Mosby\'s Dictionary defines oral hygiene as \"the condition or practice of maintaining oral tissue and structure \".
Oral hygiene includes brushing teeth to remove food particles and residues, bacteria and plaques;
Massage the gums with a toothbrush, floss or a water washer to stimulate circulation and remove foreign matter;
And clean the dentures and make sure they are suitable to prevent irritation.
Dependent or unconscious patients are assisted in maintaining healthy oral conditions.
This care includes lubrication of the lips, cleaning the inside of the cheeks, the top of the mouth and the tongue. \' (1)
Oral care is a fundamental aspect of care that affects health
Comfort of the patient. (2)
Providing effective oral hygiene for patients in the intensive care unit is particularly challenging because medical conditions, treatment interventions, equipment can harm the patient\'s oral health, and the patient\'s own oral care is not credible.
For the monitoring and management of critically ill patients, the presence of required nasal congestion tubes, trachea tubes and other items complicated the operation.
Some caregivers may even consider inserting oralcare\'s tools into the patient\'s mouth, infringing the patient\'s privacy. (3)
Oral hygiene care practices in critically ill patients include oral assessment, brushing teeth, moisturizing lips and mouth, and sucking mouth and mouth. (4-6)
The related nursing measures include repositioning and fixing of the trachea catheter, care of the trachea, and suction of the trachea. (6)
Practical experience working in the intensive care unit confirms the author\'s impression that intensive care nurses do not consider oral hygiene as a very important patient care activity.
There seems to be a recognized attitude that if oral hygiene care for patients is ignored during ashgift, it is not notable.
But we all enjoyed the experience and comfort of a clean mouth.
Most people practice oral hygiene every day, such as brushing their teeth and gargling.
So why does oral hygiene care in critically ill patients seem to receive little attention?
This article aims to answer the following questions: 1.
What are the beneficial effects of oral hygiene care on critically ill patients? 2.
How should oral health care practices be implemented?
Methods a review of oral hygiene literature for critically ill patients, including nursing practices, was used to describe best care practices and to guide the provision of effective oral hygiene for critically ill patients.
The goals set to review the literature on this aspect of patient care include the following: * describe the benefits of effective oral hygiene for sick patients * identify barriers to effective oral hygiene in key care units * describe common and recommended methods for providing oral hygiene.
Reference books for critical care were consulted to develop a basic understanding of oral health care considerations for critically ill patients.
Using keywords oralhygiene, intensive care unit conducted a search for electronic database postgraduate and ScienceDirect.
This helps to identify the latest published research on oral hygiene and related practices of nurses in intensive care settings.
Summary of articles published over 10 years
2007 copies were extracted and read to determine their relevance to the study.
11 Related articles were identified and all of them included in the review.
The literature review is presented under the following headings: 1.
Critical oral health 2.
Barriers to oral care 3.
Practice of providing oral care.
Critical oral health is affected by dental plaque, the presence and type of oral microbial flora, and oral immunity. (7)
The most important aerobic bacteria in healthy adults are S. Green.
Due to the change of oral enzyme level, the change of oral flora in critically ill patients is mainly gram-
Negative organisms in about 48 hours. (4,7)
This represents a more lethal plant that may include drugs that may lead to a ventilator
Associated Pneumonia (VAP)
Examples including S. aureus
Pneumonia, A. M. A. , and B. P. (7)
Ventilator is common in patients with ventilation, and the mortality rate is usually between 24% and 50%, probably up to 74% --
People at risk. (4,6)
There is evidence of a link between plaque and the colonization of respiratory pathogens and ventilator-associated pneumonia. (2,4,5)
Accumulation of oral micro enterprises
Organisms embedded in bacteria and saliva products allow this complex to adhere tenaciously to the face of the tooth.
When the plaque matures and becomes petrochemical, it contains a microcosm of a variety of organisms, which may become a reservoir of pathogens when oral hygiene care is insufficient or ineffective. (4,7)
Due to the immune damage of many patients in the intensive care unit, they have a tendency to have oral infection (2,7)
This may further affect their condition.
The results of the study showed that orgotic colonization was a risk factor for in-hospital pneumonia in ventilated patients. (7)
In the intensive care unit, the deterioration of the patient\'s respiratory function may require intubation and mechanical ventilation. This life-
Economical intervention that requires insertion of artificial airway can make patients face direct import or micro
Inhalation of pathogens from the mouth into the lower part of the respiratory tract.
