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.
Abidia, R. F. (2007). Oral care in the intensive care unit: a review. Journal of Contemporary Dental Practice, 8(1), 76-82.
Alspach, J. A. (2006). Core curriculum for critical care nursing. California: Saunders Elsevier.
Ames, N. J., Sulima, P., Yates, J. M., McCullagh, L., Gollins, S. L., Soeken, K., & Wallen, G. R. (2011). Effects of systematic oral care in critically ill patients: a multicenter study. American Journal of Critical Care, 20(5), e103-e114. https://doi.org/10.4037/ajcc2011359
Arigbede, A. O., Babatope, B. O., & Bamidele, M. K. (2012). Periodontitis and systemic diseases: A literature review. Journal of Indian Society of Periodontology, 16(4), 487-491. https://doi.org/10.4103/0972-124X.106878
Azarpazhooh, A., & Leake, J. L. (2006). Systematic review of the association between respiratory diseases and oral health. Journal of Periodontology, 77(9), 1465-1482. https://doi.org/10.1902/jop.2006.060010
Azimi, M., Jouybari, L., Moghadam, S., Ghaemi, E., Behnampoor, N., Sanagoo, A., & Hesam, M. (2016). Antimicrobial effects of chlorhexidine, matrica drop mouthwash (chamomile extract), and normal saline on hospitalized patients with endotracheal tubes. Iranian Journal of Nursing and Midwifery Research, 21(5), 458-463. https://doi.org/10.4103/1735-9066.193390
Berry, A. M., Davidson, P. M., Masters, J., & Rolls, K. (2007). Systematic literature review of oral hygiene practices for intensive care patients receiving mechanical ventilation. American Journal of Critical Care, 16(6), 552-562.
Campbell, D. L., & Ecklund, M. M. (2002). Development of a research-based oral care procedure for patients with artificial airways. NTI News, 7, B1-B16.
Cason, C. L., Tyner, T., Saunders, S., & Broome, L. (2007). Nurses’ implementation of guidelines for ventilator-associated pneumonia from the Centers for Disease Control and Prevention. American Journal of Critical Care, 16(1), 28-37.
Chastre, J., & Fagon, J.-Y. (2002). Ventilator-associated pneumonia. American Journal of Respiratory and Critical Care Medicine, 165(7), 867-903. https://doi.org/10.1164/ajrccm.165.7.2105078
Coppadoro, A., Bittner, E., & Berra, L. (2012). Novel preventive strategies for ventilator-associated pneumonia. Critical Care, 16(2), 210. https://doi.org/10.1186/cc11225
Dale, C., Angus, J. E., Sinuff, T., & Mykhalovskiy, E. (2013). Mouth care for orally intubated patients: a critical ethnographic review of the nursing literature. Intensive and Critical Care Nursing, 29(5), 266-274. https://doi.org/10.1016/j.iccn.2012.09.003
de Lacerda Vidal, C. F., de Lacerda Vidal, A. K., de Moura Monteiro, J. G., Cavalcanti, A., da Costa Henriques, A. P., Oliveira, M., . . . Vilela, C. Â. (2017). Impact of oral hygiene involving toothbrushing versus chlorhexidine in the prevention of ventilator-associated pneumonia: a randomized study. BMC Infectious Diseases, 17(1), 112. https://doi.org/10.1186/s12879-017-2188-0
DePaola, L. G., & Spolarich, A. E. (2007). Safety and efficacy of antimicrobial mouthrinses in clinical practice. American Dental Hygienists' Association, 81(suppl 1), 117-117.
Dochterman, J. M., & Bulechek, G. M. (2004). Nursing Interventions Classification (NIC) (4th ed.). St. Louis, MO: Mosby.
