RUNNING HEAD: ORAL CARE IN THE CRITICAL CARE SETTING 1ORAL CARE
IN THE CRITICAL CARE SETTING7
Oral Care in the Critical Care SettingCiera Pilcher, Kayla
McCollum, Lauren Friend, Kristen Finley, Nathan Knight, Rosabel
BerkleyTroy University School of Nursing
Ventilator associated pneumonia is the most common acquired
infection among ventilated patients. In the critical care unit, it
is not uncommon for the majority of the patients in the unit to be
intubated as a result of their critical care needs. Through our
clinical experience, we have made these observations, and have seen
first-hand the benefits and patient progress that occur from strict
oral hygiene and the prevention of ventilator associated pneumonia.
Flowers hospital currently implements an evidence based practice by
using Toothette packages specifically designed for each patient
that is ventilated. These packages are a comprehensive 24 hour
system that contains cleansing and suctioning components and
solutions for oral care. This system is intended to decrease
bacterial and plaque colonization in the oral cavity, which in turn
decreases the risk for pathogens entering the respiratory system.
It is evident that this practice of strict oral hygiene has become
an important task for nurses and patient safety; because of this,
we have chosen this topic and wish to further educate our peers on
its growing importance and significance in the critical care
setting. Ventilator associated pneumonia (VAP) is a potential
complication that develops in already critically ill patients who
have received mechanical ventilation for at least 48hours. (Shi,
Z., Xie, H., Wang, P., Zhang, Q., Wu, Y., Chen, E., ... Furness,
S., 2013) VAP can significantly increase the mortality of
critically ill patients in intensive care units (ICU); therefore,
prevention is the best method to improve patient related outcomes,
patient safety, increase quality of care, and help to reduce health
care associated costs as well. (Jansson, M., Ala-Kokko, T.,
Ylipalosaari, P., Syrjl, H., & Kyngs, H., 2013) Some of the
important measures to prevent and or decrease the incidence of VAP
are: continuous suctioning of subglottic secretions, semi-recumbent
position, oral hygiene, selective decontamination, and continuous
medical education. (Jess, Muoz, P., Heras, C., Snchez, G., Rello,
J., & Bouza, E., 2013) Oral care protocols have been
implemented and have been proven to reduce the incidence of VAP
anywhere from 46% to 90%. (Booker,S., Murff,S., Kitko,L., &
Jablonski,R., 2013) Ventilator Associated Pneumonia can increase
mortality rates forty to eighty percent in ventilated patients.
Chlorhexidine is an antiseptic that is effective against many gram
positive organisms, and is used during oral care in the critical
care setting. One study showed an 89.7 % reduction in VAP with the
use of 0.12% CHX, suction swabs, and mouth moisturizer. (Cuccio,L.,
Cerullo,E., Paradis,H., Padula,C., Rivet,C., Steeves,S., &
Lynch,J., 2012)In the United States, ventilator associated
pneumonia is the second most common nosocomial infection and it
develops rapidly after a patient is intubated. (Parsons, S., Lee,
C.A., Strickert, D., & Trumpp, M., 2013) A primary concern of
care in ICU nurses is prevention of ventilator-associated pneumonia
becasues the occurrence of a nosocomial infection often results in
a lengthened hospital stay, increased cost of patient care, and
further complications of an already critical patient status.
Therefore, the nurse must recognize symptoms of this nosocomial
infection, as well as implement procedures to prevent the
possibility of these infections. Signs and symptoms of VAP include:
signs of respiratory infection, fever or hypothermia (>38C or
12000 mm or