The risk of in-hospital pneumonia in mechanically ventilated patients is 21 times that of non-mechanically ventilated patients
Ventilation rates and mortality rates in these patients may exceed 50%. (5)
Treatment of pneumonia in hospital increased by 5-
Surviving patients were hospitalized for 7 days and significantly increased medical expenses. (7)
Maintaining and improving oral hygiene through oral care interventions is essential to prevent adverse consequences such as breathing machines. (5-7)
Another consideration for maintaining oral health in intubated patients is the effect of prescription drugs or treatment interventions required to manage their medical condition, as these may adversely affect the oral cavity. (8)
Dry mouth disease (drymouth) may be caused by the presence of a device in the patient that keeps the mouth open and is exacerbated by stress and anxiety. (4)
The therapeutic interventions needed by critically ill patients can exacerbate oral dryness, such as the need to maintain a mild negative fluid balance to support heart and respiratory function ,(8)
Or the use of drugs such as opium, anti-psychiatric, and drugs. (4,8)
Dry mouth can lead to a decrease in saliva flow, resulting in excessive growth of microorganisms and plaque formation. (7)
One of the most important factors affecting oral hygiene in critically ill patients is that they are unable to provide themselves with basic care in this regard.
Individuals and caregivers of critically ill patients are often entirely dependent on caregivers. (2)
Providing effective oral care to patients in key care units is particularly challenging.
Complexity of other treatment and care needs of patients
Pacedenvironment may result in lower priority for nurses in oral care than in other nursing aspects. (2)
The shortage of nurses in the intensive care unit may lead to patient care priorities with tasks to be completed, while activities considered to be more urgent take precedence over activities (
Such as oral care)
This is considered as basic care, and it is reported that oral care is often the first to be delayed when the nurse\'s time is allocated. (5)
Berry and Davidson identified special key barriers to achieving optimal oral hygiene.
These barriers are divided into mechanical barriers, communication barriers and perceived barriers for nurses. (4)
The mechanical barrier is packed with the mouth of patients with severe ventilation.
These may include a trachea catheter, an oral airway, a gastric catheter, and a temperature probe. (3,4)
Providing effective health services in this limited, occupied space, even experienced critical care nurses will face challenges.
There is a general shortage of oral care tools for nurses. (4)
There are usually mouthwash and foam cotton swab instead of toothbrush, or the toothbrush provided is of poor quality, large and not available. (5)
Communication barriers are related to language and treatment.
Practical experience has shown that patients can be carried out more easily if they are informed of oral hygiene-related care activities and understand their intentions;
For example, the patient is able to meet the requirements of the opening.
The patient\'s lack of compliance may be due to language disorders, or it may be the effect of a calming or other therapeutic intervention.
Once the internal tube is in place, inability to speak can cause irritation and frustration to the patient and result in non-compliance.
Patients with pain may also be reluctant to comply. (4)
Careful and thorough patient evaluation will help to identify these disorders and improve the nursing experience of patients and nurses.
Oral comfort and hygiene measures are important aspects of the care of mechanically ventilated patients. (6)
In this case, there is no comprehensive guideline to define the method and frequency of oral care, so there is a big difference between nurses, the oral care measures indicated and the care actually received(6)
Inadequate oral hygiene seems to be at the root of a nurse\'s perception of these activities.
The study reports that public health provision is listed as a low priority in many undergraduate care programs. (4,9)Jones et al. (2)
It was found that 41% of nurses received oral care training in the initial nursing training, 48.
5% received \"work\" training and a small number (14. 5%)
Later took part in a training course on oral care. Fifty-
There are nine nurses who do not remember receiving any oral care training.
More than half of the nurses who participated in the study required oralcare training (58%).
In a recent study, the length of intensive care experience was not related to the quality of oral care provided. (4)
However, it has been noted that there is enough time for the procedure and that oral care is considered an unpleasant task, which is a factor in providing high quality oral hygiene. (7,9)
Berry and David Son support this (4)
Although this is considered a basic practice of care, oral hygiene is likely to be downgraded to a low priority in the care of a complex critically ill patient.
This theme was further strengthened by a survey.
