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Balto H, Bekhit MS, Auda SH, Elansary A, Bhat RS, Marraiki N, Al-Hadlaq S. Synergistic effect of Salvadora persica and chitosan nanoparticles against oropharyngeal microorganisms. Sci Rep 2024; 14:12997. [PMID: 38844768 PMCID: PMC11156879 DOI: 10.1038/s41598-024-63636-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 05/30/2024] [Indexed: 06/09/2024] Open
Abstract
Herbal medicine combined with nanoparticles has caught much interest in clinical dental practice, yet the incorporation of chitosan with Salvadora persica (S. persica) extract as an oral care product has not been explored. The aim of this study was to evaluate the combined effectiveness of Salvadora persica(S. persica) and Chitosan nanoparticles (ChNPs) against oropharyngeal microorganisms. Agar well diffusion, minimum inhibitory concentration, and minimal lethal concentration assays were used to assess the antimicrobial activity of different concentrations of ethanolic extracts of S. persica and ChNPs against selected fungal strains, Gram-positive, and Gram-negative bacteria. A mixture of 10% S. persica and 0.5% ChNPs was prepared (SChNPs) and its synergistic effect against the tested microbes was evaluated. Furthermore, the strain that was considered most sensitive was subjected to a 24-h treatment with SChNPs mixture; and examined using SEM, FT-IR and GC-MS analysis. S. persica extract and ChNPs exhibited concentration-dependent antimicrobial activities against all tested strains. S. persica extract and ChNPs at 10% were most effective against S. pneumoni, K. pneumoni, and C. albicans. SEM images confirmed the synergistic effect of the SChNPs mixture, revealing S. pneumonia cells with increased irregularity and higher cell lysis compared to the individual solutions. GC-MS and FT-IR analysis of SChNPs showed many active antimicrobial phytocompounds and some additional peaks, respectively. The synergy of the mixture of SChNPs in the form of mouth-rinsing solutions can be a promising approach for the control of oropharyngeal microbes that are implicated in viral secondary bacterial infections.
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Affiliation(s)
- Hanan Balto
- Department of Restorative Dental Sciences, College of Dentistry, King Saud University, P.O. Box 62645, 11595, Riyadh, Saudi Arabia
| | - Mounir Salim Bekhit
- Department of Pharmaceutics, College of Pharmacy, King Saud University, 12372, Riyadh, Saudi Arabia
| | - Sayed H Auda
- Department of Pharmaceutics, College of Pharmacy, King Saud University, 12372, Riyadh, Saudi Arabia
| | - Afaf Elansary
- Central Research Laboratory, Female Campus, King Saud University, Riyadh, Saudi Arabia
| | - Ramesa Shafi Bhat
- Department of Biochemistry, College of Science, King Saud University, 11451, Riyadh, Saudi Arabia
| | - Najat Marraiki
- Department of Botany and Microbiology, College of Science, King Saud University, P.O. Box 2455, 11451, Riyadh, Saudi Arabia
| | - Solaiman Al-Hadlaq
- Department of Restorative Dental Sciences, College of Dentistry, King Saud University, P.O. Box 62645, 11595, Riyadh, Saudi Arabia.
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2
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Oral care to reduce costs and increase clinical effectiveness in preventing nosocomial pneumonia: a systematic review. J Evid Based Dent Pract 2023; 23:101834. [DOI: 10.1016/j.jebdp.2023.101834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 12/27/2022] [Accepted: 01/19/2023] [Indexed: 01/30/2023]
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3
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Yang L, Zhang Q, Zhai H. Comparative efficacy of different concentrations of chlorhexidine for prevention of
ventilator‐associated
pneumonia in intensive care units: A systematic review and network
meta‐analysis. Nurs Crit Care 2022. [DOI: 10.1111/nicc.12849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Li Yang
- The First People's Hospital of Lianyungang, The First Affiliated Hospital of Kangda College of Nanjing Medical University Lianyungang China
| | - Qin Zhang
- The First People's Hospital of Lianyungang, The First Affiliated Hospital of Kangda College of Nanjing Medical University Lianyungang China
| | - Huaixiang Zhai
- The First People's Hospital of Lianyungang, The First Affiliated Hospital of Kangda College of Nanjing Medical University Lianyungang China
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4
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Interventions to promote oral care regimen adherence in the critical care setting: A systematic review. Aust Crit Care 2022; 35:583-594. [PMID: 34764003 DOI: 10.1016/j.aucc.2021.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 08/04/2021] [Accepted: 08/31/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Oral care is a fundamental nurse-led intervention in the critical care setting that provides patient comfort and prevents adverse outcomes in critically ill patients. To date, there has been minimal focus on nurse-focused interventions to improve adherence to oral care regimens in the adult intensive care unit setting. OBJECTIVES The objectives of this study were to (i) identify types and characteristics of interventions to improve oral care adherence amongst critical care nurses and intervention core components, (ii) evaluate the effectiveness of interventions to improve adherence of oral care regimens, and (iii) identify the types of outcome measures used to assess oral care regimen adherence. DESIGN This is a systematic review in alignment with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. DATA SOURCES Key bibliographic databases and platforms, including Scopus, Cochrane, MEDLINE, CINAHL, Embase, PsycINFO, ProQuest, and Web of Science, were searched for studies published before July 2020. The Joanna Briggs Institute's quality appraisal tool was used to assess risk of bias in included studies. RESULTS A total of 21 original research studies were identified, of which 18 studies used multifaceted interventions. In accordance with the Joanna Briggs Institute's quality appraisal tools, four of the 20 quasi-experimental studies were rated as high quality. The one randomised control trial was of moderate quality. Outcome measures included oral care adherence behaviours, oral care knowledge, self-reported adherence, and documentation. Improved effectiveness in oral care adherence was reported in 20 studies. CONCLUSIONS Review findings confirm interventions to change behaviours improve oral care adherence. The most effective interventional approach could not be determined owing to heterogeneity in intervention design and outcome measures. Oral care in the intensive care unit is a vital, nurse-led activity that reduces the risk of hospital-acquired infection. It is recommended that future research adopt implementation science methods to ensure stakeholder engagement and feasibility. SYSTEMATIC REVIEW REGISTRATION NUMBER This review was submitted and subsequently registered on PROSPERO, the International Perspective Register of Systematic Reviews PROSPERO 2019 CRD42019123142.
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Sosa-Hernández O, Matías-Téllez B, Silva-López YE, Alarcón-Hernández V, Bello-López JM, Cureño-Díaz MA, Lugo-Zamudio GE. Economic and Epidemiological Impact of an Improvement Plan for the Decrease of Ventilator-Associated Pneumonia in a Tertiary Hospital in Mexico. J Patient Saf 2021; 17:e1889-e1893. [PMID: 32398539 DOI: 10.1097/pts.0000000000000698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The objective of this work is to measure the economic and epidemiological impact of the implementation of a comprehensive quality improvement plan (CQIP) for the prevention and reduction of ventilator-associated pneumonia (VAP) in the adult intensive care unit in a Mexican hospital. MATERIALS AND METHODS A cross-sectional, ambispective, comparative, analytical, observational study was conducted with epidemiological data on cases of health care-associated infections and with information from the Hospital Epidemiological Surveillance Unit from August 2017 to July 2018. RESULTS Before to the implementation of the CQIP, there were a total of 26 VAPs, with a rate of 32.2 per 1000 ventilator-days. After the implementation of CQIP, there were 14 VAPs, with a rate of 23.4 per 1000 ventilator-days, with a 46.2% decrease in incidence (P = 0.02). Before the installation of the interventions, the expense was $4,471,073.80, with an average cost per case of $171,964.38. The total cost per bed-day in the adult intensive care unit was $331,280.00, and for hospitalization, the cost was $192,038.00; for the use of antimicrobials, an expense of $749,689.20 was calculated, and for the use of mechanical ventilation, the cost was $2,974,275.60. The percentage of decrease in the cost of VAP after CQIP implementation was 46.5%. CONCLUSIONS The implementation of CQIP based on the risk evaluation factors of VAP resulted in their decrease, which is reflected in a patient safety and quality care improvement.
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6
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Yu XR, Xu N, Huang ST, Zhang QL, Wang ZC, Cao H, Chen Q. Effects of different oral care strategies on postoperative pneumonia in infants with mechanical ventilation after cardiac surgery: a prospective randomized controlled study. Transl Pediatr 2021; 10:359-365. [PMID: 33708522 PMCID: PMC7944187 DOI: 10.21037/tp-20-295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND To explore the effects of different oral care strategies on postoperative pneumonia in infants with mechanical ventilation after cardiac surgery. METHODS A prospective randomized controlled study was conducted at a hospital in Fujian Province, China. Participants were randomly divided into the breast milk oral care group, physiological saline oral care group, and sodium bicarbonate oral care group to explore the effects of different oral care strategies on postoperative pneumonia in infants on mechanical ventilation cardiac surgery. RESULTS The mechanical ventilation duration, the hospitalization costs, and the length of intensive care unit (ICU) stay and postoperative hospital stay in the breast milk oral care group were significantly shorter than those in the physiological saline oral care group and the sodium bicarbonate oral care group. The incidence of postoperative pneumonia in the breast milk oral care group was 3.2%, which was significantly lower than that in the physiological saline oral care group (22.6%) and the sodium bicarbonate oral care group (19.4%). CONCLUSIONS Using breast milk for oral care in infants after cardiac surgery has a lower incidence of postoperative pneumonia than traditional oral care strategies of physiological saline and sodium bicarbonate, and it is worthy of clinical application.
