Oral care in ventilated patients: Critical care nurses’ knowledge attitudes and practices

Abstract

Introduction: Several studies have shown that oral care has a key role in oral hygiene of patients receiving mechanical ventilation, reducing the incidence of Ventilator Associated Pneumonia (VAP). In the Intensive Care Unit’s stressful environment, provision of oral care, may be considered as a low priority intervention, which rather provides comfort, than an intervention for removal of threatening pathogens that colonise the oropharynx, and minimising thus the risk for pneumonia development. Aim: The aim of this study was to review oral care practices for critical care patients as well as: (a) the type and frequency of oral care in ventilated patients and (b) the knowledge and attitudes of critical care nurses towards this specific intervention. Method: A literature search was conducted in Greek and English language via the electronic databases Pubmed, CINAHL, EMBASE, SCOPUS and COCHRANE, as well as Google Scholar for the period 2003-2011, using the following Keywords oral care, ventilated patients, critical care nurses, practices, attitudes, knowledge and their equivalents in Greek. Results: Most critical care nurses provide oral care in intubated patients at least once a day. A variety of products used was detected, with foam swab preceding and following by toothbrush and mouthwashes with chlorexidine firstly and toothpaste secondly, being the most frequently products used. The majority of nurses perform evaluation of the oral cavity, but without following a written guideline. Most nurses know the mechanism of VAP development in ventilated patients, they perceive that they have received adequate training in providing oral care and they are positive towards receiving additional training. Furthermore, it seems that the higher training is received the higher the frequency of ideal practices performed. In general, nurses have positive attitudes towards oral care and they consider it to be important. Regarding protocols, guidelines and compliance to them, it has been found a lack of protocols or deviation from the latest guidelines and poor compliance of nurses to the protocols of their unit. Conclusions: In many cases, critical care nurses do not provide oral care to patients receiving mechanical ventilation according to the guidelines regarding both the type and the frequency of oral care. There is a lack of protocols used in the ICU based on the current oral care guidelines. Also, there is a need to revise the existing protocols used in many ICUs and to develop new ones according to the recent guidelines, as well as a need for more research conducted into this topic and for implementation of evidence based practises.