A Systematic Oral Care Program in Post-Mechanically Ventilated, Post-Intensive Care Patients

Chipps, Esther M.

Wednesday, 24 July 2013

Esther M. Chipps, PhD, RN
Nursing Quality and Translational Research, Wexner Medical Center, The Ohio State University Health System, Columbus, OH
Timothy Landers, n/a
Ohio State University, College of Nursing, Columbus, OH
Michele P Carr, RDH, MA
Dental Hygiene, Ohio State University, College of Dentristry, Columbus,, OH

Learning Objective 1: The learner will be able to identify known risk factors for ventilator associated pneumonia for critically ill patients.

Learning Objective 2: The learner will be able to describe the impact of an evidence-based oral care protocol in post-mechanically ventilated, post-intensive care patients.

Purpose: Patients who have been recently extubated are at an increased risk for poor oral health, bacterial colonization, and aspiration pneumonia. The aim of this study is to determine the impact of a standardized, evidence-based oral care protocol on 1). overall oral cavity health and 2). Methicillin-sensitive Staphylococcus aureus (MSSA) and methicillin-resistant Staphylococcus aureus (MRSA) colonization in post-mechanically ventilated patients, and 3). the acquisition of hospital acquired infections (HAIs).

Methods:

This is a randomized control study (n=60). Subjects have required mechanical ventilation for at least 48 hours, meet ventilator liberation criteria and have a minimum of 3 teeth. The study is initiated within 24 hours post-extubation. The oral hygiene intervention includes timed toothbrushing, flossing, mouthrinse, tongue brushing and lip balm is provided over 4 days. The control group receives routine oral care as provided by the nursing staff. Specific outcome measures include: (1) assessment of the oral cavity using the Revised-THROAT assessment (2) results of microbiological swabs to detect colonization of MSSA/MRSA (3) frequency and incidence of infections, (4) patient satisfaction with the oral care products and oral hygiene program and (5) assessment of patient quality of life. A repeated measure ANOVA will be used to detect changes in the oral cavity assessment. Descriptive statistics will be used to report changes in MSSA/MRSA colonization, AHIs, quality of life and patient satisfaction.

Results:

We have enrolled 29 of 60 subjects. An interim analysis is currently in progress and will be presented.

Conclusion:

A growing body of nursing literature has addressed the association between oral care and the prevention of VAP in the intensive care unit. In contrast, little attention has been paid to oral care of patients liberated from mechanical ventilation. We hope to develop a validated evidence-based protocol for oral care in post-mechanically ventilated, post ICU patients.

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