Grap, M. J., Munro, C. L., Hamilton, V. A., Elswick Jr, R. K., Sessler, C. N., & Ward, K. R. (2011). Early, single chlorhexidine application reduces ventilator-associated pneumonia in trauma patients. Heart & Lung: The Journal of Acute and Critical Care, 40(5), e115-e122. https://doi.org/10.1016/j.hrtlng.2011.01.006
Handa, S., Chand, S., Sarin, J., Singh, V., & Sharma, S. (2014). Effectiveness of oral care protocol on oral health status of hospitalised children admitted in intensive care units of selected hospital of Haryana. Nursing and Midwifery Research Journal, 10(1), 8-15.
Heo, S.-M., Haase, E. M., Lesse, A. J., Gill, S. R., & Scannapieco, F. A. (2008). Genetic relationships between respiratory pathogens isolated from dental plaque and bronchoalveolar lavage fluid from patients in the intensive care unit undergoing mechanical ventilation. Clinical Infectious Diseases, 47(12), 1562-1570. https://doi.org/10.1086/593193
Herlofson, B. B., & Barkvoll, P. (1996). Oral mucosal desquamation caused by two toothpaste detergents in an experimental model. European Journal of Oral Sciences, 104(1), 21-26.
Hingston, C. D., Cole, J. M., Hingston, E. J., Frost, P. J., & Wise, M. P. (2010). Oral hygiene and nosocomial pneumonia in critically ill patients. Chest, 137(1), 237-238. https://doi.org/10.1378/chest.09-1319
Ibrahim, E. H., Tracy, L., Hill, C., Fraser, V. J., & Kollef, M. H. (2001). The occurrence of ventilator-associated pneumonia in a community hospital: risk factors and clinical outcomes. Chest, 120(2), 555-561. https://doi.org/10.1378/chest.120.2.555
Knaus, W. A., Draper, E. A., Wagner, D. P., & Zimmerman, J. E. (1985). APACHE II: a severity of disease classification system. Critical Care Medicine, 13(10), 818-829.
Kumari, N., Kumari, V., Varsha, A. S. V., & Chandna, S. (2013). Effectiveness of 0.2% chlorhexidine and oral routine care in terms of oral health status and oral microbiological colony count of self care deficit clients, Experimental study. Journal of Dental and Medical Sciences, 11(5), 1-6.
Liao, Y. M., Tsai, J. R., & Chou, F. H. (2015). The effectiveness of an oral health care program for preventing ventilator‐associated pneumonia. Nursing in Critical Care, 20(2), 89-97. https://doi.org/10.1111/nicc.12037
Lorente, L., Lecuona, M., Jiménez, A., Palmero, S., Pastor, E., Lafuente, N., . . . Sierra, A. (2012). Ventilator-associated pneumonia with or without toothbrushing: a randomized controlled trial. European Journal of Clinical Microbiology & Infectious Diseases, 31(10), 2621-2629. https://doi.org/10.1007/s10096-012-1605-y
Luna, C. M., Blanzaco, D., Niederman, M. S., Matarucco, W., Baredes, N. C., Desmery, P., . . . Apezteguia, C. (2003). Resolution of ventilator-associated pneumonia: prospective evaluation of the clinical pulmonary infection score as an early clinical predictor of outcome. Critical Care Medicine, 31(3), 676-682. https://doi.org/10.1097/01.ccm.0000055380.86458.1e
Manangkot, M. V. (2015). Kesesuaian alat ukur bedside oral exam (BOE) dan oral assessment scale (OAS) dalam mengkaji status kesehatan mulut pada pasien di intensive care unit (ICU) RSUP. Dr.Hasan Sadikin Bandung [The suitability of the instrument of the oral bedside exam (BOE) and oral assessment scale (OAS) in assessing the oral health status of patients in the intensive care unit (ICU) of RSUP. Dr.Hasan Sadikin Bandung. Faculty of Nursing, Padjadjaran University, West Java, Indonesia.
