How does an evidence-based oral hygiene protocol, when compared to standard of care, affect oropharyngeal colonization and rate of iatrogenic infection in patients with chronic respiratory compromise?

Heuschneider, Stacy L.

Monday, 18 November 2013

Stacy L. Heuschneider, RN, BSN, MS, ANP-C, CCRN, ACNS-BC
Respiratory Intermediate Care Unit, Stony Brook University Medical center, Stony Brook, NY

Learning Objective 1: To describe the current incidence and etiology of hospital-acquired pneumonia

Learning Objective 2: To describe the details of a comprehensive oral care prevention protocol strategy in a chronically respiratory compromised population.

Background: Oral pathogens pose significant risk to patients with chronic conditions and are associated with hospital-acquired pneumonias (HAP). HAP is the second most common iatrogenic infection in hospital settings, accounting for 300,000 cases yearly. Mortality rates range from 24% to 50%. Invasive airway devices provide an established conduit for transmission of bacteria to the pulmonary system. Although chronic respiratory compromise carries a two-fold risk for pneumonia and tracheobronchitis, there has been little advancement in the standardization of oral hygiene protocols that are evidence-based for patients with self-care deficits, or those with alternative oxygen delivery methods.

Purpose: The purpose of this study is to examine the relationships among oropharyngeal colonization, xerostomia, gingival and plaque index, rate of iatrogenic infection and type of oral care protocol in patients with chronic respiratory compromise. Introduction of an evidence-based oral care protocol and assessments of compliance will also be implemented.

Methods: This study will utilize a pretest-posttest, one-group design to compare outcomes associated with standard oral care and an evidence-based protocol. Eligible subjects will have tracheostomy, tracheostomy on mechanical ventilation or non-invasive ventilation. Plaque, gingival indexes and xerostomia will be measured on subjects within 48 hours of admission, then bi-weekly. Saliva specimens will be cultured for pathogenic organisms. Sputum specimens will be sent for comparison and diagnostic correlation weekly and upon discharge. The pre-intervention data collection will last 6 months with subjects studied until downgrade or discharge. The interventions will be introduced among the study patients following the six-month pre-intervention period. The evidence-based oral protocol will consist of mechanical toothbrushing, oral moisturizer, oral chlorhexidine, toothbrush storage protocol, subglottic suctioning prior to cuff deflation and a comprehensive oral-systemic nursing educational program emphasizing impact of care provided. Compliance with oral care protocols will also be measured.

Results: Study in progress.

Conclusion/Convergence: Study in progress.

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