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Affiliation(s)
- Xian-Rong Yu
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Ning Xu
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Shu-Ting Huang
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Qi-Liang Zhang
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Zeng-Chun Wang
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China.,Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, Chin
| | - Hua Cao
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Qiang Chen
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China.,Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, Chin
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7
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Silva PUJ, Paranhos LR, Meneses-Santos D, Blumenberg C, Macedo DR, Cardoso SV. Combination of toothbrushing and chlorhexidine compared with exclusive use of chlorhexidine to reduce the risk of ventilator-associated pneumonia: A systematic review with meta-analysis. Clinics (Sao Paulo) 2021; 76:e2659. [PMID: 34133659 PMCID: PMC8158674 DOI: 10.6061/clinics/2021/e2659] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 04/15/2021] [Indexed: 01/08/2023] Open
Abstract
This study aimed to compare the effectiveness of 0.12% chlorhexidine alone and 0.12% chlorhexidine in combination with toothbrushing to prevent ventilator-associated pneumonia (VAP) in mechanically ventilated patients. The Embase, Latin American and Caribbean Health Science Literature, PubMed, Scientific Electronic Library Online, Scopus, LIVIVO, Web of Science, Cochrane Library, OpenThesis, and Open Access Thesis and Dissertations databases were used. Only randomized controlled trials without restrictions on the year or language of publication were included. Two reviewers assessed the risk of bias using the Joanna Briggs Institute Critical Appraisal Tool. A meta-analysis using a random-effects model estimated the combined relative risk (RR). The Grading of Recommendations, Assessment, Development and Evaluations approach was used to assess the certainty of the evidence. Initially, 2,337 studies were identified, of which 4 were considered in the systematic review and 3 in the meta-analysis (total sample: 796 patients). The studies were published between 2009 and 2017. All eligible studies had a low risk of bias. The meta-analysis revealed that the risk of VAP was 24% lower in patients receiving chlorhexidine combined with toothbrushing than in those receiving chlorhexidine alone (RR: 0.76; 95% confidence interval: 0.55-1.06), with moderate certainty of evidence and without statistical significance. In conclusion, considering the limitations of this study, a standard protocol for the prevention of VAP is not yet recommended. More studies with larger sample sizes are needed to draw strong conclusions. However, considering that toothbrushing is a simple intervention, it should be a common practice in mechanically ventilated patients, especially among patients with coronavirus disease.
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Affiliation(s)
- Pedro Urquiza Jayme Silva
- Programa de Pos-Graduacao em Odontologia, Faculdade de Odontologia, Universidade Federal de Uberlandia, Uberlandia, MG, BR
| | - Luiz Renato Paranhos
- Area de Odontologia Preventiva e Social, Faculdade de Odontologia, Universidade Federal de Uberlandia, Uberlandia, MG, BR
- Corresponding author. E-mail:
| | - Daniela Meneses-Santos
- Programa de Residencia em Cirurgia e Traumatologia Buco-Maxilo-Facial, Faculdade de Medicina, Universidade Federal de Uberlandia, Uberlandia, MG, BR
| | - Cauane Blumenberg
- Programa de Pos-Graduacao em Epidemiologia, Faculdade de Medicina, Universidade Federal de Pelotas, Pelotas, RS, BR
| | | | - Sérgio Vitorino Cardoso
- Area de Patologia, Faculdade de Odontologia, Universidade Federal de Uberlandia, Uberlandia, MG, BR
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8
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Tsuda S, Soutome S, Hayashida S, Funahara M, Yanamoto S, Umeda M. Topical povidone iodine inhibits bacterial growth in the oral cavity of patients on mechanical ventilation: a randomized controlled study. BMC Oral Health 2020; 20:62. [PMID: 32093667 PMCID: PMC7041202 DOI: 10.1186/s12903-020-1043-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 02/10/2020] [Indexed: 11/10/2022] Open
Abstract
Background Topical 0.12% chlorhexidine has been used widely to prevent ventilator-associated pneumonia in patients undergoing mechanical ventilation. However, it is not approved for mucosal application in Japan. The aims of this study were to investigate if topical povidone iodine (i) inhibits bacterial growth and (ii) disrupts the balance of the oral microbiota. Methods This randomized controlled clinical trial included 23 patients who underwent mechanical ventilation in the intensive care unit. The patients were divided randomly into two groups: the intervention group (n = 16) and the control group (n = 7). All patients received oral cleaning with 3% hydrogen peroxide, followed by irrigation with tap water. The patients in the intervention group received 10% povidone iodine applied topically to the oral cavity. The concentration of total bacteria in the oropharyngeal fluid were determined before, immediately after, 1 h, 2 h, and 3 h after oral care using the Rapid Oral Bacteria Quantification System, which is based on dielectrophoresis and impedance measurements. The number of streptococci, methicillin-resistant Staphylococcus aureus, Streptococcus pneumoniae, Pseudomonas aeruginosa, Porphyromonas gingivalis, and Candida albicans before, immediately after, 1 h, and 3 h after oral care were estimated based on real-time polymerase chain reaction data. Results After irrigation of the oral cavity, the number of bacteria decreased, but increased again at 1 h after oral care in the control group; however, in the intervention group, the concentration of bacteria was significantly lower than that in the control group at 1 hour (p = 0.009), 2 h (p = 0.001), and 3 h (p = 0.001) after oral care. The growth of all bacterial species tested was inhibited in the intervention group at 3 h after oral care, suggesting that povidone iodine did not disturb the balance of the oral microbiota. Conclusions Topical application of povidone iodine after cleaning and irrigation of the oral cavity inhibited bacterial growth in the oropharyngeal fluid of patients on mechanical ventilation while not disrupting the balance of the oral microbiota. Trial registration University Hospitals Medical Information Network Clinical Trials Registry (UMIN-CTR), UMIN000028307. Registered 1 September 2017.
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Affiliation(s)
- Shoma Tsuda
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8588, Japan
| | - Sakiko Soutome
- Oral Care Center, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8588, Japan.
| | - Saki Hayashida
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8588, Japan
| | - Madoka Funahara
- Kyushu Dental University School of Oral Health Sciences, 2-6-1 Manazuru, Kokurakitaku, Kitakyushu, 803-8580, Japan
| | - Souichi Yanamoto
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8588, Japan
| | - Masahiro Umeda
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8588, Japan
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9
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Jackson L, Owens M. Does oral care with chlorhexidine reduce ventilator-associated pneumonia in mechanically ventilated adults? ACTA ACUST UNITED AC 2019; 28:682-689. [PMID: 31188655 DOI: 10.12968/bjon.2019.28.11.682] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Oral colonisation by pathogens contributes to contracting ventilator-associated pneumonia (VAP). The aim of this review was to determine whether the use of the antiseptic chlorhexidine in the intra-oral cavity reduced its incidence in the critically ill, mechanically ventilated adult. The findings from this review led to the conclusion that chlorhexidine reduced the occurrence of VAP. Although a recommendation to implement the use of intra-oral chlorhexidine for mechanically-ventilated patients within critical care can be made, further exploration into required frequency and method of administration would be beneficial to reduce unnecessary exposure and hinder pathogenic resistance.
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Affiliation(s)
- Laura Jackson
- Nursing Sister, Neurosurgical Critical Care Ward L06/L07, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds
| | - Melissa Owens
- Lecturer, School of Nursing and Healthcare Leadership, Faculty of Health Studies, University of Bradford
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10
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de Carvalho Baptista IM, Martinho FC, Nascimento GG, da Rocha Santos CE, Prado RFD, Valera MC. Colonization of oropharynx and lower respiratory tract in critical patients: Risk of ventilator-associated pneumonia. Arch Oral Biol 2018; 85:64-69. [DOI: 10.1016/j.archoralbio.2017.09.029] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 06/20/2017] [Accepted: 09/24/2017] [Indexed: 11/16/2022]
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11
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Kelekar U. Oral Health Matters in Bending the Cost Curve. WORLD MEDICAL & HEALTH POLICY 2017. [DOI: 10.1002/wmh3.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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12
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Ory J, Raybaud E, Chabanne R, Cosserant B, Faure JS, Guérin R, Calvet L, Pereira B, Mourgues C, Guelon D, Traore O. Comparative study of 2 oral care protocols in intensive care units. Am J Infect Control 2017; 45:245-250. [PMID: 28341071 DOI: 10.1016/j.ajic.2016.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 09/06/2016] [Accepted: 09/06/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND The quality of oral care is important in limiting the emergence of ventilator-associated pneumonia (VAP) in intubated patients. Our main objective was to measure the quality improvement in oral care following the implementation of a new oral care protocol. We also monitored VAP rates. MATERIAL/METHODS This was a cohort study of patients in 5 adult ICUs covering different specialties. During period 1, caregivers used a foam stick for oral care and during period 2 a stick and tooth brushing with aspiration. Oral chlorhexidine was used during both periods. The caregivers rated improvement in oral health on the basis of 4 criteria (tongue, mucous membranes, gingivae, and teeth). Caregiver satisfaction was also assessed. The incidence of VAP was monitored. RESULTS A total of 2,030 intubated patients admitted to intensive care units benefited from oral care. The patient populations during the 2 periods were similar with regard to demographic data and VAP potential risk factors. Oral health was significantly better from the third day of oral care in period 2 onward (period 1, 6.4 ± 2.1; period 2, 5.6 ± 1.8; P = .043). Caregivers found the period 2 protocol easier to implement and more effective. VAP rates decreased significantly between the 2 periods (period 1, 12.8%; period 2, 8.5%; P = .002). CONCLUSIONS Our study showed that the implementation of a simple strategy improved the quality of oral care of patients in intensive care units, and decreased VAP rates.
