Major Articles
Survey of oral care practices in US intensive care units

https://doi.org/10.1016/j.ajic.2003.05.001Get rights and content

Abstract

Background

Research has shown that oral care involving toothbrushes and topical antimicrobials improves the oral health of medically compromised patients and may reduce the incidence of nosocomial infections including pneumonia. This survey research was undertaken to determine the type and frequency of oral care in intensive care units (ICUs) in the United States and the attitudes, beliefs, and knowledge of health care workers.

Methods

A randomly selected survey of 102 ICUs within the continental United States participated with 556 respondents; 97% of respondents were registered nurses.

Measurements

Frequency and type of oral care provided, attitudes and beliefs, and knowledge and training in oral care were measured.

Results

Ninety-two percent of respondents perceived oral care to be a high priority. The primary methods of oral care involved the use of foam swabs, moisturizers, and mouthwash. Toothbrushes and toothpaste were used infrequently by almost 80% of respondents. The majority of nurses indicated a need for research-proven oral care standards and desired to learn more.

Conclusions

In this random sample of ICUs, oral care methods were not consistent with current research and oral care protocols. The translation of oral care research into practice in the ICU may improve the quality of care and decrease the incidence of ventilator-associated pneumonia.

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)

  • A.J DeRiso 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)
  • K Kite

    Changing mouth care practice in intensive care: implications of the clinical setting context

    Intens Crit Care Nurs

    (1995)
  • J.L Trouillet et al.

    Ventilator-associated pneumonia caused by potentially drug-resistant bacteria

    Am J Respir Crit Care Med

    (1998)
  • A Torres et al.

    Incidence, risk and prognosis factors of nosocomial pneumonia in mechanically ventilated patients

    Am Rev Respir Dis

    (1990)
  • S Ewig 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)
  • M Garrouste-Orgeas 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)
  • F.A Scannapieco et al.

    Colonization of dental plaque by respiratory pathogens in medical intensive care unit patients

    Crit Care Med

    (1992)
  • D.M Treloar et al.

    Use of a clinical assessment tool for orally intubated patients

    Am J Crit Care

    (1995)
  • D.C Bergmans 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)
  • M Abele-Horn et al.

    Decrease in nosocomial pneumonia in ventilated patients by selective oropharyngeal decontamination (SOD)

    Intensive Care Med

    (1997)
  • J Pugin et al.

    Oropharyngeal decontamination decreases incidence of ventilator-associated pneumonia: a randomized, placebo-controlled, double-blind clinical trial

    JAMA

    (1991)
  • F Fourrier et al.

    Effects of dental plaque antiseptic decontamination on bacterial colonization and nosocomial infections in critically ill patients

    Intensive Care Med

    (2000)
  • T Genuit et al.

    Prophylactic chlorhexidine oral rinse decreases ventilator-associated pneumonia in surgical ICU patients

    Surg Infect

    (2001)
  • M Yoshida et al.

    Oral care reduces pneumonia of elderly patients in nursing homes, irrespective of dentate or edentate status

    Nippon Ronen Igakkai Zasshi

    (2001)
  • T Yoneyama

    Effect of oral health care in prevention of aspiration pneumonia

    Nippon Ronen Igakkai Zasshi

    (2001)
  • P Coleman

    Improving oral health care for the frail elderly: a review of widespread problems and best practices

    Geriatr Nurs

    (2002)
  • Cited by (0)

    View full text