Physiologic factors contributing to a transition in oral immunity among mechanically ventilated adults

Knowledge Evaluation of Oral Diseases and Perception of Cooperation with Dental Experts for Oral Care of Nurses in Intensive Care Units in Korea: A Preliminary Study

The aim of this study was to identify the status of education and knowledge concerning oral diseases for oral care as they relate to intensive care unit (ICU) nurses, as well as to investigate the perception of oral care education and practice, as led by dental experts. This study conducted a self-report survey consisting of 33 questions on education and knowledge about oral diseases, as well as perception of dental expert-led education and practice, targeting 240 nurses in the ICU. Finally, 227 questionnaires were analyzed, and 75.3% of the participants were staff nurses, and 41.4% were in the medical ICU. In the area of education and knowledge of major oral diseases, more than 50% of the respondents treating gingivitis, periodontitis, and dental caries did not complete dental education, and it was found that more than half of the respondents were unable to distinguish diseases of the mouth. It was recognized that more than half of nurses required dental expert-led education and practice. In this study, the education and knowledge of oral diseases of ICU nurses were found to be insufficient, and the need for the cooperation of dental experts was high. Therefore, collaboration to improve oral care practical guidelines for realistically applicable ICU patients will be needed.

Effect of an oral hygienic care program for stroke patients in the intensive care unit

PURPOSE

The effects of an oral hygienic care program (OHCP) have been reported in several diseases. However, no study exists investigating the influence of an OHCP on stroke patients or patients in the intensive care unit (ICU) has been reported, thus we sought to investigate the potential effect of an OHCP.

MATERIALS AND METHODS

Fifty-six consecutive stroke patients who were admitted to the ICU were randomly assigned to two groups: the intervention (29 patients) and control groups (27 patients). The OHCP included tooth brushing with an inter-dental brush and tongue cleaner and cleaning with chlorhexidine was administered to patients by one dentist once per day during admission in the ICU (mean, 2.2 weeks). The plague index, gingival index, clinical attachment loss, and colonization degree of candida albicans were assessed.

RESULTS

After OHCP, the plaque index, gingival index, and colonization degree of candida albicans in saliva showed a significant decrease in the intervention group compared to those of the control group (p<0.05). However, no significant difference was observed in clinical attachment loss and the colonization degree of candida albicans on the tongue (p>0.05).

CONCLUSION

Our OHCP was effective in improving the oral hygienic status and periodontal health of stroke patients during their stay in the ICU. Therefore, we recommend administration of the OHCP for stroke patients during their stay in the ICU.

Ventilator-associated pneumonia, liver disease and oral chlorhexldine

As part of the ventilator care bundle, the Department of Health (DH) in the U.K. recommends the use of chlorhexidine (CHX) for oral care to prevent the occurrence of ventilator-associated pneumonia (VAP) in all mechanically ventilated patients. Due to the heterogenous nature of this population, however, it is important to consider whether such recommendations are also relevant to specific critical care patient population groups. This article reviews the available scientific evidence on the use of CHX in the prevention of VAP, with a focus on critically ill mechanically ventilated patients who have liver dysfunction. Findings will be discussed with reference to the wider research literature in order to make recommendations for future practice.

Indigenous Microflora and Innate Immunity of the Head and Neck

The normal flora of the head and neck exists in a delicate balance within tightly regulated ecologic niches, counterbalanced by a highly efficient innate immune system of the host. Invasion by the normal oral flora is rare when mucosal defenses remain intact. An understanding of the indigenous microflora and the innate mucosal defense mechanisms is necessary for an appropriate evaluation of infections and therapies in this area.

Oral Health and Care in the Intensive Care Unit: State of the Science

Oral health is influenced by oral microbial flora, which are concentrated in dental plaque. Dental plaque provides a microhabitat for organisms and an opportunity for adherence of the organisms to either the tooth surface or other microorganisms. In critically ill patients, potential pathogens can be cultured from the oral cavity. These microorganisms in the mouth can translocate and colonize the lung, resulting in ventilator-associated pneumonia. The importance of oral care in the intensive care unit has been noted in the literature, but little research is available on mechanical or pharmacological approaches to reducing oral microbial flora via oral care in critically ill adults. Most research in oral care has been directed toward patients’ comfort; the microbiological and physiological effects of tooth brushing in the intensive care unit have not been reported. Although 2 studies indicated reductions in rates of ventilator-associated pneumonia in cardiac surgery patients who received chlorhexidine before intubation and postoperatively, the effects of chlorhexidine in reducing ventilator-associated pneumonia in other populations of critically ill patients or its effect when treatment with the agent initiated after intubation have not been reported. In addition, no evaluation of the effectiveness of pharmacological and mechanical interventions relative to each other or in combination has been published. Additional studies are needed to develop and test best practices for oral care in critically ill patients.

State of nursing science: on the edge

Nurse scientists have had great and important successes contributing to science and to patient care. To review the state of nursing science is an enormous and complex challenge, and yet the pace of discovery constantly quickens. The purpose of this article, which was read at the 2002 State of the Science Congress, was to use the human response model to describe the domains of nursing science and note exemplary, innovative developments in the context of the model's "person" and "environmental" domains. Advances are noted in genetics, aging, development, and gender studies; also noted is work in infection care, disaster care, and identification of health disparities. Asked to predict the future, we chose instead to describe societal challenges and speculate how nursing leaders can contribute importantly by applying nursing's unique perspective. Benchmarks of our success will include reversal of the nursing shortage, patients living to their highest potential, and penetration of evidence based care into clinical practice and health policy. Furthermore, the media and the public will view nurse scientists as key informants related to clinical care. Nurse scientists will be elected to lead major interdisciplinary organizations, our training programs will prepare new scientists with the knowledge and skills to enter a competitive and ever-evolving field, our schools will have adequate infrastructure to support the advancement using cutting-edge technology, centers of excellence will provide research consultation and collaboration beyond university boundaries, and nurse scientists will assume a more visible role in translational research.