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Jansson MM, Syrjälä HP, Ohtonen PP, Meriläinen MH, Kyngäs HA, Ala-Kokko TI. Effects of simulation education on oral care practices - a randomized controlled trial. Nurs Crit Care 2017; 22:161-168. [PMID: 28093837 DOI: 10.1111/nicc.12276] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 10/24/2016] [Accepted: 11/22/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Implementation of evidence-based oral care protocols, nurse education programmes and assessment tools may reduce the risk of developing ventilator-associated pneumonia by increasing critical care nurses' knowledge and skills in adhering to current oral care recommendations. AIMS To evaluate the longitudinal effects of single-dose simulation education with structured debriefing and verbal feedback on critical care nurses' knowledge and skills in adhering to current oral care recommendations. DESIGN A randomized controlled trial with repeated measurements. METHOD The data for the study were collected in a single academic centre in a 22-bed adult, mixed, medical-surgical intensive care unit in Finland from February 2012 to March 2014. The effectiveness of simulation education was evaluated through the validated Ventilator Bundle Questionnaire and Observation Schedule at baseline (n = 30) and 24 months (n = 17) after simulation education. Data were analysed using a linear mixed model and intention-to-treat analyses. RESULTS During the study period, the average knowledge score in the intervention group increased significantly (44·0% to 56·0% of the total score) in the final post-intervention measurement (pt = 0·51, pg = 0·002, pt*g = 0·023). However, single-dose simulation education with structured debriefing and verbal feedback had no impact on critical care nurses' skill scores. CONCLUSION Single-dose simulation education had only a minimal effect on critical care nurses' knowledge and skills in adhering to current oral care recommendations. Despite increased awareness, there was no significant difference in oral care practices between the study groups after simulation education. RELEVANCE FOR CLINICAL PRACTICE The need for regularly repeated educational sessions with theoretical training and practical exercises and direct feedback is evident. Certain aspects of oral care, such as prevention of microaspiration of oropharyngeal secretions and moistening of oral mucosa and lips, require more reinforcement than others.
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Affiliation(s)
- Miia M Jansson
- Division of Intensive Care, Department of Anesthesiology, Oulu University Hospital, Oulu, Finland.,Unit of Nursing Science and Health Management, University, Oulu, Finland.,Medical Research Center, Oulu, Finland
| | - Hannu P Syrjälä
- Chief of Department of Infection Control, Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Pasi P Ohtonen
- Department of Anesthesiology, Oulu University Hospital, Oulu, Finland
| | - Merja H Meriläinen
- Division of Intensive Care, Department of Anesthesiology, Oulu University Hospital, Medical Research Center, Oulu, Finland
| | - Helvi A Kyngäs
- Unit of Nursing Science and Health Management, Medical Research Center Northern Ostrobothnia Hospital, Oulu, Finland
| | - Tero I Ala-Kokko
- Division of Intensive Care, Department of Anesthesiology, Oulu University Hospital, Oulu, Finland; Medical Research Center, Oulu, Finland
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14
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Wang EW, Layon AJ. Chlorhexidine gluconate use to prevent hospital acquired infections-a useful tool, not a panacea. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:14. [PMID: 28164099 DOI: 10.21037/atm.2017.01.01] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Elizabeth Wenqian Wang
- Department of Hospital Medicine, The Medicine Institute, The Geisinger Health System, Danville, PA 17822-2037, USA
| | - A Joseph Layon
- Department of Critical Care Medicine, The Medicine Institute, The Geisinger Health System, Danville, PA 17822-2037, USA
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15
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Gastric reflux: association with aspiration and oral secretion pH as marker of reflux: a descriptive correlational study. Dimens Crit Care Nurs 2016; 34:84-90. [PMID: 25650493 DOI: 10.1097/dcc.0000000000000096] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Gastric reflux leading to pulmonary aspiration is a frequent event in mechanically ventilated, gastric-fed patients, which can lead to ventilator-associated complications and pneumonia. OBJECTIVES The objectives of this study were to determine the association between gastric reflux and aspiration using the presence of pepsin in oral or tracheal secretions as a marker of reflux or aspiration and to determine the association between the pH (range, 0-14) and the presence of pepsin in oral secretions. METHODS A descriptive correlational study was conducted in mechanically ventilated surgical or medical patients receiving gastric tube feedings. Oral secretions were suctioned hourly and tracheal secretions every 2 to 3 hours for 12-hour periods over 1 to 2 days in 15 patients. RESULTS There were 142 paired samples of oral tracheal secretions. A majority of samples (60%) had the same results, with 32% both pepsin-positive and 27% both pepsin-negative. The range of pH measurements was 4 to 8, with a mean of 6.3 ± 0.05. Ninety oral specimens had a pH of 4 to 6. Forty-seven of the oral specimens with pH measures between 4 and 6 (52%) were pepsin-positive. The correlation of pH percent pepsin-positive oral secretions was not significant. CONCLUSION Aspiration events were more frequent than reflux events. Measurement of actual pepsin concentration to detect new reflux and aspiration events is recommended in future studies. Bedside pH measures of oral secretions are not a valid marker of gastric reflux.
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16
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Chinnadurai K, Fenlason L, Bridges B, Espahbodi M, Chinnadurai S, Blood-Siegfried J. Implementation of a Sustainable Ventilator-Associated Pneumonia Prevention Protocol in a Pediatric Intensive Care Unit in Managua, Nicaragua. Dimens Crit Care Nurs 2016; 35:323-331. [PMID: 27749435 DOI: 10.1097/dcc.0000000000000178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) is a common nosocomial infection in pediatric intensive care units (ICUs). Ventilator-associated pneumonia protocols decrease the incidence of VAP; however, many components of these protocols are not feasible in all settings. This study was done in a large pediatric hospital in Nicaragua. OBJECTIVE The aim of this study is to implement a sustainable evidence-based VAP protocol, in a different culture, for the purpose of decreasing VAP rates. METHODS This quality improvement study used a bidirectional cohort design with the retrospective group as the control and the prospective group as the experimental population. A daily checklist monitored compliance to the implemented protocol in the prospective group. A 2-sided Fisher exact test compared the differences in VAP rates between the 2 populations. RESULTS During the 90-day implementation period, 123 ventilated patients in 3 separate ICU wings were evaluated, with 99 included in the final analysis. These data for 2014 were compared with the VAP rates recorded for the same time period in 2013. The highest adherence to the protocol was demonstrated by ICU wing 1, with a 90% decrease in VAP rates. No statistical difference in VAP rates was demonstrated by ICU 2, and ICU 3 demonstrated an increase in both patient acuity and VAP rates. DISCUSSION Implementation of a sustainable VAP protocol in a pediatric ICU in Nicaragua can reduce the incidence of VAP. Multiple barriers and challenges associated with implementation in a resource-constrained environment are discussed.
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Affiliation(s)
- Kelsey Chinnadurai
- Kelsey Chinnadurai, DNP, is from the Vanderbilt Department of Anesthesiology in Nashville, Tennessee. Lindy Fenlason, MD, MPH, is from the Vanderbilt Department of Pediatrics in Nashville, Tennessee. Brian Bridges, MD, is from the Vanderbilt Department of Pediatrics in Nashville, Tennessee. Mana Espahbodi, BS, is from the Vanderbilt School of Medicine in Nashville, Tennessee. Sivakumar Chinnadurai, MD, MPH, is from the Vanderbilt Department of Otolaryngology in Nashville, Tennessee. Jane Blood-Siegfried, DNSc, PNP, is from the Duke University School of Nursing in Durham, North Carolina
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Miranda AF, de Paula RM, de Castro Piau CGB, Costa PP, Bezerra ACB. Oral care practices for patients in Intensive Care Units: A pilot survey. Indian J Crit Care Med 2016; 20:267-73. [PMID: 27275074 PMCID: PMC4876647 DOI: 10.4103/0972-5229.182203] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess the level of knowledge and difficulties concerning hospitalized patients regarding preventive oral health measures among professionals working in Intensive Care Units (ICUs). STUDY POPULATION AND METHODS A cross-sectional survey was conducted among 71 health professionals working in the ICU. A self-administered questionnaire was used to determine the methods used, frequency, and attitude toward oral care provided to patients in Brazilian ICUs. The variables were analyzed using descriptive statistics (percentages). A one-sample t-test between proportions was used to assess significant differences between percentages. t-statistics were considered statistically significant for P < 0.05. Bonferroni correction was applied to account for multiple testing. RESULTS Most participants were nursing professionals (80.3%) working 12-h shifts in the ICU (70.4%); about 87.3% and 66.2% reported having knowledge about coated tongue and nosocomial pneumonia, respectively (P < 0.05). Most reported using spatulas, gauze, and toothbrushes (49.3%) or only toothbrushes (28.2%) with 0.12% chlorhexidine (49.3%) to sanitize the oral cavity of ICU patients (P < 0.01). Most professionals felt that adequate time was available to provide oral care to ICU patients and that oral care was a priority for mechanically ventilated patients (80.3% and 83.1%, respectively, P < 0.05). However, most professionals (56.4%) reported feeling that the oral cavity was difficult to clean (P < 0.05). CONCLUSION The survey results suggest that additional education is necessary to increase awareness among ICU professionals of the association between dental plaque and systemic conditions of patients, to standardize oral care protocols, and to promote the oral health of patients in ICUs.