In this study, 5% of nurses rated oralcare as low priority. (2)
A study by Munro et al. , (7)
Compared to all other patient care activities they require, intensive care nurses were asked to rate their priority in giving oral care, indicating that nurses rated oral care on average 53. 9 on a100-point scale.
In complex and highly technical critical care settings, the lack of oral hygiene priorities may be due to insufficient oral health knowledge or a lack of understanding of the importance of oral hygiene by registered nurses. (4)Furr et al. (5)
They reported in their conclusions that oral care education, sufficient time to provide oral care, to treat oral care as a priority, and not to treat oral care as an unpleasant care, with the provision of better
To highlight the importance of this task for clinicians, it is necessary to focus on education and training activities. (4)
It has been proven that the use of a standardized comprehensive oral care programme can affect the integrity and frequency of oral care practices of intensive care nurses. (6)
When comparing the practices of intensive care nurses before and after the implementation of oral health care programs, it was noted that the frequency of various aspects of oral health care activities was significantly increased. (6)
The practice of providing oral care has no clear consensus on the frequency of implementation of oral care. (4)
In a study by Cutler and Davis ,(6)
In the case of the implementation of a standardized program for the management of oral health care, the recommended frequency of oral cleaning is 2-
Every hour, but they point out that in practice it is in 2-and 4-
We recommend that further investigations be conducted in this regard. (6)
Other authors support this view and they recommend that nurses in intensive care units work together to develop evidence
Provide guidance for best practices in intensive care units. (4)
It is reported that the use of toothbrush foam cotton swab to remove plaque has great benefits. (4)
The ordinary adult toothbrush is too large to reach the mouth of the patient with intubation, so it is recommended to use a soft toothbrush
Baby toothbrush. (4)
It can be better access to all areas of the mouth, and can also be used to gently brush the tongue, and also to brush the gums in toothless patients. (4,7)
Brush your teeth with your children
The size brush is better than the foam swabs
in that removes plaque and bacteria. (5)
Despite this evidence, nearly 80% of respondents found that toothbrushes and toothpaste are rarely used. (5)
Toothpaste and toothbrush are used in non-
Patients with intubation, patients with sponge braces were more patients with intubation. (9)
In the survey, only 38 were reported by emergency nurses.
9% the frequency of using a toothbrush to provide oral care for intubated patients. (7)
Although there is evidence that using a toothbrush is better than a foam wipe, cotton and foam swab are another common method of oral care.
This experience is supported by the study, which shows that scrub is still the preferred method of oral care in key care units. (2,5)
It is reported that there are very few plaques for blood drawing technology
Ability to clear. (2,4)
Foam sticks help moisturize your mouth between brushing your teeth. (2)
Toothpaste is considered not important for the elimination of plaque, but the effect of local application of fluoride has long been considered as the key to preventing corruption. (4)Non-
Foam toothpaste is preferred as it is easier to clean as any residue of the toothpaste can have a dry effect on the foam. (4)
Hanneman and Gusick (10)
Reported that the use of oral care products after intubation is different (
Sodium chloride, peroxide mixture, chlorhexidine)and non-intubated (
Toothbrush, toothpaste, mouthwash)patients.
A variety of oral rinses are discussed in the literature, and the following are: * wash bitai 0. 1-0.
2% has an inhibitory effect on gram
Positive and G-
Negative organisms and yeast
There is aslow in zebitai-
Property released to maintain antimicrobial activity for up to 12 hours. (4,8)
* Sodium bicarbonate mouthwash 1% is a cleaning agent that is reported to reduce the viscosity of oral mucus and therefore can enhance the removal of oral debris.
It is important to use it at recommended concentrations as it may cause mucosal stimulation.
However, so far, no randomized controlled study has supported its use in the intensive care unit population. (4)
* Hydrogen peroxide is an acidic solution that must be diluted correctly before use due to the risk of mucosal stimulation.
It was reported that there were subjective complaints of discomfort and mucosal damage in the healthy participants group who received hydrogen peroxide mouthwash. (4)
With the establishment of the benefits of toothbrush, the use of hydrogen peroxide
It is not recommended to use a soaked foam stick in the sick population. (4)
* Sodium chloride can promote the healing of oral mucosal lesions because it can easily lead to dryness, but the use of routine as a mouse is limited in an intensive care setting. (4)
* Water can be used in combination with small and soft water
Clean the teeth and gums with a toothbrush, or as the only agent for gargle and removal of the mouth.
