APH 2006, 64, 231-249:
Possible enabling and disabling factors when implementing an oral
hygiene protocol in nursing homes.
L. De Visschere, G-J. Van der Putten, C. de Baat, J. Schols, J. Vanobbergen
Aim: This study explored possible disabling and enabling factors in
order to develop and implement a structured oral hygiene protocol in
Methods: Data were collected from a representative sample of residents
(n=359) and health care workers (n=225) in 16 Belgian nursing
homes selected by a technique of stratified random sampling based on
number of residents and management. Oral hygiene and specific characteristics
on individual patient level were assessed during a clinical examination and, on institutional level, in addition to the stratification
variables, oral hygiene facilities, behaviour of the director, personnel
behaviour and knowledge were assessed by a self-administered validated
Main findings: The mean dental plaque index and the mean denture
plaque index were 2.17 (maximum=3) and 2.13 (maximum=4)
respectively. Significant positive correlations were found between the
availability of oral hygiene facilities in an institution and personnel knowledge,
supportive and directive behaviour of the directors, number of residents,
mean age and degree of dependency of residents. Multiple
regression analysis revealed personnel knowledge as the most predictive
variable for the availability of oral hygiene facilities on institutional
level. On an individual level, degree of dependency was the only significant
determinant for the presence of dental plaque (adjusted OR: 3.09).
The only significant explanatory variable for denture plaque was the
management of the institution with better denture cleanliness for residents
in commercial institutions (adjusted OR: 0.43).
Principal conclusions: After controlling for potential confounders,
primary enabling factors affecting the implementation of an oral hygiene
protocol were good personnel knowledge, the type of management of the
institution and the supportive and directive behaviour of the board of
directors. Potentially disabling factors were high degree of dependency
of the residents, high mean age of the residents and a high proportion
of dentate residents.