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Affiliation(s)
- Alexandre Franco Miranda
- Department of Preventive Dentistry, Post Graduation, Program in Health Sciences, University of Brasilia, Brazil; Department of Dentistry for Special Patients, Geriatric and Hospital Dentistry, Catholic University of Brasilia, Brazil
| | - Renata Monteiro de Paula
- Department of Dentistry for Special Patients, Geriatric and Hospital Dentistry, Catholic University of Brasilia, Brazil
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Hayashida S, Funahara M, Sekino M, Yamaguchi N, Kosai K, Yanamoto S, Yanagihara K, Umeda M. The effect of tooth brushing, irrigation, and topical tetracycline administration on the reduction of oral bacteria in mechanically ventilated patients: a preliminary study. BMC Oral Health 2016; 16:67. [PMID: 27268137 PMCID: PMC4895927 DOI: 10.1186/s12903-016-0224-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 05/26/2016] [Indexed: 11/18/2022] Open
Abstract
Background One of the main causes of ventilator-associated pneumonia (VAP) is thought to be aspiration of oropharyngeal fluid containing pathogenic microorganisms. The aim of this study was to examine the effects of various oral care methods on the reduction of oral bacteria during intubation. Methods First, the effect of mechanical oral cleaning was investigated. The bacterial count on the tongue and in the oropharyngeal fluid was measured after tooth brushing, irrigation, and three hours after irrigation in mechanically ventilated patients at the intensive care unit (ICU). Next, the efficacy of topical administration of tetracycline and povidone iodine on the inhibition of bacterial growth on the tongue and in the oropharyngeal fluid was examined in oral cancer patients during neck dissection. Results The number of bacteria in the oropharyngeal fluid was approximately 105–106 cfu/mL before surgery, but increased to 108 cfu/mL after intubation. Oral care with tooth brushing and mucosal cleaning did not reduce oral bacteria, while irrigation of the oral cavity and oropharynx significantly decreased it to a level of 105 cfu/mL (p < 0.001). However, oral bacteria increased again to almost 108 cfu/mL within three hours of irrigation. Oral bacteria did not decrease by topical povidone iodine application. In contrast, 30 min after topical administration of tetracycline, the number of oral bacteria decreased to 105 cfu/mL, and remained under 106 cfu/mL throughout the entire experimental period of 150 min. Conclusions While the present studies are only preliminary, these results indicate that irrigation of the oral cavity and oropharynx followed by topical antibiotic administration may reduce oral bacteria in mechanically ventilated patients. Trial registration UMIN000018318, 1 August 2015.
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Affiliation(s)
- Saki Hayashida
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, 41-7-1 Sakamoto, Nagasaki, 852-8588, Japan.
| | - Madoka Funahara
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, 41-7-1 Sakamoto, Nagasaki, 852-8588, Japan
| | - Motohiro Sekino
- Division of intensive care, Nagasaki University Hospital, 41-7-1 Sakamoto, Nagasaki, 852-8588, Japan
| | - Noriko Yamaguchi
- Division of intensive care, Nagasaki University Hospital, 41-7-1 Sakamoto, Nagasaki, 852-8588, Japan
| | - Kosuke Kosai
- Department of Laboratory Medicine, Nagasaki University Graduate School of Medicine, 41-7-1 Sakamoto, Nagasaki, 852-8588, Japan
| | - Souichi Yanamoto
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, 41-7-1 Sakamoto, Nagasaki, 852-8588, Japan
| | - Katsunori Yanagihara
- Department of Laboratory Medicine, Nagasaki University Graduate School of Medicine, 41-7-1 Sakamoto, Nagasaki, 852-8588, Japan
| | - Masahiro Umeda
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, 41-7-1 Sakamoto, Nagasaki, 852-8588, Japan
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Waltrick R, Possamai DS, de Aguiar FP, Dadam M, de Souza Filho VJ, Ramos LR, Laurett RDS, Fujiwara K, Caldeira Filho M, Koenig Á, Westphal GA. Comparison between a clinical diagnosis method and the surveillance technique of the Center for Disease Control and Prevention for identification of mechanical ventilator-associated pneumonia. Rev Bras Ter Intensiva 2016; 27:260-5. [PMID: 26465248 PMCID: PMC4592121 DOI: 10.5935/0103-507x.20150047] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 06/19/2015] [Indexed: 01/01/2023] Open
Abstract
Objective >To evaluate the agreement between a new epidemiological surveillance method of
the Center for Disease Control and Prevention and the clinical pulmonary infection
score for mechanical ventilator-associated pneumonia detection. Methods This was a prospective cohort study that evaluated patients in the intensive care
units of two hospitals who were intubated for more than 48 hours between August
2013 and June 2014. Patients were evaluated daily by physical therapist using the
clinical pulmonary infection score. A nurse independently applied the new
surveillance method proposed by the Center for Disease Control and Prevention. The
diagnostic agreement between the methods was evaluated. A clinical pulmonary
infection score of ≥ 7 indicated a clinical diagnosis of mechanical
ventilator-associated pneumonia, and the association of a clinical pulmonary
infection score ≥ 7 with an isolated semiquantitative culture consisting of
≥ 104 colony-forming units indicated a definitive diagnosis. Results Of the 801 patients admitted to the intensive care units, 198 required mechanical
ventilation. Of these, 168 were intubated for more than 48 hours. A total of 18
(10.7%) cases of mechanical ventilation-associated infectious conditions were
identified, 14 (8.3%) of which exhibited possible or probable mechanical
ventilatorassociated pneumonia, which represented 35% (14/38) of mechanical
ventilator-associated pneumonia cases. The Center for Disease Control and
Prevention method identified cases of mechanical ventilator-associated pneumonia
with a sensitivity of 0.37, specificity of 1.0, positive predictive value of 1.0,
and negative predictive value of 0.84. The differences resulted in discrepancies
in the mechanical ventilator-associated pneumonia incidence density (CDC, 5.2/1000
days of mechanical ventilation; clinical pulmonary infection score ≥ 7,
13.1/1000 days of mechanical ventilation). Conclusion The Center for Disease Control and Prevention method failed to detect mechanical
ventilatorassociated pneumonia cases and may not be satisfactory as a surveillance
method.
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Affiliation(s)
- Renata Waltrick
- Programa de Residência em Medicina Intensiva, Hospital Municipal São José, Joinville, SC, BR
| | - Dimitri Sauter Possamai
- Programa de Residência em Medicina Intensiva, Hospital Municipal São José, Joinville, SC, BR
| | | | - Micheli Dadam
- Serviço de Fisioterapia, Centro Hospitalar Unimed, Joinville, SC, BR
| | | | - Lucas Rocker Ramos
- Faculdade de Medicina, Universidade da Região de Joinville, Joinville, SC, BR
| | | | - Kênia Fujiwara
- Comissão de Controle de Infecção Hospitalar, Centro Hospitalar Unimed, Joinville, SC, BR
| | - Milton Caldeira Filho
- Programa de Residência em Medicina Intensiva, Hospital Municipal São José, Joinville, SC, BR
| | - Álvaro Koenig
- Comissão de Controle de Infecção Hospitalar, Centro Hospitalar Unimed, Joinville, SC, BR
| | - Glauco Adrieno Westphal
- Programa de Residência em Medicina Intensiva, Hospital Municipal São José, Joinville, SC, BR
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Arefian H, Vogel M, Kwetkat A, Hartmann M. Economic Evaluation of Interventions for Prevention of Hospital Acquired Infections: A Systematic Review. PLoS One 2016; 11:e0146381. [PMID: 26731736 PMCID: PMC4701449 DOI: 10.1371/journal.pone.0146381] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 12/16/2015] [Indexed: 11/24/2022] Open
Abstract
Objective This systematic review sought to assess the costs and benefits of interventions preventing hospital-acquired infections and to evaluate methodological and reporting quality. Methods We systematically searched Medline via PubMed and the National Health Service Economic Evaluation Database from 2009 to 2014. We included quasi-experimental and randomized trails published in English or German evaluating the economic impact of interventions preventing the four most frequent hospital-acquired infections (urinary tract infections, surgical wound infections, pneumonia, and primary bloodstream infections). Characteristics and results of the included articles were extracted using a standardized data collection form. Study and reporting quality were evaluated using SIGN and CHEERS checklists. All costs were adjusted to 2013 US$. Savings-to-cost ratios and difference values with interquartile ranges (IQRs) per month were calculated, and the effects of study characteristics on the cost-benefit results were analyzed. Results Our search returned 2067 articles, of which 27 met the inclusion criteria. The median savings-to-cost ratio across all studies reporting both costs and savings values was US $7.0 (IQR 4.2–30.9), and the median net global saving was US $13,179 (IQR 5,106–65,850) per month. The studies’ reporting quality was low. Only 14 articles reported more than half of CHEERS items appropriately. Similarly, an assessment of methodological quality found that only four studies (14.8%) were considered high quality. Conclusions Prevention programs for hospital acquired infections have very positive cost-benefit ratios. Improved reporting quality in health economics publications is required.
