Oral intensity: reducing non-ventilator-associated hospital-acquired pneumonia in care-dependent, neurologically impaired patients

Fraser Health.
Canadian journal of neuroscience nursing 11/2013; 35(2):10-7.
Source: PubMed


The purpose of this point-of-care study was to test the efficacy of a prevention-based oral care protocol in reducing non-ventilator-associated hospital-acquired pneumonia in a neurosurgical population outside the critical care environment. The researchers hypothesized that an enhanced oral care protocol would decrease the incidence of pneumonia.
This quasi-experimental, comparative study took place on an acute neurosurgical unit at a tertiary care trauma hospital in Western Canada. Subjects were non-intubated, care-dependent adults with a primary diagnosis of neurologic injury/insult, and at high risk for pneumonia. The prospective study group comprised 34 subjects; two subjects were excluded from the study analysis. The retrospective study group comprised 51 subjects. Data were collected for both groups for a six-month period. Retrospective data were collected through chart review. The prospective group were eligible neurosurgical patients who received the enhanced oral care protocol. Data collection tools were developed and diagnostic criteria for hospital-acquired pneumonia were determined. The pneumonia rates between subjects who received standard oral care (retrospective group) and those who received an enhanced, prevention-based, oral care protocol (prospective group) were compared.
A statistically significant decrease in the pneumonia rate occurred in the prospective group (p < 0.05).
An enhanced oral care protocol was beneficial in reducing the incidence of non-ventilator-associated hospital-acquired pneumonia.
Nurses play a vital role in preventing hospital-acquired pneumonia. Foundational nursing practices, such as regular oral hygiene, are important aspects of care in preventing nosocomial infections and related costs, optimizing health, and promoting quality care.

77 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: After mechanical cleaning in oral care, eliminating residual oral contaminants has an important role in preventing their aspiration, especially in individuals with weak airway protection. We examined the effectiveness of wiping the oral cavity after oral care on eliminating contaminants in 31 patients who were hospitalized in our neurology inpatient unit. The amount of bacteria on the tongue, palate, and buccal vestibule was counted before and just after oral care, after eliminating contaminants either by rinsing with water and suction or by wiping with mouth wipes, and 1 h after oral care. Oral bacteria amounts were decreased significantly by both elimination procedures after oral care. These findings suggest that wiping with mouth wipes is as effective as mouth rinsing to decrease bacteria following oral care. With a lower risk of contaminant aspiration, wiping may be a suitable alternative to rinsing, especially in dysphagic individuals.
    Geriatric nursing (New York, N.Y.) 04/2014; 35(4). DOI:10.1016/j.gerinurse.2014.03.003 · 1.20 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Hospital-acquired pneumonia is a significant burden to healthcare systems around the world. Although there is a considerable body of evidence on prevention of ventilator associated pneumonia, less is known about strategies to prevent hospital-acquired pneumonia in non-critical care settings. Objective: To systematically review the randomised controlled trial evidence for prevention of hospital-acquired pneumonia in non-critical care settings. Methods: We searched EMBASE, CINAHL+, MEDLINE and the Cochrane Library. Seventeen different searches were conducted in parallel through each database. Studies were included if they were randomised controlled trials reporting hospital-acquired pneumonia as an endpoint. Studies were excluded if they were performed in critical care or community settings. All studies published up to the end of December 2014 were considered, with no language restrictions. Data were independently extracted by two authors and the Delphi risk of bias tool was applied to assess trial quality. Results: Five thousand one hundred and one titles were identified across 17 searches. Only two studies were eligible for inclusion in the final review, one from a search of physical therapy interventions and one from a search of enteral feeding. The heterogeneity of the interventions did not permit metaanalysis. One trial suggested possible benefits to early mobilisation; the other trial suggested no benefit or harm from early enteral feeding via nasogastric tube. Both trials enrolled patients with acute stroke. No trials in non-stroke, non-critical care populations were eligible for inclusion in the review. Conclusions: There is currently insufficient trial evidence on preventing non-critical care hospital-acquired pneumonia to make recommendations on practice. © 2015 Elsevier Masson SAS and European Union Geriatric Medicine Society.
    European geriatric medicine 04/2015; 44(suppl 1). DOI:10.1016/j.eurger.2015.03.007 · 0.73 Impact Factor