Effects of an Oral Care Programme on Oral Hygiene and Ventilator-Associated Pneumonia amongst Critically Ill Patients: A Randomised Controlled Trial
Keywords:
oral care, ventilator-associated pneumonia, critically ill patients, oral endotracheal tube, randomised controlled trialTube, Randomized Controlled TrialAbstract
Objective: To compare the scores on oral hygiene and rates of ventilator-associated
pneumonia (VAP) between critically ill patients receiving the oral care programme and those
receiving standard care.
Design: Double-blind, randomised controlled trial
Methodology: The sample consisted of patients with acquired brain injuries. The patients
were aged > 18 years old, had a Glasgow Coma Score (GCS) of < 8, and were intubated with an oral
endotracheal tube. The patients were assigned into the experimental group and control group by
means of block randomisation with allocation concealment. The method of double blinding was used
to prevent measurement biases from the patients/family and the data collector. The experimental
group received the oral care programme consisting of an oral assessment, the use of oral care
equipment and solutions, and oral care guidelines, while the control group received standard care.
The patients’ general data were analysed using descriptive statistics. Inter- and intra-group
comparisons of oral hygiene scores were analysed using the Mann-Whitney test and the Friedman
test, respectively. The VAP rates were compared using a Chi-square test.
Results: The study started with 26 members in the experimental group and 28 in the control
group. By the end of the study, however, the number of members of each group had decreased to 10
and 11, respectively. As measured on the 5th, 6th and 7th days of the study, the experimental group
displayed better oral hygiene than the control group did, with signifcantly lower average oral hygiene
problem scores (p = .009, p = .018 and p = .001, respectively). Similarly, the experimental group
showed a lower inclination to develop VAP than the control group did (11.5% and 14.3%,
respectively), but the difference was not statistically signifcant (p > .05).
Recommendations: The oral care programme of this study contributed to the improvement of
critically ill patients’ oral hygiene, as well as reducing the rate of VAP development. It is, therefore,
recommended that this programme be put to regular use and applied to other medical units treating
patients who have similar characteristics.
Downloads
References
1. Prendergast V, Kleiman C, King M. The Bedside Oral Exam and the Barrow Oral Care Protocol: translating evidence-based oral care into practice. Intensive Crit Care Nurs 2013; 29(5):282-90.
2. Prendergast V, Kleiman C. Interprofessional practice: translating evidence-based oral care to hospital care.J Dent Hyg 2015; 89(suppl 1):33-5.
3.Klompas M, Branson R, Eichenwald EC, Greene LR, Howell MD, Lee G, Magill SS, Maragakis LL, Priebe GP, Speck K, Yokoe DS. Strategies to prevent ventilator-associated pneumonia in acute care hospitals: 2014 update. Infect Control Hosp Epidemio 2014; 35(S2):S133-54.
4. Villar CC, Pannuti CM, Nery DM, Morillo CM, Carmona MJ, Romito GA. Effectiveness of intraoral chlorhexidine protocols in the prevention of ventilator-associated pneumonia: meta-analysis and systematic review. Respir Care 2016: respcare-04610.
5. Yagmur FN. A Recent View and Evidence-Based Approach to Oral Care of Intensive Care Patient. IJCS 2016; 9(3):1177.
6. Marsh PD, Devine DA. How is the development of dental bioflms influenced by the host?. J Clin Periodontol 2011; 38(s11):28-35.
7. Munro N, Ruggiero M. Ventilator-associated pneumonia bundle: Reconstruction for best care. AACN Adv Crit Care 2014; 25(2):163-75.
8. Prendergast V, Jakobsson U, Renvert S, Hallberg IR. Effects of a standard versus comprehensive oral care
protocol among intubated neuroscience ICU patients: results of a randomized controlled trial. J Neurosci Nurs 2012; 44(3):134-46.