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Affiliation(s)
- Habibollah Arefian
- Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
- Hospital Pharmacy, Jena University Hospital, Jena, Germany
- * E-mail:
| | - Monique Vogel
- Center for Clinical Studies, Jena University Hospital, Jena, Germany
| | - Anja Kwetkat
- Department of Geriatric Medicine, Jena University Hospital, Jena, Germany
| | - Michael Hartmann
- Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
- Hospital Pharmacy, Jena University Hospital, Jena, Germany
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Trouillet JL, Luyt CE, Brechot N, Chastre J. Intérêt des soins de bouche et du brossage des dents dans la prévention des pneumonies acquises sous ventilation mécanique. MEDECINE INTENSIVE REANIMATION 2016. [DOI: 10.1007/s13546-015-1148-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Kiyoshi-Teo H, Blegen M. Influence of Institutional Guidelines on Oral Hygiene Practices in Intensive Care Units. Am J Crit Care 2015; 24:309-18. [PMID: 26134330 DOI: 10.4037/ajcc2015920] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Maintaining oral hygiene is a key component of preventing ventilator-associated pneumonia; however, practices are inconsistent. OBJECTIVES To explore how characteristics of institutional guidelines for oral hygiene influence nurses' oral hygiene practices and perceptions of that practice. METHODS Oral hygiene section of a larger survey study on prevention of ventilator-associated pneumonia. Critical care nurses at 8 hospitals in Northern California that had more than 1000 ventilator days in 2009 were recruited to participate in the survey. Twenty-one questions addressed oral hygiene practices and practice perceptions. Descriptive statistics, analysis of variance, and Spearman correlations were used for analyses. RESULTS A total of 576 critical care nurses (45% response rate) responded to the survey. Three types of institutional oral hygiene guidelines existed: nursing policy, order set, and information bulletin. Nursing policy provided the most detail about the oral hygiene care; however, adherence, awareness, and priority level were higher with order sets (P < .05). The content and method of disseminating these guidelines varied, and nursing practices were affected by these differences. Nurses assessed the oral cavity and used oral swabs more often when those practices were included in institutional guidelines. CONCLUSIONS The content and dissemination method of institutional guidelines on oral hygiene do influence the oral hygiene practices of critical care nurses. Future studies examining how institutional guidelines could best be incorporated into routine workflow are needed.
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Affiliation(s)
- Hiroko Kiyoshi-Teo
- Hiroko Kiyoshi-Teo is a clinical assistant professor in the School of Nursing, Oregon Health & Science University, Portland, Oregon. Mary Blegen is a professor emerita in the School of Nursing, University of California, San Francisco
| | - Mary Blegen
- Hiroko Kiyoshi-Teo is a clinical assistant professor in the School of Nursing, Oregon Health & Science University, Portland, Oregon. Mary Blegen is a professor emerita in the School of Nursing, University of California, San Francisco
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Santos PSDS, Mariano M, Kallas MS, Vilela MCN. Impact of tongue biofilm removal on mechanically ventilated patients. Rev Bras Ter Intensiva 2015; 25:44-8. [PMID: 23887759 PMCID: PMC4031859 DOI: 10.1590/s0103-507x2013000100009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 02/28/2013] [Indexed: 11/22/2022] Open
Abstract
Objective To evaluate the effectiveness of a tongue cleaner in the removal of tongue biofilm
in mechanically ventilated patients. Methods Tongue biofilm and tracheal secretion samples were collected from a total of 50
patients: 27 in the study group (SG) who were intubated or tracheostomized under
assisted ventilation and treated with the tongue cleaner and 23 in the control
group (CG) who did not undergo tongue cleaning. Oral and tracheal secretion
cultures of the SG (initially and after 5 days) and the CG (at a single
time-point) were performed to evaluate the changes in bacterial flora. Results The median age of the SG patients was 77 years (45-99 years), and that of the CG
patients was 79 years (21-94 years). The length of hospital stay ranged from
17-1,370 days for the SG with a median stay of 425 days and from 4-240 days for
the CG with a median stay of 120 days. No significant differences were found when
the dental plaque indexes were compared between the SG and the CG. There was no
correlation between the index and the length of hospital stay. The same bacterial
flora was found in the dental plaque of 9 of the 27 SG patients before and after
the tongue scraper was used for 5 days compared with the CG (p=0.683). Overall, 7
of the 27 SG patients had positive bacterial cultures for the same strains in both
tongue biofilm and tracheal secretions compared with the CG (p=0.003). Significant
similarities in strain resistance and susceptibility of the assessed
microorganisms were observed between oral and tracheal microflora in 6/23 cases in
the CG (p=0.006). Conclusion The use of a tongue cleaner is effective at reducing tongue biofilm in patients on
mechanical ventilation and facilitates oral hygiene interventions performed by
caregivers. Clinical Trials Registry NCT01294943
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Saddki N, Mohamad Sani FE, Tin-Oo MM. Oral care for intubated patients: a survey of intensive care unit nurses. Nurs Crit Care 2014; 22:89-98. [PMID: 25349099 DOI: 10.1111/nicc.12119] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 03/05/2014] [Accepted: 06/18/2014] [Indexed: 12/28/2022]
Abstract
AIMS This study aimed to determine attitudes and practices of intensive care unit (ICU) nurses towards provision of oral care for intubated patients. BACKGROUND Oral care is as an essential nursing intervention for intubated patients to maintain patient comfort and prevent colonization of dental plaque by respiratory pathogens. DESIGN This was a cross-sectional study. METHODS Data were collected from 93 ICU nurses of a teaching hospital in the East Coast of Peninsular Malaysia using a self-administered questionnaire. RESULTS Some nurses agreed that oral cavity of intubated patients was difficult (40·8%) and unpleasant (16·2%) to clean, but all of them realized the importance of oral care and the majority (97·9%) would like to learn more about it. Most nurses reported providing oral care at least two times daily using various methods and products such as suction toothbrush (90·4%), manual toothbrush (49·5%), cotton swab (91·5%) and foam swab (65·7%). Chlorhexidine gluconate oral rinse was the preferred mouthwash (97·8%) and swabs (93·5%) solution although few used non-optimal products such as sodium bicarbonate (14·0%), tap water (4·3%) and hydrogen peroxide (3·2%) to wash their patients' mouths. While the majority of nurses agreed that oral care supplies and equipments were available (93·6%) and suitable (88·2%), most of them also thought they need better hospital support (88·2%). CONCLUSIONS The nurses' attitudes towards oral care were generally positive and most oral care methods were appropriate. However, some methods and products used were inconsistent with the current recommendations and they have mixed views about the suitability of oral care supplies and equipment provided by the hospital. RELEVANCE TO CLINICAL PRACTICE Recommendations were made for providing standard oral care protocols for intubated patients and oral care training programs for ICU nurses to support delivery of quality patient care.
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Affiliation(s)
- Norkhafizah Saddki
- School of Dental Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | | | - Mon Mon Tin-Oo
- School of Dental Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
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Abstract
UNLABELLED Nosocomial and ventilator associated pneumonias that plague critically ill, elderly and long-term care residents could be reduced with effective oral hygiene practices facilitated collaboratively between nurses and dental hygienists. BACKGROUND Nosocomial pneumonias, specifically aspiration pneumonias and ventilator-associated pneumonias in the elderly and infirm have become a major health care issue, The provision of oral care in hospital and hospital-like facilities presents challenges that can prevent patients from receiving optimal oral care One sequela can be aspiration pneumonia which ranks first in mortality and second in morbidity among all nosocomial infections. Since aspiration pneumonia is linked to the colonization of oral bacteria in dental plaque and biofilm, it is time to look for creative solutions to integrating the expertise of dental hygienists into health care teams in these institutional settings. METHODS A comprehensive review of the literature was conducted regarding the etiology and prevalence of health care related pneumonias. Evidence describing the challenges and barriers that the nurses, nursing staff, and dental hygienists face in the provision of oral care in hospitals and long-term care facilities is provided. Intercollaborative solutions to providing optimal oral care in hospitals and long-term care facilities are suggested. CONCLUSION Dental hygienists have the expertise and practice experience to provide oral care in hospitals, long-term care and residential facilities. They can contribute to solving oral care challenges through intercollaboration with other health care team members. Yet, there are long-standing systemic barriers that must be addressed in order to provide this optimal care. Dental hygienists becoming better assimilated within the total health care team in hospital and residential facilities can positively impact the suffering, morbidity and mortality associated with aspiration pneumonias.
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Affiliation(s)
- Caren M Barnes
- Applied and Clinical Research, Department of Dental Hygiene, Nebraska Center for Materials and Nanoscience, University of Nebraska Medical Center, College of Dentistry, Lincoln, NE 68583-0740, USA.
