Influence of Institutional Guidelines on Oral Hygiene Practices in Intensive Care Units

Provision of Oral Care in the Cardiothoracic Intensive Care Unit: Survey of Nursing Staff Training, Confidence, Methods, Attitudes, and Perceived Barriers

BACKGROUND

Poor oral health is associated with adverse outcomes in critical care settings. Although provision of oral care is a fundamental aspect of nursing practice, both formal training and practice among nursing staff remain unclear.

METHOD

Cardiothoracic intensive care unit nurses were recruited to complete a 16-item survey regarding training, confidence, methods, prioritization, and barriers to provision of oral care.

RESULTS

A total of 108 nurses participated (70% response rate). Formal training in oral care was reported by 38%, most frequently reported as less than 1 hour (53%) in duration. Of the respondents, 70% reported confidence in providing oral care. Nine methods and 16 products were identified, with variability in the frequency of provision. Prioritization of oral care was rated most frequently as moderate (53%), with 28% reporting barriers.

CONCLUSION

Despite limited formal training, surveyed nurses reported confidence in providing oral care. Methods, frequency, and prioritization were variable. Both development of formal curricula and evaluation of adherence to standardized protocols for oral care are warranted. [J Contin Educ Nurs. 2023;54(7):313-321.].

Introducing Standardized Assessment and Management of Oral Cares in a Rehabilitation Unit: Patient Outcomes and Experiences

PURPOSE

The aim of this study was to improve patient oral hygiene outcomes in a rehabilitation unit by implementing a nursing education package and oral hygiene assessment tool.

DESIGN

A case-control design with 50 rehabilitation patients was performed.

METHODS

Nursing staff received education and training in applying the Modified Oral Health Assessment Tool. Clinician assessment of patient oral hygiene occurred on admission and at days 5-7. Each patient reported their perceptions of oral hygiene and comfort prior to hospitalization, while in the hospital, and after transfer to the rehabilitation unit.

FINDINGS

Oral hygiene rating scores improved significantly from admission to the rehabilitation unit to days 5-7 (p = .00). The mean score of patient perceived cleanliness improved from hospital admission to admission to the rehabilitation unit.

CONCLUSION

Oral hygiene was improved following admission to a rehabilitation unit with a consistent and individualized approach to oral hygiene.

CLINICAL RELEVANCE

The introduction of a consistent and individualized approach to oral hygiene demonstrates positive patient outcomes and high patient acceptance.

Intensive care nurses fail to translate knowledge and skills into practice - A mixed-methods study on perceptions of oral care

OBJECTIVES

To identify intensive care nurses' perceptions of oral care according to Coker et al.'s (2013) conceptual framework and to contribute to the knowledge base of oral care in intensive care.

DESIGN/METHODS

This was a concurrent embedded mixed-methods design, with more weight given to the quantitative part. Participants responded to the Nursing Care related to Oral Health questionnaire, including perceptions of oral care antecedents (18 items), defining attributes (17 items), and consequences (6 items) and two open-ended questions. The data were analysed with descriptive and correlation statistics and qualitative content analysis.

SETTING

Intensive care nurses (n = 88) in six general intensive care units.

RESULTS

Intensive care nurses perceived that an important part of nursing care was oral care, especially to intubated patients. They perceived that the nursing staff was competent in oral care skills and had access to different kinds of equipment and supplies to provide oral care. The oral cavity was inspected on a daily basis, mostly without the use of any assessment instruments. Oral care seemed to be task-oriented, and documentation of the patients' experiences of the oral care process was rare.

CONCLUSIONS

The antecedents, knowledge and skills are available to provide quality oral care, but intensive care nurses seem to have difficulties translating these components into practice. Thus they might have to shift their task-oriented approach towards oral care to a more person-centred approach in order to be able to meet patients' needs.

The practice of dentistry in intensive care units in Brazil

Objective

To evaluate the practice of dentistry in intensive care units.

Methods

An observational survey study was conducted in which questionnaires were sent via the online platform for collaboration in intensive care research in Brazil (AMIBnet). The study was carried out from June to October 2017. The questionnaires, which contained 26 closed questions about hospitals and dentistry practices in the intensive care units, were sent to 4,569 professionals from different specialties practicing in the units.

Results

In total, 203 questionnaires were returned, resulting in a response rate of 4.44%. Most of the responses were from intensive care units in the Southeast region of the country (46.8%). Public hospitals (37.9%) and private hospitals (36.4%) had similar participation rates. Of the respondents, 55% indicated that a bedside dentistry service was present, and they were provided in different ways.

Conclusion

The presence of dentistry services and oral health service delivery training and protocols were correlated. The oral care methods varied greatly among the intensive care units surveyed.

Effect of Oral Care Program on Prevention of Ventilator-associated Pneumonia in Intensive Care Unit Patients: A Randomized Controlled Trial

Background:

Ventilator-associated pneumonia (VAP) is one of the most common nosocomial infections that increase mortality rate and the length of hospitalization. Oral care can improve patient's oral health, however, the role of oral care in the reduction in incidence rate of VAP is indisputable. The aim of this study was to investigate the effect of oral care on the frequency of VAP of patients in intensive care unit.

Materials and Methods:

This clinical trial was conducted on 80 participants who were randomly assigned to a control group and an intervention group from 2016 to 2017. Data were collected at the first, third, and fifth days of the study using a demographic and clinical characteristics questionnaire and the Clinical Pulmonary Infection Score for detecting pneumonia. Data analysis was performed using descriptive and inferential statistics in SPSS software.

Results:

The results of this study showed that the frequency of pneumonia on the third and fifth days was 15.80% (6) and 23.70% (9) in the control group and 10.50% (4) and 7.90% (3) in the intervention group, respectively. Chi-square test did not show a significant difference (p = 0.059); however, the frequency of pneumonia in the intervention group reduced compared with the control group.

Conclusions:

According to the results of this study, the oral care program could not significantly decrease the incidence of VAP in critically ill patients compared with routine oral care practices. Similar studies with a larger sample size and longer duration should be conducted for better results.

The Effects of Aloe vera-Peppermint (Veramin) Moisturizing Gel on Mouth Dryness and Oral Health among Patients Hospitalized in Intensive Care Units: A Triple-Blind Randomized Placebo-Controlled Trial

Objective:

Mouth dryness is one of the most prevalent problems in Intensive Care Units (ICUs). It facilitates dental plaque formation. The aim of this study was to analyze the effects of Aloe vera-Peppermint (Veramin) moisturizing gel on mouth dryness and oral health among patients hospitalized in ICUs.

Methods:

This triple-blind two-group randomized placebo-controlled clinical trial was undertaken in 2016–2017 on a convenient sample of 80 patients. Patients were randomly allocated to an intervention and a placebo group. Oral care for patients in the intervention and the placebo groups was provided for 5 successive days using Veramin moisturizing gel and a placebo gel, respectively. Data were collected at the 1^st, 3^rd, and 5^th days of the study using a demographic and clinical characteristics questionnaire, the Challacombe scale (for mouth dryness assessment), and the Mucosal-Plaque Index (for oral health assessment). The Chi-square, Fisher Exact, Mann–Whitney U, and Friedman tests were used for data analysis.

Findings:

In the 5^th day, the mean score of mouth dryness in the intervention group was significantly lower than the placebo group (P = 0.0001). On the other hand, in the third and the 5^th days, the oral health mean score in the intervention group was significantly lower than the placebo group (P = 0.0001).

Conclusion:

Veramin moisturizing gel is effective in significantly relieving mouth dryness, preventing dental plaque formation, and improving oral health. Thus, it can be used for improving oral care outcomes in ICUs.