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Deborah Leader, RN

The Importance of Oral Care (and Other Steps) in Intubated Patients

By March 11, 2009

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You may have seen it - a hospitalized patient who is intubated whose mouth looks drier than the Sahara Desert. Nothing is more irritating to me as a critical care nurse. The importance of oral care for intubated patients should not be overlooked, by nurses, doctors, or family members. Why? Because along with other steps, providing oral care every 6 to 8 hours can help reduce the incidence of ventilator-associated pneumonia (VAP).

Ventilator-associated pneumonia is a preventable, secondary consequence of intubation and subsequent mechanical ventilation in a hospitalized patient. Unfortunately, many people with COPD end up in the hospital and are intubated as a result of respiratory failure. This means that if your loved one is in the hospital and gets intubated, they are at risk for developing this serious illness. VAP can occur in intubated patients within 48 hours or more of mechanical ventilation. Mechanically ventilated patients are at an increased risk for VAP for reasons such as a decreased level of consciousness, an open mouth and aspiration of secretions. But studies have shown that initiation of certain steps, including, but not limited to oral care, can help reduce the incidence of VAP. Are the doctors and nurses taking care of your loved one doing what they should be to prevent VAP?

Here are the steps health care workers can take to help reduce VAP in an intubated patient:

  • Providing oral hygiene every 6 to 8 hours - one study showed that the VAP rate dropped to zero within a week of initiating an oral care program of brushing the teeth of intubated patients every 8 hours.
  • Elevating the head of the bed 30 degrees - a simple step that nurses can easily see to every shift.
  • Using sequential compression devices for prevention of thromboembolism - the doctor must order these but the nurses must make sure to put them on.
  • Practicing good hand hygiene - including washing your hands before and after patient contact. If you don't see both doctors and nurses practicing this step EVERY time they come in contact with the patient, remind them to do so.
  • Administering gastric-acid histamine2 blockers - drugs like famotidine, ranitidine or cimetidine are most commonly used for this. The doctor can order this while the nurse can administer it.
  • Providing daily sedation interruptions to assess neurological status - the nurse can do this without an order as a safety measure when using sedation.
  • Initiating early mobilization - the doctor can order physical therapy for the patient, or the nurse can take extra time to mobilize the patient herself with the help of an aide or another nurse.
  • Ventilator tubing condensation removal - this can be done by a respiratory therapist or an experienced, critical care nurse.
  • Glove use - I don't know how many times I see RTs and nurses suctioning patients without gloves. They need to be reminded to wear those gloves every time they suction and/or touch a patient.

Is your loved one in the hospital and currently intubated? If so, do you see any of the nurses implementing the steps above? Have you voiced your concerns yet to the doctor? Share your comments below.

Source:

Fields LB. Oral care intervention to reduce incidence of ventilator-associated pneumonia in the neurologic intensive care unit. Journal of Neuroscience Nursing. 2008 Oct;40(5):291-8

Abbott CA, Dremsa T, Stewart DW, Mark DD, Swift CC. Adoption of a ventilator-associated pneumonia clinical practice guideline. Worldviews Evid Based Nurs. 2006;3(4):139-52. p>

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