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Abstract
Upper respiratory infections are commonplace, especially in young people, and are often contagious Lower respiratory infections are often contagious and some are potentially fatal Asthma is common and may be life-threatening Chronic obstructive pulmonary disease is common and disabling Tuberculosis worldwide is an important infection, affecting people with HIV/AIDS or malnutrition particularly Lung cancer is common and usually has a poor prognosis
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Kalisch BJ, Xie B, Dabney BW. Patient-Reported Missed Nursing Care Correlated With Adverse Events. Am J Med Qual 2013; 29:415-22. [DOI: 10.1177/1062860613501715] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Boqin Xie
- University of Michigan, Ann Arbor, MI
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Abstract
BACKGROUND Several studies have demonstrated that oral care with chlorhexidine gluconate (CHG) 0.12% solution reduces the incidence of ventilator-associated pneumonia (VAP) in mechanically ventilated patients with endotracheal tubes in the ICU. Minimal evidence shows the effectiveness of any oral care protocols in preventing VAP in mechanically ventilated patients with tracheostomies in a step-down or progressive care unit (PCU). OBJECTIVE To determine the effectiveness of an oral care protocol in reducing the VAP rate in mechanically ventilated patients with tracheostomies in the PCU. METHODS A 12-month prospective study was conducted on 75 mechanically ventilated patients who had tracheostomies. The oral care protocol consisted of tooth brushing with toothpaste and applying CHG 0.12% solution every 12 hours. At the conclusion of the study, the VAP rate in the study population was compared with the National Health and Safety Network (NHSN) report for 2009 benchmark of 1.5 per 1,000 ventilator days. RESULTS After the oral care protocol was implemented in the PCU, the VAP rate was 1.1 per 1,000 ventilator days over 12 months, compared with the NHSN report for 2009 of 1.5 per 1,000 ventilator days. CONCLUSIONS Tooth brushing with toothpaste and applying CHG 0.12% solution may be an effective oral care protocol to reduce the VAP rate in patients in PCUs with tracheostomies who are being mechanically ventilated.
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Zhang TT, Tang SS, Fu LJ. The effectiveness of different concentrations of chlorhexidine for prevention of ventilator-associated pneumonia: a meta-analysis. J Clin Nurs 2013; 23:1461-75. [PMID: 23952970 DOI: 10.1111/jocn.12312] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2013] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To evaluate the effectiveness of chlorhexidine for the prevention of ventilator-associated pneumonia and explore the preferred concentration of chlorhexidine. BACKGROUND The implementation of effective oral care measures could reduce the incidence of ventilator-associated pneumonia, but among several randomised controlled trials, whether using chlorhexidine is effective and which concentration is more appropriate remain controversial. DESIGN A meta-analysis was conducted. METHODS We searched the Cochrane Library, PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, China Biology Medicine disc and Chinese National Knowledge Infrastructure to collect randomised controlled trials of mechanically ventilated adult patients receiving oral care with chlorhexidine to prevent ventilator-associated pneumonia. The quality of randomised controlled trials was critically appraised, data were extracted by two reviewers independently, and disagreement was resolved by consensus. Meta-analyses were conducted for the eligible randomised controlled trials by revman 5.1. Relative risks and 95% CIs were calculated with the Mantel-Haenszel model, and heterogeneity was assessed with the I(2) test. RESULTS Eighteen randomised controlled trials were included and a meta-analysis was used. All studies indicated chlorhexidine could significantly prevent and reduce the incidence of ventilator-associated pneumonia [RR = 0·59, 95% CI (0·50-0·69), p < 0·00001]. Nine studies showed 0·12% chlorhexidine had a significant effect [RR = 0·53, 95% CI (0·43-0·67), p < 0·00001]. Three studies proved the effect of the 2% chlorhexidine on the prevention of ventilator-associated pneumonia [RR = 0·55, 95% CI (0·37-0·81), p = 0·002]. CONCLUSION Chlorhexidine can prevent and reduce the incidence of ventilator-associated pneumonia. Chlorhexidine of 0·12% has the best effect on the prevention of ventilator-associated pneumonia according to the meta-analysis, cost analysis, adverse reactions and drug resistance analysis. RELEVANCE TO CLINICAL PRACTICE Ventilator-associated pneumonia remains a leading cause of morbidity and mortality in intensive care unit, and implementing effective oral care can reduce the incidence of ventilator-associated pneumonia. Chlorhexidine of 0·12% is recommended in our study.
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Affiliation(s)
- Ting-Ting Zhang
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Jiaotong University School of Medicine, Shanghai, China
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Rothaug O, Müller-Wolff A, Kaltwasser R, Dubb R, Hermes C. [Methods for endotracheal tube fixation. Results of a survey of intensive care nurses]. Med Klin Intensivmed Notfmed 2013; 108:507-15. [PMID: 23868519 DOI: 10.1007/s00063-013-0264-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 06/19/2013] [Accepted: 06/24/2013] [Indexed: 11/30/2022]
Abstract
There are a wide variety of strategies and methods used in securing and managing the oral endotracheal tube and mouth and oral care in German clinical intensive care nursing for mechanically ventilated patients. There are no nationally recognized guidelines or recommendations on this topic. A survey among intensive care nurses identified the most widely used nursing strategies and methods. Regarding the results of the survey and international literature findings, the commonly used strategies and methods are discussed. Following these discussions, there are recommendations for improving nursing care of orally intubated patients in intensive care, including the aspects of evidence identified, currently used methods and patient needs. Also included are aspects of patient safety, potential complications and quality-orientated nursing care within a system having limited overall nursing care resources.
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Affiliation(s)
- O Rothaug
- Operative Intensivstation 0117/0118, Universitätsmedizin Göttingen, Göttingen, Deutschland,
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Ganz FD, Ofra R, Khalaila R, Levy H, Arad D, Kolpak O, Nun MB, Drori Y, Benbenishty J. Translation of Oral Care Practice Guidelines Into Clinical Practice by Intensive Care Unit Nurses. J Nurs Scholarsh 2013; 45:355-62. [DOI: 10.1111/jnu.12039] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Freda DeKeyser Ganz
- Pi , Head, Master's Program; Hadassah-Hebrew University School of Nursing; Faculty of Medicine; Jerusalem Israel
| | - Raanan Ofra
- Lecturer, Sheba School of Nursing; Tel Hashomer Israel
| | - Rabia Khalaila
- Director, Faculty of Nursing; Zefat Academic College Zefat; Israel
| | - Hadassa Levy
- Head Nurse, Cardiology; Rambam Health Care Campus; Haifa Israel
| | - Dana Arad
- Staff Nurse, Ichilov Medical Center; Tel Aviv Israel
| | - Orly Kolpak
- ICU Head Nurse, Western Galilee Hospital-Nahariya; Nahariya Israel
| | | | - Yardena Drori
- Head Nurse, Cardiac ICU; Haemek Hospital; Afula Israel
| | - Julie Benbenishty
- Academic Consultant/Trauma Coordinator, Nursing Administration; Hadassah Hebrew University Hospital; Jerusalem Israel
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Soins de bouche et pneumonies acquises sous ventilation mécanique. MEDECINE INTENSIVE REANIMATION 2013. [DOI: 10.1007/s13546-013-0667-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Toothbrushing for critically ill mechanically ventilated patients: a systematic review and meta-analysis of randomized trials evaluating ventilator-associated pneumonia. Crit Care Med 2013; 41:646-55. [PMID: 23263588 DOI: 10.1097/ccm.0b013e3182742d45] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Oral care may decrease ventilator-associated pneumonia in the ICU. The objective of this review was to summarize and critically appraise randomized trials in mechanically ventilated patients in the ICU testing the effect of oral care strategies involving toothbrushing on ventilator-associated pneumonia. SEARCH METHODS We searched EMBASE, MEDLINE, and the Cochrane Controlled Trials Register and Database of Systematic Reviews from 1980 until March 2012, independently and in duplicate, as well as personal files and reference lists. In duplicate, articles were selected if they were randomized trials, enrolled adult critically ill patients, compared any kind of oral care involving toothbrushing with any other kind of oral care or control with or without toothbrushing, and examined ventilator-associated pneumonia. In duplicate, we abstracted trial characteristics and quality using the Cochrane risk of bias tool. The results were combined using a random effects model. RESULTS We included six trials enrolling 1,408 patients, five of which compared toothbrushing to usual oral care and one of which compared electric with manual toothbrushing. In four trials, there was a trend toward lower ventilator-associated pneumonia rates (risk ratio, 0.77; 95% confidence interval, 0.50-1.21; p = 0.26). This trend was also observed in one trial reporting fewer cases of ventilator-associated pneumonia per 1,000 ventilator days (20.68 vs. 25.89; p = 0.53) in patients receiving toothbrushing vs. no toothbrushing. The only trial with low risk of bias suggested that toothbrushing significantly reduced ventilator-associated pneumonia (risk ratio, 0.26; 95% confidence interval, 0.10-0.67; p = 0.006). Use of chlorhexidine antisepsis seems to attenuate the effect of toothbrushing on ventilator-associated pneumonia (p for the interaction = 0.02). One trial comparing electric vs. manual toothbrushing showed no difference in ventilator-associated pneumonia rates (risk ratio, 0.96; 95% confidence interval, 0.47-1.96; p = 0.91). Toothbrushing did not impact on length of ICU stay, or ICU or hospital mortality. CONCLUSIONS In intubated, mechanically ventilated critically ill patients, toothbrushing did not significantly reduce the risk of ventilator-associated pneumonia overall. Toothbrushing has no effect on mortality or length of stay. Electric and manual toothbrushing seem to have similar effects. More research is needed on this aspect of oral care to evaluate its potential to decrease ventilator-associated pneumonia.
