Transcript oral health poster powerpoint

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Introduction
Oral health cont.
Caring for patients’ oral health is an important part of a nurse’s role in
patient care. It serves different purposes for patients, including that it is a
comfort measure and reduces potentially dangerous oral flora that could
lead to further medical complications such as ventilator-associated
pneumonia (VAP). Oral health and interventions to maintain oral health
will be described and shown to influence the prevention of VAP.
Oral Health
The oral cavity is the largest
opening in the human body and
can potentially be the access site
for pathogenic organisms. The
maintenance of a healthy oral
cavity can prevent the acquisition
of harmful microorganisms that
can cause infections. The
accumulation of dental plaque,
oral microbial flora, and local
immunity are three factors that
influence oral health and the
number of organisms in the oral
cavity (Munro & Grap, 2004).
Saliva acts to maintain oral immunity through the mechanical removal of
dental plaque and microorganisms that are present in the oral cavity.
Saliva contains several immune mediators that actively fight against
infections. Lactoferrin has been demonstrated to be an antibacterial
agent that binds to iron in the body and prevents bacteria from
replicating (Weinberg, 2001). IgA, an antibody found in saliva, functions
to prevent microorganism attachment to the mucosa of the upper
respiratory tract (O’Neal, Brown, & Munro, 2002). Critically ill individuals
with reduced IgA have demonstrated an increased susceptibility to upper
and lower respiratory tract infections (O’Neal et al., 2002).
On intensive care units many patients are intubated, which can increase
the development of VAP. VAP is pneumonia that occurs in patients who
have either a tracheostomy or an endotracheal tube, and the onset
occurs after 48 hours of intubation (Grap & Munro, 2004; Safer
Healthcare Now! 2007). Oral care is one factor that reduces a patient’s
chance of developing VAP, which is important because ventilated patients
who develop VAP have a higher mortality rate—46% compared to 32% of
ventilated patients who do not have VAP (Ibrahim, Hill, Fraser, & Kollef,
2001). The health care system can currently save a minimum of $14,000
per patient if VAP is prevented (Safer Healthcare Now! 2007).
Oral Health Interventions
Dental plaque is a collection of bacteria embedded in bacterial byproducts,
salivary products, and food debris that attach to the hard surfaces of the
teeth (Grap & Munro, 2004). Research has shown that within 48 hours of
hospitalization, a critically ill patient’s normal flora changes to include
virulent and pathogenic organisms, such as Methicillin-resistant
Staphylococcus aereus and Pseudomonar aereus, that normally are
not present (Grap & Munro, 2004).
The goals for oral health should focus on preventing the development of
dental plaque and stimulating local immunity (Halm & Armola, 2009).
Mechanical interventions include physically removing dental plaque by
brushing the teeth and swabbing the mouth with foam swabs. Research
has suggested that tooth brushing is the best method of removing dental
plaque from the teeth and that foam swabs do not reduce the amount of
dental plaque in oral cavities (Halm & Armola, 2009).
Pharmaceutical interventions include the use of antibiotics or other
antibacterial agents to reduce the colonization of bacteria in the oral
cavity. Research on pharmaceutical interventions has shown that
chlorohexidine is one of the best agents to reduce the colonization of oral
flora and the incidence of lower respiratory tract infections in critically ill
patients, compared to a placebo (Grap & Munro, 2004). Chlorohexidine, a
broad- spectrum antibacterial agent, is preferred over other topic
antibiotics because it has no resistance, whereas other antibiotics induce
bacteria resistance (Halm & Armola, 2009).
Unit Policies
This section is a basic summarization of oral care during a typical 12-hour
shift. Once each shift, a nurse should assess the oral cavity, brush the
teeth with a soft toothbrush, and rinse with chlorohexidine. Every two
hours or as necessary, a nurse should moisturize the mouth, lubricate the
lips, and remove oral secretions.
Safer Healthcare Now! (2007) proposed
four key interventions in addition to oral
health care, hand hygiene, and nutrition
to prevent the development of VAP:
(a) elevation of the head of bed greater
than 30º: Research has demonstrated
that patients in a supine position have a
34% incidence rate of VAP compared to
8% for those in a semirecumbent position
(Drakulovic et al., 1999);
(b) daily “sedation vacations” and assessment of readiness to extubate
by performing spontaneous breathing trials: Research has shown that the
length of mechanical ventilation can be decreased with daily weaning
assessments (Safer Healthcare Now! 2007);
(c) use of oral rather than nasal tubes to access the stomach and
trachea: Nasotracheal and nasogastric tubes have an increased risk of
sinusitis, which can potentially lead to VAP (Holzpfel et al., 1999); and
(d) use of EVAC tubes for drainage of subglottic secretions: EVAC tubes
are designed to remove pooled secretions above the endotracheal tube
cuff, which can reduce the risk of aspiration and VAP (Safer Healthcare
Now! 2007).
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