PRACTICE TRENDS IN INTENSIVE CARE NURSING.

Ventilator associated pneumonia and Oral hygiene needs within the intensive care unit (Nursing Based)



Abstract

Oral hygiene considerably affects children's well being. It is an essential part of intensive and critical care nursing because intubated and ventilated patients in the Pediatric Intensive Care Unit (PICU) are reliant on the health care team to tend to their everyday basic needs. Fourteen articles were identified as being relevant to pediatric oral care in the PICU. These articles were subsequently appraised, and an oral hygiene in the PICU guideline was developed. Research highlighted the relationship between poor oral hygiene in the intensive care unit (ICU) and an increase in dental plaque accumulation, bacterial colonization of the oropharynx, and higher nosocomial infection rates, particularly ventilator-associated pneumonia. Research and a local, informal audit found the provision of oral hygiene care to PICU children varied widely and was often inadequate. Children in the PICU need their mouths regularly assessed and cleaned. Maintaining consistent, regular, and standardized oral hygiene practices in the PICU will also set an example for children and their families, encouraging and teaching them about the life-long importance of oral hygiene.

Introduction

Oral hygiene in children is essential for the development of strong, healthy teeth and to minimize the risk of infection (Thomson, Ayers, & Broughton, 2003). In the critical care setting, poor oral hygiene has been associated with increased dental plaque accumulation, bacterial colonization of the oropharynx, and higher nosocomial infection rates, particularly ventilator-associated pneumonia (VAP) (Fourrier, Duvivier, Boutigny, Roussel-Delvallez, & Chopin, 1998; Franklin, Senior, James, & Roberts, 2000; Grap & Munro, 2004). Yet, research suggests that some nurses perceive oral hygiene care to be a low priority (McNeill, 2000; O'Reilly, 2003), and they may lack the necessary knowledge of oral health assessment and hygiene practices (Adams, 1996; Fitch, Munro, Glass, & Pellegrini, 1999).

Ventilator-associated pneumonia (VAP) is pneumonia in mechanically ventilated patients that develops later than or at 48 h after the patient has been placed on mechanical ventilation. VAP is the second most common hospital-acquired infection among pediatric and neonatal intensive care unit (ICU) (NICU) patients (41, 43). Overall, VAP occurs in 3 to 10% of ventilated pediatric ICU (PICU) patients (1, 28). Surveillance studies of nosocomial infections in NICU patients indicate that pneumonia comprises 6.8 to 32.3% of nosocomial infections in this setting (26, 39, 48). The incidence of VAP is higher in adult ICU patients, ranging from 15 to 30% (8, 31, 50, 70, 90). NICU VAP rates vary by birth weight category as well as by institution. Two large studies are summarized in Table 1. The most recent National Nosocomial Infection Surveillance (NNIS) data from 2002 to 2004 show NICU VAP rates ranging from 1.4 to 3.5 per 1,000 ventilator days (68). In 1998, a cross-sectional study of hospital-acquired infections in 50 children's hospitals was performed by the Pediatric Prevention Network (88). Of 43 children's hospitals that returned questionnaires reporting NICU and PICU surveillance data, the VAP rate by device days was reported by 19 hospitals, and 12 ...