Is Oral Care an Effective Intervention for Reducing the Incidence of Pneumonia in Mechanically Ventilated Patients?
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Hospital-acquired infections (HAI) are preventable and pose a threat to hospitals and patients; increasing the cost, nominally and physically, for both. Pneumonia makes up approximately 15% of all HAI and is the leading cause of nosocomial deaths. Pneumonia is most frequently caused by bacterial microorganisms reaching the lungs by way of aspiration, inhalation or the hematogenous spread of a primary infection. There are two categories of Hospital-Acquired Pneumonia (HAP); Health-Care Associated Pneumonia (HCAP) and Ventilator-associated pneumonia (VAP).
VAP develops in a patient after 48 hours or more of endotracheal intubation. According to a study by Relio et al. (as citied in Fields, L.B., 2008, Journal of Neuroscience Nursing, 40(5), 291-8) VAP adds an additional cost of $29,000-$40,000 per patient and increases the morality rate by 40-80%. Mechanically ventilated patients are at an increased risk in developing VAP due to factors such as circumvention of body’s own natural defense mechanisms in the upper respiratory tract (the filtering and protective properties of nasal mucosa and cilia), dry open mouth, and aspiration of oral secretions, altered consciousness, immobility, and possible immunosuppression. Furthermore, the accumulation of plaque in the oral cavity creates a biofilm that allows the patient’s mouth to become colonized with bacteria.
Many interventions are already in place to improve patient outcomes while on a ventilator. For example, elevating the head of the bed to 30 degrees, preventing venous thrombus via sequential compression devices or anticoagulant drugs, initiating early mobilization and practicing good hand hygiene were among the interventions listed by Fields, L.B., 2008. However, oral care was n...
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...he data collected by the above mentioned studies it is time to shift our thinking of oral care as simply a comfort measure to an effective intervention to lower costs, for both the patients and the hospital, and prevent the development of pneumonia.
Fields, L. B. (2008). Oral care intervention to reduce incidence of ventilator-associated pneumonia in the neurologic intensive care unit. Journal of Neuroscience Nursing,
40(5), 291-8. Retrieved from http://search.proquest.com/docview/219184601?accountid=14400 Jones, D. J., Munro, C. L., & Grap, M. J. (2011). Natural history of dental plaque accumulation in mechanically ventilated adults: A descriptive correlational study. Intensive &
Critical Care Nursing, 27(6), 299-304. doi:http://dx.doi.org/10.1016/j.iccn.2011.08.005