Major ArticlesSurvey of oral care practices in US intensive care units
Section snippets
Subjects and sampling
The Human Studies Committee of the University of Louisville approved the Survey of Oral Care Practices in Intensive Care Units conducted from March to July 2002. The 27-item questionnaire was designed to gather information related to current oral care practices, training, and attitudes among nurses in ICUs across the United States. Demographic information and nurses' training experiences were included as well.
The questionnaire was developed by the research team because of a lack of a previously
Attitudes, beliefs, and knowledge
Oral care was perceived as a very high priority for mechanically ventilated patients by over 91% of nurses. Although 63% (n = 346) of respondents found cleaning the oral cavity to be difficult, only 43% (n = 236) found it to be unpleasant. More than 60% (n = 334) of the nurses found that no matter what they did, the mouths of their mechanically ventilated patients seemed to get worse the longer they were on the ventilator (Table 3).
Nurses' attitudes regarding oral care were examined using a t test by
Discussion
Aspiration of contaminated secretions was recognized as the most likely mechanism of transmission of bacteria into the lungs, resulting in pneumonia in the scenario presented in the survey. This finding would seem to indicate that the respondents recognize that the oropharynx serves as a reservoir for potential respiratory pathogens. The predominant use of foam swabs, moisturizers, and alcohol-free mouthwashes and the majority of respondents reporting a decline in oral status among mechanically
Conclusion
Effective oral care that includes toothbrushing and antimicrobial solutions has been shown to improve patient oral health and may significantly reduce respiratory infections in mechanically ventilated patients. The results of this survey indicate that oral care currently provided in ICUs may be ineffective in removing dental plaque and respiratory pathogens from the oropharynx of ventilated patients. Large, multiple-site clinical trials, changes in nursing curricula, national guidelines, and
References (32)
- et al.
Chlorhexidine gluconate 0.12% oral rinse reduces the incidence of total nosocomial respiratory infection and nonprophylactic systemic antibiotic use in patients undergoing heart surgery
Chest
(1996) Changing mouth care practice in intensive care: implications of the clinical setting context
Intens Crit Care Nurs
(1995)- et al.
Ventilator-associated pneumonia caused by potentially drug-resistant bacteria
Am J Respir Crit Care Med
(1998) - et al.
Incidence, risk and prognosis factors of nosocomial pneumonia in mechanically ventilated patients
Am Rev Respir Dis
(1990) - et al.
Bacterial colonization patterns in mechanically ventilated patients with traumatic and medical head injury: incidence, risk factors, and association with ventilator-associated pneumonia
Am J Respir Crit Care Med
(1999) - et al.
Oropharyngeal or gastric colonization and nosocomial pneumonia in adult intensive care unit patients: a prospective study based on genomic DNA analysis
Amer J Respir Crit Care Med
(1997) - et al.
Colonization of dental plaque by respiratory pathogens in medical intensive care unit patients
Crit Care Med
(1992) - et al.
Use of a clinical assessment tool for orally intubated patients
Am J Crit Care
(1995) - et al.
Prevention of ventilator-associated pneumonia by oral decontamination: a prospective, randomized, double-blind, placebo-controlled study
Am J Respir Crit Care Med
(2001) - et al.
Decrease in nosocomial pneumonia in ventilated patients by selective oropharyngeal decontamination (SOD)
Intensive Care Med
(1997)