Impact of oral hygiene on prevention of ventilator-associated pneumonia in neuroscience patients

The effect of oropharyngeal aspiration before position change on reducing the incidence of ventilator- associated pneumonia

The aim of this study was to investigate the effect of oropharyngeal aspiration on ventilator-associated pneumonia (VAP) incidence just prior to changing patient position. This randomized controlled experimental study was conducted between July 2015 and April 2019 in anesthesiology and reanimation of intensive care unit (ICU). The patients of experimental group underwent oropharyngeal aspiration under surgical aseptic conditions before each position change. Patients of the control group received oropharyngeal aspiration only as needed. The mean age of the patients was 62.87 ± 17.33 years. The mean and median duration of stay in the ICU were 27.28 ± 30.69 and 18.00 days respectively. The mean and median of duration of the mechanical ventilation support were 26.72 ± 30.65 and 18.00 (min 4; max 168) days respectively. Thirty percent of the patients were VAP. The mean duration of VAP development was 7.50 ± 5.07 days. The rate of VAP development was 11.23/1000 mechanical ventilator days. Only 8.3% of the experimental group patients developed VAP; 91.7% of the control group patients developed VAP. The VAP rate in the control group was 16.82/1000 mechanical ventilator days and the VAP rate in the experimental group was 2.41/1000 mechanical ventilator days. Most VAP agents were multidrug resistant. Distribution of isolated microorganisms was as Acinetobacter baumannii, Pseudomonas aeruginosa, Corynebacterium striatum, Staphylococcus aureus, Providencia stuartii, Serratia marcescens, Stenotrophomonas maltophilia, and Aspergillus flavus. In our study, it was concluded that oropharyngeal aspiration performed prior to patient position change prevented the development of VAP.

Oral assessment and nursing interventions among Nigerian nurses-knowledge, practices and educational needs

BACKGROUND

Assessment of oral condition, oral care, and informing the attending doctor of unusual oral findings for possible consultation or referral to a dentist are the advocated roles of hospital nurses. The objective of the study was thus to assess the roles of Nigerian nurses in the assessment of oral conditions of hospitalized patients.

METHODS

This questionnaire-based cross-sectional survey of all nurses caring for hospitalized patients in the University of Benin Teaching Hospital was conducted in the first half of 2010.

RESULTS

Of the 384 studied participants, 94.3% considered oral care as an important aspect of nursing care and 73.4% had oral health component in their nursing school curriculum. A total of 80.7% reported suspicious and abnormal findings in hospitalized patients to the attending doctor. Amongst the respondents, 38.0% reported ability to conduct good oral tissue examination. Only 28.1% demonstrated good knowledge of common oral diseases. Three-quarters (73.4%) thought that it is compulsory for nurses to assess the oral condition of hospitalized patients. The 67.7% and 21.9% of the respondents did the assessment on admission and discharge respectively. The majority (90.1%) desired training on oral care of hospitalized patients.

CONCLUSION

There is a need to improve the skill and competence of nurses in the assessment of oral condition to make them a substantive partner in the oral care of hospitalized patients.

Effect of continuous oral suctioning on the development of ventilator-associated pneumonia: a pilot randomized controlled trial

BACKGROUND

Both continuous and intermittent aspiration of subglottic secretions by means of specially designed endotracheal tubes containing a separate dorsal lumen that opens into the subglottic region have been shown to be useful in reducing ventilator-associated pneumonia (VAP). However, the high cost of these tubes restricts their use.

OBJECTIVE

The aim of this pilot randomized controlled trial was to test the effect of a low-cost device (saliva ejector) for continuous oral suctioning (COS) on the incidence of VAP in patients receiving mechanical ventilation.

METHODS

The study was conducted in the six-bed medical-surgical ICU of a hospital with over 400 beds that provides comprehensive medical services to the public. The design of this study was a parallel-group randomized controlled trial. While both the experimental and control groups used the conventional endotracheal tube, the saliva ejector was only applied to patients assigned to the experimental group. The device was put between the patient's cheek and teeth, and then connected to 100mmHg of suction for the continuous drainage of saliva.