9. Barnes CM. Dental hygiene intervention to prevent nosocomial pneumonias. J Evid Based Dent Pract 2014; 14:103 14.
10. Speck K, Rawat N, Weiner NC, Tujuba HG, Farley D, Berenholtz S. A systematic approach for developing a ventilator-associated pneumonia prevention bundle. Am J Infect Control 2016; 44(6):652-6.63
11. McGuire DB, Fulton JS, Park J, Brown CG, Correa ME, Eilers J, et al. Systematic review of basic oral care for the management of oral mucositis in cancer patients.Support Care Cancer2013;21(11):3165-77.
12. American dental association. [Internet]. 2017 [cited 2017 Jul 23]. Available from: https://www. mouthhealthy.org/en/az-topics/b/brushing-yourteeth.
13. Krisdapong S. Which toothbrushing method is the best. Journal of Health Science 2017; 25(6): 1159-1155. (in Thai)
14. Ibrahim SM, Mudawi AM, Omer O. Nurses’ knowledge, attitude and practice of oral care for intensivecareunitpatients.OJST2015;5(07):179.
15. Kothari M, Pillai RS, Kothari SF, Spin-Neto R, Kumar A, Nielsen JF. Oral health status in patients with acquired brain injury: A systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2017; 123(2):205-19.
16. Carney N, Totten AM, O’reilly C, Ullman JS, Hawryluk GW, Bell MJ, et al. Guidelines for the management of severe traumatic brain injury. Neurosurgery. 2017; 80(1):6-15.
17. Niyomdecha N. Chlorhexidine Gluconate (CHG): Antimicrobial activity and medical applications. J Med Tech Assoc Thailand April 2015; 43(1),5255-5126. (in Thai)
18. Cutler LR, Sluman P. Reducing ventilator associated pneumonia in adult patients through high standards of oral care: A historical control study. Intensive Crit Care Nurs 2014; 30(2):61-8.
19. Bernard R. Fundamentals of biostatistics (5th ed.). Duxbury: Thomson Learning. 2000.
20. Fleiss JL, Levin B, Paik MC. Statistical methods for rates and proportions. John Wiley & Sons; 2013.
21. Ngamjarus C, Chongsuvivatwong V, McNeil EB. n4Studies: Sample size and power calculations for android. The Thailand Research Fund: Prince of Songkla University. 2014. for android. The Royal Golden Jubilee Ph.D. Program - The Thailand Research Fund & Prince of Songkla University.
22. Longlalerng W, Ua-Kit N. The effect of a clinical nursing practice guideline for oral care in critical patients with endotracheal tubes. Thai Journal of Cardio-Thoracic Nursing 2016; 27(1), 98-113. (in Thai)
23. Wongrungreang Y, Sangsajja J. Criteria for diagnosis of nosocomail infection. Bangkok: Bamrasnaradura Infectious Diseases Institute; 2013. (in Thai)
24. Kumar G, Singh DK. Tooth brush and brushing technique. J Adv Med 2013;2(1):1-8.
25. Klompas M, Speck K, Howell MD, Greene LR, Berenholtz SM. Reappraisal of routine oral care with chlorhexidine gluconate for patients receiving mechanical ventilation: systematic review and metaanalysis. JAMA Intern Med 2014; 174(5):751-61.
26. Silvestri L, Weir I, Gregori D, Taylor D, Van Saene J, Van Saene H. Effectiveness of oral chlorhexidine on nosocomial pneumonia, causative microorganisms and mortality in critically ill patients: a systematic review and meta-analysis. Minerva Anestesiol 2014; 80(7):805-20.
27.El-RabbanyM,ZaghlolN,BhandariM,Azarpazhooh A. Prophylactic oral health procedures to prevent hospital-acquired and ventilator-associated pneumonia: a systematic review. Int J Nurs Stud 2015; 52(1):452-64.
28. George J, John J. The signifcance of brushing time in removing dental plaque. Int J Dentistry Oral Sci 2016; 3(8):315-7.
