Preventing Healthcare- Associated Pneumonia (HAP) in Head Trauma Patients using Toothbrush Kits for Oral Care

Saturday, 16 November 2013: 3:55 PM

Nguyen Thi Ngoc Hue, MSc
Department of Nursing, Cho Ray Hopsital, Ho Chi Minh City, Vietnam
Patricia R. Messmer, PhD, RN-BC, FAAN
School of Nursing, Miami Dade College, Miami, FL

Learning Objective 1: To gain knowledge of oral care practices using a tootbrush kit versus swab cleanser

Learning Objective 2: To discuss prevention of Healthcare-Associated Pneumonia (HAP)in Neuro ICU patients

Background: Healthcare-Associated Pneumonia (HAP) is a preventable secondary consequence of intubation and mechanical ventilation, common infection in Neuro ICUs (Fox, 2006; Cutler & Davis, 2005; Grap & Munro, 2004). Etiologic factors involve colonizing and opportunistic bacteria from the oral cavity.

Research question: What is the incidence of HAI and VAP between two groups of head trauma patients with ETT receiving two different types of oral care (Comparison of toothbrush oral care practice to swab cleansing every 12 hours in reducing HAP risk).

Theoretical Framework Pender (2002) Health Promotion Model

Methods: Randomized controlled trial (RCT) was designed to determine the effects of oral care and HAP outcomes in Neuro ICU  patients with ETT or on mechanical ventilator over 6 months. Sample: 310 patients; 155 per group randomly selected for either cleansing swabs or toothbrush oral care practices and given investigator form, assessment of HAP (CDC). Data collected: encoded/analysis by SPSS 13.0.

Results: Mean age- 38; gender- 83% males, 17% females.  HAP incidence is 5.8% in general population, 9% patients cleansing swab group and 2.6% patients tooth brush oral care group; differences statistically significant (P = 0.015) by cleansing swab group and 2.6% patients in tooth brush group. Differences statistically significant (P = 0.015).

Multivariable logistic regression of HAP risk factors showed that re- intubation (OR:1.95; 95% CI: 1.68 – 4.32), ventilator (OR:3.64; 95%CI:2.62- 8.04), re-feeding tube (OR:17.44; 95% CI: 2.67 – 114.05). Differences were statistically significant (P < 0.05). Oral care by tooth brush was more effective than swabs in plaque removal and gingival stimulation, reducing incidence of HAP.

Conclusions: Oral care using tooth brushes is essential to prevent oral problems and HAP complications for Neuro ICU patients.  Maintaining oral care process of intubated patients improves oral health, reduces HAP, hospitalization time and healthcare costs while improving the quality of care.