Ventilator-Associated Pneumonia
Oral Care in Prevention of Ventilator-Associated Pneumonia
September 19, 2013
Literature Review
The review of literature was conducted using the following databases CINAHL, PubMed and Medline using the keywords oral care, mouth care, ventilator-associated pneumonia, ventilator, critical care and hygiene. Of the articles retrieved there were randomized, nonrandomized and quasi experimental. Location of the studies included single centers to university hospital settings in multiple critical care units.
Results of the studies were difficult to compare due to the different methodologies, interventions and protocols used in each study. Standard oral protocols were used and revised and new protocols were added to the ventilator bundle. The main themes identified were oral care with chlorahexadine, chlorahexadine with other product and other products.
The findings are discussed in the following sections that follow.
Grap et al and Cuccio et al both used CHX and a rinse in their studies in the prevention of VAP. Grap et al (2011) used a single rinse dose of 5ml (0.12%) chlorhexidine to the oral cavity areas for their intervention with specimens obtained at 48 and 72 hours. Cuccio et al (2012) also use a 0.12% CHX rinses with a rigorous oral care protocol including tooth brushing during a 6 month pre-implementation and 12 months after implementation. However, neither study discussed the frequency of oral care needed in VAP prevention.
Sona et al (2009), Kausahara et al (2012) and Munro et al (2009) used a combination of swabs, toothbrushing, CHX and sodium monoflurophosphate when performing oral care. Sona et al approach initiated a pre-intervention, post-intervention study comparing cleaning teeth with sodium monoflurophosphate 0.7% paste every 12 hours and brush, rinsing with tap water, and application of 0.12% chlorhexidine gluconate swab twice daily. Kusahara et al tested the effectiveness on the intervention group of
September 19, 2013
Literature Review
The review of literature was conducted using the following databases CINAHL, PubMed and Medline using the keywords oral care, mouth care, ventilator-associated pneumonia, ventilator, critical care and hygiene. Of the articles retrieved there were randomized, nonrandomized and quasi experimental. Location of the studies included single centers to university hospital settings in multiple critical care units.
Results of the studies were difficult to compare due to the different methodologies, interventions and protocols used in each study. Standard oral protocols were used and revised and new protocols were added to the ventilator bundle. The main themes identified were oral care with chlorahexadine, chlorahexadine with other product and other products.
The findings are discussed in the following sections that follow.
Grap et al and Cuccio et al both used CHX and a rinse in their studies in the prevention of VAP. Grap et al (2011) used a single rinse dose of 5ml (0.12%) chlorhexidine to the oral cavity areas for their intervention with specimens obtained at 48 and 72 hours. Cuccio et al (2012) also use a 0.12% CHX rinses with a rigorous oral care protocol including tooth brushing during a 6 month pre-implementation and 12 months after implementation. However, neither study discussed the frequency of oral care needed in VAP prevention.
Sona et al (2009), Kausahara et al (2012) and Munro et al (2009) used a combination of swabs, toothbrushing, CHX and sodium monoflurophosphate when performing oral care. Sona et al approach initiated a pre-intervention, post-intervention study comparing cleaning teeth with sodium monoflurophosphate 0.7% paste every 12 hours and brush, rinsing with tap water, and application of 0.12% chlorhexidine gluconate swab twice daily. Kusahara et al tested the effectiveness on the intervention group of