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Berkey DB, Scannapieco FA. Medical considerations relating to the oral health of older adults. SPECIAL CARE IN DENTISTRY 2013; 33:164-76. [PMID: 23795637 DOI: 10.1111/scd.12027] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This review paper was written in conjunction with the 2010 National Coalition Consensus Conference: Oral Health of Vulnerable Older Adults and Persons with Disabilities. It provides an overview of specific medical considerations involved with dental diagnosis and treatment of this "at risk population." The role of oral inflammation is referenced within the context of the oral/systemic paradigm (e.g., diabetes, cardiovascular disease/stroke, respiratory diseases, and cognition). Oral manifestations associated with multi-organ diseases, tobacco/alcohol use, and medications are additionally discussed. Finally, the paper encourages development of interdisciplinary approaches to positively influence health outcomes.
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Affiliation(s)
- Douglas B Berkey
- University of Colorado, School of Dental Medicine, Aurora, CO, 80045, USA.
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Flodgren G, Conterno LO, Mayhew A, Omar O, Pereira CR, Shepperd S. Interventions to improve professional adherence to guidelines for prevention of device-related infections. Cochrane Database Syst Rev 2013:CD006559. [PMID: 23543545 DOI: 10.1002/14651858.cd006559.pub2] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Healthcare-associated infections (HAIs) are a major threat to patient safety, and are associated with mortality rates varying from 5% to 35%. Important risk factors associated with HAIs are the use of invasive medical devices (e.g. central lines, urinary catheters and mechanical ventilators), and poor staff adherence to infection prevention practices during insertion and care for the devices when in place. There are specific risk profiles for each device, but in general, the breakdown of aseptic technique during insertion and care for the device, as well as the duration of device use, are important factors for the development of these serious and costly infections. OBJECTIVES To assess the effectiveness of different interventions, alone or in combination, which target healthcare professionals or healthcare organisations to improve professional adherence to infection control guidelines on device-related infection rates and measures of adherence. SEARCH METHODS We searched the following electronic databases for primary studies up to June 2012: the Cochrane Effective Paractice and Organisation of Care (EPOC) Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and CINAHL. We searched reference lists and contacted authors of included studies. We also searched the Cochrane Database of Systematic Reviews and Database of Abstracts of Reviews of Effectiveness (DARE) for related reviews. SELECTION CRITERIA We included randomised controlled trials (RCTs), non-randomised controlled trials (NRCTs), controlled before-after (CBA) studies and interrupted time series (ITS) studies that complied with the Cochrane EPOC Group methodological criteria, and that evaluated interventions to improve professional adherence to guidelines for the prevention of device-related infections. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risk of bias of each included study using the Cochrane EPOC 'Risk of bias' tool. We contacted authors of original papers to obtain missing information. MAIN RESULTS We included 13 studies: one cluster randomised controlled trial (CRCT) and 12 ITS studies, involving 40 hospitals, 51 intensive care units (ICUs), 27 wards, and more than 3504 patients and 1406 healthcare professionals. Six of the included studies targeted adherence to guidelines to prevent central line-associated blood stream infections (CLABSIs); another six studies targeted adherence to guidelines to prevent ventilator-associated pneumonia (VAP), and one study focused on interventions to improve urinary catheter practices. We judged all included studies to be at moderate or high risk of bias.The largest median effect on rates of VAP was found at nine months follow-up with a decrease of 7.36 (-10.82 to 3.14) cases per 1000 ventilator days (five studies and 15 sites). The one included cluster randomised controlled trial (CRCT) observed, improved urinary catheter practices five weeks after the intervention (absolute difference 12.2 percentage points), however, the statistical significance of this is unknown given a unit of analysis error. It is worth noting that N = 6 interventions that did result in significantly decreased infection rates involved more than one active intervention, which in some cases, was repeatedly administered over time, and further, that one intervention involving specialised oral care personnel showed the largest step change (-22.9 cases per 1000 ventilator days (standard error (SE) 4.0), and also the largest slope change (-6.45 cases per 1000 ventilator days (SE 1.42, P = 0.002)) among the included studies. We attempted to combine the results for studies targeting the same indwelling medical device (central line catheters or mechanical ventilators) and reporting the same outcomes (CLABSI and VAP rate) in two separate meta-analyses, but due to very high statistical heterogeneity among included studies (I(2) up to 97%), we did not retain these analyses. Six of the included studies reported post-intervention adherence scores ranging from 14% to 98%. The effect on rates of infection were mixed and the effect sizes were small, with the largest median effect for the change in level (interquartile range (IQR)) for the six CLABSI studies being observed at three months follow-up was a decrease of 0.6 (-2.74 to 0.28) cases per 1000 central line days (six studies and 36 sites). This change was not sustained over longer follow-up times. AUTHORS' CONCLUSIONS The low to very low quality of the evidence of studies included in this review provides insufficient evidence to determine with certainty which interventions are most effective in changing professional behaviour and in what contexts. However, interventions that may be worth further study are educational interventions involving more than one active element and that are repeatedly administered over time, and interventions employing specialised personnel, who are focused on an aspect of care that is supported by evidence e.g. dentists/dental auxiliaries performing oral care for VAP prevention.
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Affiliation(s)
- Gerd Flodgren
- Department of Public Health, University of Oxford, Oxford, UK.
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Yildiz M, Durna Z, Akin S. Assessment of oral care needs of patients treated at the intensive care unit. J Clin Nurs 2013; 22:2734-47. [PMID: 23534462 DOI: 10.1111/jocn.12035] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2012] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To assess the oral hygiene needs and the status of the oral mucus membranes of patients being treated in an intensive care unit and to determine the personal- or treatment-related variables associated with oral hygiene and the status of the oral mucus membranes of patients. BACKGROUND Oral hygiene has an impact on the clinical outcomes and well-being of critically ill patients. DESIGN A descriptive, cross-sectional design was used. METHOD The study was conducted in the intensive care unit of a private hospital located in Istanbul. The study sample consisted of 60 patients treated in the intensive care unit for five consecutive days. Oral assessments were conducted once per day every morning for five days. The oral assessments were performed using the Oral Assessment Tool and Oral Assessment Checklist. RESULTS The oral hygiene status and the health of the oral mucus membranes improved over the consecutive five-day assessments, and the routine oral care provided by nurses in the intensive care unit was effective in preventing oral mucus membrane-related complications. CONCLUSIONS The frequency of oral care and oral moistening should be determined according to the patient's condition and the presence of risk factors for oral complications. Oral mucus membranes should be assessed closely and systematically in all critically ill patients who are mechanically ventilated, are receiving oxygen therapy, are undergoing invasive procedures, have a history of chronic health problems or are receiving enteral or parenteral nutrition. RELEVANCE TO CLINICAL PRACTICE To prevent infections or complications during intensive care treatment, it is important for nurses working in critical care units to develop and implement oral care assessments and evidence-based oral care protocols.
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Affiliation(s)
- Melek Yildiz
- Memorial Hospital, Infection Control Department, Istanbul, Turkey
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Hillier B, Wilson C, Chamberlain D, King L. Preventing Ventilator-Associated Pneumonia Through Oral Care, Product Selection, and Application Method. AACN Adv Crit Care 2013. [DOI: 10.4037/nci.0b013e31827df8ad] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Objective:Review the literature to identify the most effective method of oral hygiene to reduce the incidence of ventilator-associated pneumonia (VAP).Background:Ventilator-associated pneumonia is the most common nosocomial infection in patients being treated with mechanical ventilation.Method:This study is a systematic literature review. The databases searched included Web of Science, Cumulative Index to Nursing and Allied Health Literature, Ovid, and MEDLINE.Results:Implementation of oral care protocols and nurse education programs reduced VAP. Although chlorhexidine was the most popular oral care product, no consensus emerged on concentration or protocols for oral care.Conclusion:No consensus on best practice for oral hygiene in patients being treated with mechanical ventilation was found. Chlorhexidine was the most popular oral care product. Implementation of an oral care protocol, ongoing nurse education, and evaluation were important in reducing the incidence of VAP. Future research should analyze chlorhexidine concentration, application techniques, and frequency of oral care, to optimize VAP prevention.
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Affiliation(s)
- Bianca Hillier
- Bianca Hillier is Intensive and Critical Care RN, Flinders Medical Centre, Adelaide, Australia. Christine Wilson is Lecturer in Paramedical Studies, Flinders University, Sturt Rd, Bedford Park, Adelaide, Australia . Di Chamberlain is Senior Lecturer in Nursing, Flinders University, Adelaide, Australia. Lindy King is Associate Dean, Higher Degrees, Flinders University, Adelaide, Australia
| | - Christine Wilson
- Bianca Hillier is Intensive and Critical Care RN, Flinders Medical Centre, Adelaide, Australia. Christine Wilson is Lecturer in Paramedical Studies, Flinders University, Sturt Rd, Bedford Park, Adelaide, Australia . Di Chamberlain is Senior Lecturer in Nursing, Flinders University, Adelaide, Australia. Lindy King is Associate Dean, Higher Degrees, Flinders University, Adelaide, Australia
| | - Di Chamberlain
- Bianca Hillier is Intensive and Critical Care RN, Flinders Medical Centre, Adelaide, Australia. Christine Wilson is Lecturer in Paramedical Studies, Flinders University, Sturt Rd, Bedford Park, Adelaide, Australia . Di Chamberlain is Senior Lecturer in Nursing, Flinders University, Adelaide, Australia. Lindy King is Associate Dean, Higher Degrees, Flinders University, Adelaide, Australia
| | - Lindy King
- Bianca Hillier is Intensive and Critical Care RN, Flinders Medical Centre, Adelaide, Australia. Christine Wilson is Lecturer in Paramedical Studies, Flinders University, Sturt Rd, Bedford Park, Adelaide, Australia . Di Chamberlain is Senior Lecturer in Nursing, Flinders University, Adelaide, Australia. Lindy King is Associate Dean, Higher Degrees, Flinders University, Adelaide, Australia
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Mouth Care in Patients Receiving Mechanical Ventilation: A Systematic Review. Nurs Midwifery Stud 2012. [DOI: 10.5812/nms.8543] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Zurmehly J. Oral care education in the prevention of ventilator-associated pneumonia: quality patient outcomes in the intensive care unit. J Contin Educ Nurs 2012; 44:67-75. [PMID: 23230853 DOI: 10.3928/00220124-20121203-16] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2012] [Accepted: 11/01/2012] [Indexed: 11/20/2022]
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) is associated with high morbidity and mortality rates in mechanically ventilated patients in the United States. Routine oral care has been shown to have a direct effect on reducing VAP rates. METHODS Intensive care unit registered nurses attended educational sessions about oral care and also used online education modules. Nursing care involving 180 intubated patients was observed, and changes were noted in practices related to oral care. RESULTS After the education intervention, the frequency of oral care increased significantly (p = .001) to tooth brushing every 4 hours and swabbing every 12 hours with 0.12% chlorhexidine solution. The evidence-based practice education intervention decreased VAP rates by 62.5%. CONCLUSION Significant reductions in VAP rates may be achieved through improved education and implementation of oral care protocols with 0.12% chlorhexidine solution.