RESULTS

Fourteen patients were randomized to receive COS and 13 patients were randomized to the control group. The two groups were similar in demographics, reasons for intubation, co-morbidity, and risk factors for acquiring VAP. VAP was found in 3 patients (23.1%; 71 episodes of VAP per 1000 ventilation days) receiving COS and in 10 patients (83.3%; 141 episodes of VAP per 1000 ventilation days) in the control group (relative risk, 0.28; 95% confidence interval, 0.10-0.77; p=0.003). The duration of mechanical ventilation in the experimental group was 3.2 days (SD 1.3), while that in the control group was 5.9 days (SD 2.8) (p=0.009); and the length of ICU stay was 4.8 days (SD 1.6) versus 9.8 days (SD 6.3) for the experimental and control groups, respectively (p=0.019).

CONCLUSION

Continuous clearance of oral secretion by the saliva ejector may have an important role to play in reducing the rate of VAP, decreasing the duration of mechanical ventilation, and shortening the length of stay of patients in the ICU.

[Effectiveness of oral care in the prevention of ventilator-associated pneumonia. systematic review and meta-analysis of randomised clinical trials]

OBJECTIVE

To determine the effectiveness of oral care in preventing pneumonia associated with mechanical ventilation (VAP).

METHOD

A search was made for randomised clinical trials (RCTs) in CINAHL, Cuiden Plus, Pub Med, EMBASE, ENFISPO, Cochrane, Cuiden, DARE, EBE, JBI, and reverse lookup from the beginning of indexing of each database up to 3 May 2010. There were no restrictions on language, age, sex or underlying disease. RCTs that compared oral care and determined their effectiveness in preventing VAP were included. The different interventions were analysed to determine the most effective and protective. Epidat 3.1 was used for analysing the data. Out of a total of 858 articles reviewed, only 14 met the inclusion criteria.

RESULTS

Using a random effects model statistically significant results were found in favour of chlorhexidine as a protective factor against VAP (RR=0.7065, 95% CI: 0.5568-0.8963). The application of 0.12% chlorhexidine twice a day gave an RR: 0.69, 95% CI: 0.53-0.91 and 0.2% chlorhexidine four times daily: (RR=0.53, 95% CI: 0.31 to 0.90), being statistically significant. The application of 0.12% and 0.2% chlorhexidine three times a day and brushing did not give statistically significant results.

CONCLUSIONS

The use of chlorhexidine in oral care is a protective factor against VAP. Tooth brushing did not prevent VAP. More RCTs using this intervention are needed to confirm these results.

Oropharyngeal secretion volume in intubated patients: the importance of oral suctioning

BACKGROUND

Aspiration of secretions that accumulate above the cuff of the endotracheal tube is a risk factor for ventilator-associated pneumonia. Routine suctioning of oropharyngeal secretions may reduce this risk; the recommended frequency for suctioning is unknown.

OBJECTIVES

To quantify the volume of secretions suctioned from the oropharynx of critically ill patients at 2 different intervals to assist in identifying a recommended frequency for oropharyngeal suctioning.

METHODS

A prospective, repeated measure, single-group design was used. Twenty-eight patients who were orally intubated and treated with mechanical ventilation were enrolled; 2 were extubated during data collection, yielding a sample of 26 patients. The patients were suctioned at baseline with a deep suction catheter, and the volume and weight of secretions were recorded. The procedure was repeated at 2-hour and 4-hour intervals.

RESULTS

Most of the patients were male (mean age, 49 years). Three suctioning passes were needed to clear secretions, with a mean time of 48.1 seconds. The mean volume of secretions at the 2-hour interval was 7.5 mL. Five patients required suctioning before the 4-hour interval. For the remaining 21 patients, the volume retrieved was 6.5 mL at the 2-hour interval and 7.5 mL at the 4-hour interval (P = .27). The 5 patients who required extra suctioning had significantly more secretions at the 2-hour interval (11.6 mL vs 6.5 mL; P = .05).

CONCLUSIONS

A minimum frequency of oropharyngeal suctioning every 4 hours is recommended. However, more frequent suctioning may be needed in a subset of patients.