cayro’s, mentor and UF Nursing DNP project chair.
With the award, Rodriguez-Cayro hopes to continue investigating the connection between oral health and systemic health. She hopes to hire a statistician to analyze the study results and would like to pursue the study’s publication. Ultimately, she hopes to help establish a hospital-wide oral care protocol.
“The experience was absolutely amazing. I really enjoyed collaborating with critical care and dentistry. Nurses rarely collaborate with dentistry,” she said. “I wanted it to be nursing-based because, in my opinion, that is where the buck stops. We are the ones that have to do the work.”
Study participants included, Philip Efron, MD, FACS, FCCM, professor, director of Sepsis and Critical Illness Research Center, executive director of surgery, UF Health Critical Care Organization; Poliana Mendes Duarte, DMD, PhD, clinical associate professor, UF College of Dentistry; Shannon Wallet, PhD, chair and Louis and Marge Atkins Endowed Professor of the Department of Oral Biology, UF College of Dentistry; and Amber Dean, BSN, RN, cardiac surgery ICU manager, UF Health Shands.
Retrieved from: https://nursing.ufl.edu/2024/08/21/dnp-student-study-shows-proper-oral-care-may-lower-pneumonia-risk-in-all-patients/.