Marino, P. J., Hannigan, A., Haywood, S., Cole, J. M., Palmer, N., Emanuel, C., . . . Williams, D. W. (2016). Comparison of foam swabs and toothbrushes as oral hygiene interventions in mechanically ventilated patients: a randomised split mouth study. BMJ Open Respiratory Research, 3(1), e000150. https://doi.org/10.1136/bmjresp-2016-000150
McNeill, H. E. (2000). Biting back at poor oral hygiene. Intensive and Critical Care Nursing, 16(6), 367-372. https://doi.org/10.1054/iccn.2000.1531
Morton, P. G., & Fontaine, D. K. (2013). Critical care nursing: A holistic approach. Philadelphia: Wolters Kluwer.
Musliha. (2010). Keperawatan gawat darurat [Emergency nursing]. Jakarta: NuMed.
Nicolosi, L. N., del Carmen Rubio, M., Martinez, C. D., González, N. N., & Cruz, M. E. (2014). Effect of oral hygiene and 0.12% chlorhexidine gluconate oral rinse in preventing ventilator-associated pneumonia after cardiovascular surgery. Respiratory Care, 59(4), 504-509. https://doi.org/10.4187/respcare.02666
O'Keefe-McCarthy, S. (2006). Evidence-based nursing strategies to prevent ventilator-acquired pneumonia. Dynamics, 17(1), 8-11.
Pear, S., Stoessel, K., & Shoemake, S. (2007). Oral care is critical care: The role of oral care in the prevention of hospital-acquired pneumonia. Retrieved from https://www.halyardhealth.com.au/media/74346/4%20-oral%20care%20study%20guide%20.pdf
Perrie, H., & Scribante, J. (2011). A survey of oral care practices in South African intensive care units. Southern African Journal of Critical Care, 27(2), 42-46.
Potting, C. M. J., Uitterhoeve, R., Op Reimer, W. S., & van Achterberg, T. (2006). The effectiveness of commonly used mouthwashes for the prevention of chemotherapy‐induced oral mucositis: a systematic review. European Journal of Cancer Care, 15(5), 431-439. https://doi.org/10.1111/j.1365-2354.2006.00684.x
Prendergast, V., Jakobsson, U., Renvert, S., & Hallberg, I. R. (2012). Effects of a standard versus comprehensive oral care protocol among intubated neuroscience ICU patients: results of a randomized controlled trial. Journal of Neuroscience Nursing, 44(3), 134-146. https://doi.org/10.1097/JNN.0b013e3182510688
Rello, J., Lorente, C., Diaz, E., Bodi, M., Boque, C., Sandiumenge, A., & Santamaria, J. M. (2003). Incidence, etiology, and outcome of nosocomial pneumonia in ICU patients requiring percutaneous tracheotomy for mechanical ventilation. Chest, 124(6), 2239-2243. https://doi.org/10.1378/chest.124.6.2239
Rezaei, S., Rezaei, K., Mahboubi, M., Jarahzadeh, M. H., Momeni, E., Bagherinasab, M., . . . Memarzadeh, M. R. (2016). Comparison the efficacy of herbal mouthwash with chlorhexidine on gingival index of intubated patients in Intensive Care Unit. Journal of Indian Society of Periodontology, 20(4), 404. https://doi.org/10.4103/0972-124x.194269
Saleem, H. G. M., Seers, C. A., Sabri, A. N., & Reynolds, E. C. (2016). Dental plaque bacteria with reduced susceptibility to chlorhexidine are multidrug resistant. BMC Microbiology, 16(1), 214. https://doi.org/10.1186/s12866-016-0833-1
University of California Davis Health System. (2009). Critical care services CPT codes 99291-99292. Retrieved from https://health.ucdavis.edu/compliance/pdf/billing_coding/crit_care_cpt_adv_2009.pdf
Urden, L. D., Stacy, K. M., & Lough, M. E. (2014). Critical care nursing: Diagnosis and management. Missouri: Elsevier Inc.
Webb, M. (2011). Oral health and systemic disease: A rapid review of the evidence. Wales: Public Health Wales NHS Trust.
This work is licensed under a Creative Commons Attribution 4.0 International License.