Hospital tap water has been identified as a serious source of hospital infections transmitted by water, especially hospital infections caused by P. (4)
It can be a cost to use a small bottle of sterile water-
Effective mouthwash for intensive care patients. (4)
Borolum is a way to reduce the dryness of the mouth, make the patient more comfortable, and control the excessive growth of bacteria. (3)* Povidone-iodine.
Iodine may be useful in the treatment of mucosal wounds after surgery, and for intensive care patients, regular mouthwash has questionable value because it has no resistance
Plaque effects and long-term use may result in a large amount of absorption. (4)
Lemon and glycerin cotton swab.
While the initial action may stimulate the flow of saliva, this mechanism may run out during overuse and lead to oral dryness. (4,7)
Due to the acid and de-mining effects of the enamel, these swabs
are no longer commonly used for oral care in intensive care patients. (4,7)
Saliva replacement is an important drug in Runze\'s oral cavity.
This alternative must contain the saliva enzymes, milk Ferrin and whey protein, which are essential to promoting the natural immune process. (4)
The lips of intubated patients have an extreme risk of dryness and rupture.
This is because the patient is unable to naturally remove the lips by tongue bypassing the surface of the lips.
Oil fudge and wool are used to prevent dehydration of lips, as they can be closed and reduce cross-water loss. (4)
Dental Syringes with curved nozzles can be used to apply the mouse to intubated patients. (4)
The use of a flexible suction catheter is advocated, as it can reach the area under the sound door, and is essential to remove secretions gathered above the cuff of the trachea catheter.
It is important to remove the sundries on the tongue.
This procedure involves a striker.
Fast movement along the back of the tongue, preferably with a small, soft
Conclusion oral hygiene is a complicated and important process and should be carried out effectively for all patients.
This is especially true for critically ill patients with impaired immunity and risk of infection.
It is important that good oral hygiene habits reduce the potential libraries in mice.
This may help to reduce the transport of organisms to the lungs through a trachea catheter and reduce the risk of a ventilator. (7)
Effective oral health care practices in critically ill patients by limiting the development of plaque colonization and in-hospital respiratory infections, play a role in infection prevention and control, and can reduce the negative impact of the treatment required.
The most important obstacle to effective oral hygiene care practice is the nurse\'s perception of these activities.
It has been noted in the literature that oral hygiene has received lower attention compared to other activities considered more important to the care of critically ill patients.
It is worth considering whether this low-priority oral care is applicable to other healthcare practitioners in intensive care settings.
There are deficiencies in oral health education and training, which is likely to strengthen the priority of clinicians on these activities.
When considering the impact of poor oral hygiene care on critically ill patients, it is critical that critical care nurses give priority to the basic but necessary aspects of patient care in the oral hygiene component.
Key caregivers use their skills and knowledge in a technology-driven environment, but this should not weaken the important basic practices of patient care as part of the field of professional care. (11)
Effective oral hygiene care can be small (child-sized), soft-
Toothbrush and toothpaste, use water and flexible suction catheter to clean the mouth after brushing your teeth.
The teeth, gums and tongue should be cleaned gently.
A family that tries to cope with the stress of a loved one\'s admission to hospital usually does not really become a place where a simple toothbrush is placed in patient care.
Many patients may not be able to afford it in South Africa.
Patients should be investigated for providing a small toothbrush as part of their entry into the intensive care unit as a strategy to help prevent complications that may result from poor oral hygiene.
This may have a positive impact on the cost of care.
Oral health care practice should be implemented from the patient\'s entry into the intensive care unit.
Due to lack of confidence in determining the frequency of oral hygiene implementation, nurses should assess the needs of each patient and determine the frequency of intervention accordingly.
Oral hygiene cannot be rated as low priority by critically ill patients and special attention needs to be paid to education and training to emphasize the importance of oral hygiene care.
Further studies are needed to determine the ideal frequency and time of oral care and their relationship to infection prevention and control of hospitalized patients receiving mechanical ventilation.
We need evidence-
Basic guidelines for oral health care in critically ill patients.
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Louis, BCur Jennifer, MCur, BCur Bachelor of Science (Critical Care), PgDN (