Esther M Chipps1, Michele Carr2, Rachel Kearney3, Jennifer MacDermott4, Tania Von Visger4, Kristin Calvitti4, Brenda Vermillion5, Michele L Weber6, Cheryl Newton4, Jamie St Clair4, Dorina Harper4, Todd Yamokoski7, Marcia Belcher7, Naeem Ali8, Armando E Hoet9, Joany Van Balen10, Christopher Holloman11, Timothy Landers12. 1. Clinical Nurse Scientist, Wexner Medical Center, Clinical Associate Professor, College of Nursing, The Ohio State University, Columbus, OH. 2. Associate Professor, College of Dentistry, The Ohio State University, Columbus, OH. 3. Assistant Professor-Dental Hygiene, The Ohio State University, Columbus, OH. 4. Clinical Nurse Specialist, Wexner Medical Center, The Ohio State University, Columbus, OH. 5. Nursing Education Assistant Professor-Practice, College of Nursing, Wexner Medical Center, The Ohio State University, Columbus, OH. 6. Clinical Nurse Specialist, Clinical Assistant Professor, Wexner Medical Center, The Ohio State University, Columbus, OH. 7. Clinical Nurse Specialist, Richard M. Ross Heart Hospital, The Ohio State University, Columbus, OH. 8. Associate Professor-Clinical, Wexner Medical Center, The Ohio State University, Columbus, OH. 9. Department of Veterinary Preventive Medicine, College of Veterinary Medicine, College of Public Health, The Ohio State University, Columbus, OH. 10. Department of Veterinary Preventive Medicine, College of Veterinary Medicine, The Ohio State University, Columbus, OH. 11. Department of Statistics, The Ohio State University, Columbus, OH. 12. Assistant Professor, College of Nursing, The Ohio State University, Columbus, OH.
Abstract
BACKGROUND: Oral care is standard practice to prevent hospital-associated infections while patients are intubated and in the intensive care unit. Following extubation and transfer, infections remain an important risk for patients, but less attention is paid to oral care. Few studies have assessed the impact of oral care in recently extubated acutely ill patients. AIMS: To develop an evidence-based oral care protocol for hospitalized patients and determine the impact of this protocol on health outcomes in recently extubated patients. METHODS: In this randomized controlled trial, subjects were randomized to usual care or an intervention protocol that included tooth brushing, tongue scraping, flossing, mouth rinsing, and lip care. Major outcome measures were the revised THROAT (R-THROAT; oral cavity assessment) and overall prevalence of methicillin-sensitive Staphylococcus aureus and methicillin-resistant S. aureus on oral cultures. RESULTS:Seventy-four subjects were randomized. As measured by the R-THROAT, oral cavity health improved over time in both groups, but the intervention group demonstrated significantly more improvement than the control group (R-THROAT score improved by 1.97 intervention vs. 0.87 control; p = .04). Two categories, tongue and mouth comfort, demonstrated the most significant improvement. There was no difference in MSSA/MRSA colonization between the groups at the conclusion of the study. Overall, subjects in the intervention group were more satisfied with their protocol than subjects in the usual care group. LINKING EVIDENCE TO ACTION: This study offers an important evaluation of an oral care protocol after extubation. Results demonstrated improvement in the oral cavity assessment with the designed oral care protocol. Patients expressed a preference for the intervention protocol, which included a battery-operated toothbrush, higher-quality toothpaste and mouth rinse, tongue scraper, floss, and lip balm. The implementation of an oral care protocol specifically addressing patients in the immediate postintubation is essential.
RCT Entities:
BACKGROUND: Oral care is standard practice to prevent hospital-associated infections while patients are intubated and in the intensive care unit. Following extubation and transfer, infections remain an important risk for patients, but less attention is paid to oral care. Few studies have assessed the impact of oral care in recently extubated acutely ill patients. AIMS: To develop an evidence-based oral care protocol for hospitalized patients and determine the impact of this protocol on health outcomes in recently extubated patients. METHODS: In this randomized controlled trial, subjects were randomized to usual care or an intervention protocol that included tooth brushing, tongue scraping, flossing, mouth rinsing, and lip care. Major outcome measures were the revised THROAT (R-THROAT; oral cavity assessment) and overall prevalence of methicillin-sensitive Staphylococcus aureus and methicillin-resistant S. aureus on oral cultures. RESULTS: Seventy-four subjects were randomized. As measured by the R-THROAT, oral cavity health improved over time in both groups, but the intervention group demonstrated significantly more improvement than the control group (R-THROAT score improved by 1.97 intervention vs. 0.87 control; p = .04). Two categories, tongue and mouth comfort, demonstrated the most significant improvement. There was no difference in MSSA/MRSA colonization between the groups at the conclusion of the study. Overall, subjects in the intervention group were more satisfied with their protocol than subjects in the usual care group. LINKING EVIDENCE TO ACTION: This study offers an important evaluation of an oral care protocol after extubation. Results demonstrated improvement in the oral cavity assessment with the designed oral care protocol. Patients expressed a preference for the intervention protocol, which included a battery-operated toothbrush, higher-quality toothpaste and mouth rinse, tongue scraper, floss, and lip balm. The implementation of an oral care protocol specifically addressing patients in the immediate postintubation is essential.