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Kollef MH. Ventilator-associated complications, including infection-related complications: the way forward. Crit Care Clin 2012. [PMID: 23182526 DOI: 10.1016/j.ccc.2012.10.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Acute respiratory failure represents the most common condition requiring admission to an adult intensive care unit. Ventilator-associated pneumonia (VAP) has been used as a marker of quality for patients with respiratory failure. Hospital-based process-improvement initiatives to prevent VAP have been successfully used. The use of ventilator-associated complications (VACs) has been proposed as an objective marker to assess the quality of care for this patient population. The use of evidence-based bundles targeting the reduction of VACs, as well as the conduct of prospective studies showing that VACs are preventable complications, are reasonable first-steps in addressing this important clinical problem.
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Affiliation(s)
- Marin H Kollef
- Washington University School of Medicine, St Louis, MO 63110, USA.
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Dale C, Angus JE, Sinuff T, Mykhalovskiy E. Mouth care for orally intubated patients: a critical ethnographic review of the nursing literature. Intensive Crit Care Nurs 2012; 29:266-74. [PMID: 23092851 DOI: 10.1016/j.iccn.2012.09.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 09/11/2012] [Accepted: 09/22/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this critical ethnographic literature review was to explore the evolution of nursing discourse in oral hygiene for intubated and mechanically ventilated patients. METHODS The online databases CINAHL and MEDLINE were searched for nurse-authored English language articles published between 1960 and 2011 in peer-reviewed journals. Articles that did not discuss oral problems or related care for intubated adult patients were excluded. Articles that met the inclusion criteria were chronologically reviewed to trace changes in language and focus over time. RESULTS A total of 469 articles were identified, and 84 papers met all of the inclusion criteria. These articles presented an increasingly scientific and evaluative nursing discourse. Oral care originally focused on patient comfort within the literature; now it is emphasized as an infection control practice for the prevention of ventilator-associated pneumonia (VAP). Despite concern for its neglected application, the literature does not sufficiently address mouth care's practical accomplishment. CONCLUSIONS Mouth care for orally intubated patients is both a science and practice. However, the nursing literature now emphasises a scientific discourse of infection prevention. Inattention to the social and technical complexities of practice may inhibit how nurses learn, discuss and effectively perform this critical aspect of patient care.
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Affiliation(s)
- Craig Dale
- Trauma, Emergency and Critical Care Program, Sunnybrook Health Sciences Centre, B508 - 2075 Bayview Avenue, Toronto, Ontario, Canada M4N 3M5.
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Gu WJ, Gong YZ, Pan L, Ni YX, Liu JC. Impact of oral care with versus without toothbrushing on the prevention of ventilator-associated pneumonia: a systematic review and meta-analysis of randomized controlled trials. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2012; 16:R190. [PMID: 23062250 PMCID: PMC3682292 DOI: 10.1186/cc11675] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 09/26/2012] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Ventilator-associated pneumonia (VAP) remains a common hazardous complication in mechanically ventilated patients and is associated with increased morbidity and mortality. We undertook a systematic review and meta-analysis of randomized controlled trials to assess the effect of toothbrushing as a component of oral care on the prevention of VAP in adult critically ill patients. METHODS A systematic literature search of PubMed and Embase (up to April 2012) was conducted. Eligible studies were randomized controlled trials of mechanically ventilated adult patients receiving oral care with toothbrushing. Relative risks (RRs), weighted mean differences (WMDs), and 95% confidence intervals (CIs) were calculated and heterogeneity was assessed with the I(2) test. RESULTS Four studies with a total of 828 patients met the inclusion criteria. Toothbrushing did not significantly reduce the incidence of VAP (RR, 0.77; 95% CI, 0.50 to 1.21) and intensive care unit mortality (RR, 0.88; 95% CI, 0.70 to 1.10). Toothbrushing was not associated with a statistically significant reduction in duration of mechanical ventilation (WMD, -0.88 days; 95% CI, -2.58 to 0.82), length of intensive care unit stay (WMD, -1.48 days; 95% CI, -3.40 to 0.45), antibiotic-free day (WMD, -0.52 days; 95% CI, -2.82 to 1.79), or mechanical ventilation-free day (WMD, -0.43 days; 95% CI, -1.23 to 0.36). CONCLUSIONS Oral care with toothbrushing versus without toothbrushing does not significantly reduce the incidence of VAP and alter other important clinical outcomes in mechanically ventilated patients. However, the results should be interpreted cautiously since relevant evidence is still limited, although accumulating. Further large-scale, well-designed randomized controlled trials are urgently needed.
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Ventilator-associated pneumonia with or without toothbrushing: a randomized controlled trial. Eur J Clin Microbiol Infect Dis 2012; 31:2621-9. [PMID: 22422274 DOI: 10.1007/s10096-012-1605-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Accepted: 03/03/2012] [Indexed: 01/09/2023]
Abstract
Certain guidelines for the prevention of ventilator-associated pneumonia (VAP) recommend oral care with chlorhexidine, but none refer to the use of a toothbrush for oral hygiene. The role of toothbrush use has received scant attention. Thus, the objective of this study was to compare the incidence of VAP in critical care patients receiving oral care with and without manual brushing of the teeth. This was a randomized clinical trial developed in a 24-bed medical-surgical intensive care unit (ICU). Patients undergoing invasive mechanical ventilation for than 24 h were included. Patients were randomly assigned to receive oral care with or without toothbrushing. All patients received oral care with 0.12 % chlorhexidine digluconate. Tracheal aspirate samples were obtained during endotracheal intubation, then twice a week, and, finally, on extubation. There were no significant differences between the two groups of patients in the baseline characteristics. We found no statistically significant differences between the groups regarding the incidence of VAP (21 of 217 [9.7 %] with toothbrushing vs. 24 of 219 [11.0 %] without toothbrushing; odds ratio [OR] = 0.87, 95 % confidence interval [CI] = 0.469-1.615; p = 0.75). Adding manual toothbrushing to chlorhexidine oral care does not help to prevent VAP in critical care patients on mechanical ventilation.
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Ausbruch mit Burkholderia-cepacia-Komplex durch kontaminierte Mundspüllösung. Anaesthesist 2012; 61:25-9. [DOI: 10.1007/s00101-011-1954-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 08/22/2011] [Accepted: 09/26/2011] [Indexed: 11/25/2022]
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García Araguas T, Irigoyen Aristorena I, Zazpe Oyarzun C, Baztán Madoz B, Barado Hugalde J. Evaluación de un programa de prevención de neumonía asociada a ventilación mecánica (NAVM): resultados al año. ENFERMERIA INTENSIVA 2012; 23:4-10. [DOI: 10.1016/j.enfi.2011.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Revised: 12/11/2011] [Accepted: 12/13/2011] [Indexed: 11/29/2022]
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Kollef MH. Prevention of Nosocomial Pneumonia in the Intensive Care Unit: Beyond the Use of Bundles. Surg Infect (Larchmt) 2011; 12:211-20. [DOI: 10.1089/sur.2010.060] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- Marin H. Kollef
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
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Abstract
Tooth brushing in critically ill patients has been advocated by many as a standard of care despite the limited evidence to support this practice. Attention has been focused on oral care as the evidence accumulates to support an association between the bacteria in the oral microbiome and those respiratory pathogens that cause pneumonia. It is plausible to assume that respiratory pathogens originating in the oral cavity are aspirated into the lungs, causing infection. A recent study of the effects of a powered toothbrush on the incidence of ventilator-associated pneumonia was stopped early because of a lack of effect in the treatment group. This review summarizes the evidence that supports the effectiveness of tooth brushing in critically ill adults and children receiving mechanical ventilation. Possible reasons for the lack of benefit of tooth brushing demonstrated in clinical trials are discussed. Recommendations for future trials in critically ill patients are suggested. With increased emphasis being placed on oral care, the evidence that supports this intervention must be evaluated carefully.
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Affiliation(s)
- Nancy J Ames
- Clinical Center, National Institutes of Health in Bethesda, Maryland 20892, USA.
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