Effects of Chlorhexidine Solution Formula on Oral Health Status and Occurrence of Ventilator -Associated Pneumonia among Intubated Intensive Care Unit Patients

Background: Oral infections can be a potential source of infection resulting in a variety of systemic diseases, especially in intubated patients in an Intensive Care Unit (ICU). Endotracheal tube (ETT) of the intubated patient’s mouth can be an entry point and place of bacteria colonization that causes ventilator-associated pneumonia which is one of the causes of the patient’s death in ICU. Nurses as caregivers have an important role in providing oral care intervention to maintain oral health and prevent the infection.Objective: This study aimed to analyze the effect of oral care intervention on oral health status of intubated patients in the ICU. Methods: This was a pre-experimental study with one group pre-test post-test design. A consecutive sampling was used to select 18 intubated patients in the ICU of Al Islam hospital in Bandung. Oral health status was evaluated by Beck Oral Assessment Scale (BOAS). Descriptive analysis was used for the univariate analysis and t-test was used for bivariate analysis. Results: The results showed that oral health scores before and after intervention were 11.94 and 13.28 (p=.004). The BOAS subscales had a significant worsening of the lips, gingiva, oral mucosa and saliva (p<.05), while there was an improvement in teeth subscale after oral care intervention (p<.001).Conclusion: The results suggested that the oral health status of intubated patients had worsened, despite routinely oral care intervention using chlorhexidine gluconate. Mucosa care may become an essential part of the oral care intervention for intubated patients. Therefore, additional topical agent is needed to maintain the moisture of the mucosal membrane, so that the oral health status of intubated patients will be better.

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Oral Health Status and Development of Ventilator-Associated Pneumonia: A Descriptive Study

American Journal of Critical Care ◽

10.4037/ajcc2006.15.5.453 ◽

2006 ◽

Vol 15 (5) ◽

pp. 453-460 ◽

Cited By ~ 57

Author(s):

Cindy L. Munro ◽

Mary Jo Grap ◽

R.K. Elswick ◽

Jessica McKinney ◽

Curtis N. Sessler ◽

...

Keyword(s):

Health Status ◽

Oral Health ◽

Dental Plaque ◽

Severity Of Illness ◽

Oral Health Status ◽

Microbial Colonization ◽

Apache Ii ◽

Apache Ii Score ◽

Ventilator Associated Pneumonia ◽

Time Correlations

• Background Ventilator-associated pneumonia is a significant cause of morbidity and mortality and may be influenced by oral health. • Objective To describe the relationship between ventilator-associated pneumonia and oral health status, changes in oral health status during the first 7 days after intubation, and microbial colonization of the oropharynx and trachea. • Methods A total of 66 patients were enrolled within 24 hours of intubation and were followed up for up to 7 days. Data on oral health measures and the Clinical Pulmonary Infection Score (CPIS) were collected at baseline, day 4 (n = 37), and day 7 (n = 21). A regression model was used to predict risk of pneumonia at day 4. • ResultsDental plaque and oral organisms increased over time. Correlations were significant for baseline and day 4 dental plaque (P < .001), baseline salivary lactoferrin and day 4 plaque (P = .01), and lower salivary volume and higher day 4 CPIS (P = .02). Potential pathogens were identified in oral cultures for 6 patients before or at the same time as the appearance of the organisms in tracheal aspirates. Correlations were significant with day 4 CPIS for score on the Acute Physiology and Chronic Health Evaluation (APACHE) II (P = .007), day 4 salivary volume (P = .02), interaction of APACHE II score and day 1 CPIS (P<.001), and interaction of day 1 CPIS and plaque (P=.01). • Conclusions Higher dental plaque scores confer greater risk for ventilator-associated pneumonia, particularly for patients with greater severity of illness. Salivary volume and lactoferrin may affect the risk.

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The impact of oral care on oral health status and prevention of ventilator-associated pneumonia in critically ill patients

Australian Critical Care ◽

10.1016/j.aucc.2016.07.002 ◽

2017 ◽

Vol 30 (2) ◽

pp. 69-73 ◽

Cited By ~ 7

Author(s):

Abdullah Haghighi ◽

Vida Shafipour ◽

Masoumeh Bagheri-Nesami ◽

Afshin Gholipour Baradari ◽

Jamshid Yazdani Charati

Keyword(s):

Health Status ◽

Oral Health ◽

Critically Ill ◽

Critically Ill Patients ◽

Oral Care ◽

Oral Health Status ◽

Ventilator Associated Pneumonia ◽

The Impact

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The Impact of Systematic Oral Care on Oral Health Status in Patients of Intensive Care Units

Journal of Health and Care ◽

10.29252/jhc.20.3.244 ◽

2018 ◽

Vol 20 (3) ◽

pp. 244-251

Author(s):

Vajihe Atashi ◽

Ahmadreza Yazdannik ◽

Hosein Mahjobipoor ◽

Hojjatollah Yousefi ◽

Reza Bekhradi ◽

...

Keyword(s):

Intensive Care ◽

Health Status ◽

Oral Health ◽

Intensive Care Units ◽

Oral Care ◽

Oral Health Status ◽

The Impact

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

American Journal of Critical Care ◽

10.4037/ajcc2004.13.1.25 ◽

2004 ◽

Vol 13 (1) ◽

pp. 25-34 ◽

Cited By ~ 123

Author(s):

Cindy L. Munro ◽

Mary Jo Grap

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Oral Health ◽

Critically Ill ◽

Critically Ill Patients ◽

Dental Plaque ◽

Oral Care ◽

Microbial Flora ◽

Tooth Surface ◽

Ventilator Associated Pneumonia

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.

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