Tim Collins1, Catherine Plowright2, Vanessa Gibson3, Louise Stayt4, Sarah Clarke5, Jo Caisley6, Claire Harcourt Watkins7, Emily Hodges8, Gillian Leaver9, Sarah Leyland10, Patricia McCready11, Sara Millin12, Julie Platten13, Michelle Scallon14, Patsy Tipene8, Gabby Wilcox15. 1. South East Critical Care Network, Kent, UK. 2. East Kent Hospitals University NHS Foundation Trust, UK. 3. Open University. 4. Oxford Brookes University, Oxford, UK. 5. Acute Care Team, University Hospitals Plymouth NHS Trust, Plymouth, UK. 6. Princess Mary's Royal Air Force Nursing Service, UK. 7. Intensive Care, Glangwili General Hospital, Hywel Dda University Health Board, Haverfordwest, UK. 8. The Queen Elizabeth Hospital NHS Foundation Trust, King's Lynn, UK. 9. Thames Valley and Wessex Operational Delivery Network, UK. 10. Clinical Placements, St Georges University Hospitals NHS Foundation Trust, UK. 11. Guy's and St Thomas' NHS Foundation Trust, UK. 12. North Bristol NHS Trust, Bristol, UK. 13. North of England Critical Care Network, North Shields, UK. 14. Open University, Ireland. 15. Swansea Bay University Health Board, Morriston Hospital, Swansea, UK.
Abstract
BACKGROUND: Patients who are critically ill are at increased risk of hospital acquired pneumonia and ventilator associated pneumonia. Effective evidence based oral care may reduce the incidence of such iatrogenic infection. AIM: To provide an evidence-based British Association of Critical Care Nurses endorsed consensus paper for best practice relating to implementing oral care, with the intention of promoting patient comfort and reducing hospital acquired pneumonia and ventilator associated pneumonia in critically ill patients. DESIGN: A nominal group technique was adopted. A consensus committee of adult critical care nursing experts from the United Kingdom met in 2018 to evaluate and review the literature relating to oral care, its application in reducing pneumonia in critically ill adults and to make recommendations for practice. An elected national board member for the British Association of Critical Care Nurses chaired the round table discussion. METHODS: The committee focused on 5 aspects of oral care practice relating to critically ill adult patients. The evidence was evaluated for each practice within the context of reducing pneumonia in the mechanically ventilated patient or pneumonia in the non-ventilated patient. The five practices included the frequency for oral care; tools for oral care; oral care technique; solutions used and oral care in the non-ventilated patient who is critically ill and is at risk of aspiration. The group searched the best available evidence and evaluated this using the Grading of Recommendations Assessment, Development, and Evaluation system to assess the quality of evidence from high to very low, and to formulate recommendations as strong, moderate, weak, or best practice consensus statement when applicable. RESULTS: The consensus group generated recommendations, delineating an approach to best practice for oral care in critically ill adult patients. Recommendations included guidance for frequency and procedure for oral assessment, toothbrushing, and moisturising the mouth. Evidence on the use of chlorhexidine is not consistent and caution is advised with its routine use. CONCLUSION: Oral care is an important part of the care of critically ill patients, both ventilated and non-ventilated. An effective oral care programme reduces the incidence of pneumonia and promotes patient comfort. RELEVANCE TO CLINICAL PRACTICE: Effective oral care is integral to safe patient care in critical care.
BACKGROUND:Patients who are critically ill are at increased risk of hospital acquired pneumonia and ventilator associated pneumonia. Effective evidence based oral care may reduce the incidence of such iatrogenic infection. AIM: To provide an evidence-based British Association of Critical Care Nurses endorsed consensus paper for best practice relating to implementing oral care, with the intention of promoting patient comfort and reducing hospital acquired pneumonia and ventilator associated pneumonia in critically illpatients. DESIGN: A nominal group technique was adopted. A consensus committee of adult critical care nursing experts from the United Kingdom met in 2018 to evaluate and review the literature relating to oral care, its application in reducing pneumonia in critically ill adults and to make recommendations for practice. An elected national board member for the British Association of Critical Care Nurses chaired the round table discussion. METHODS: The committee focused on 5 aspects of oral care practice relating to critically ill adult patients. The evidence was evaluated for each practice within the context of reducing pneumonia in the mechanically ventilated patient or pneumonia in the non-ventilated patient. The five practices included the frequency for oral care; tools for oral care; oral care technique; solutions used and oral care in the non-ventilated patient who is critically ill and is at risk of aspiration. The group searched the best available evidence and evaluated this using the Grading of Recommendations Assessment, Development, and Evaluation system to assess the quality of evidence from high to very low, and to formulate recommendations as strong, moderate, weak, or best practice consensus statement when applicable. RESULTS: The consensus group generated recommendations, delineating an approach to best practice for oral care in critically ill adult patients. Recommendations included guidance for frequency and procedure for oral assessment, toothbrushing, and moisturising the mouth. Evidence on the use of chlorhexidine is not consistent and caution is advised with its routine use. CONCLUSION: Oral care is an important part of the care of critically illpatients, both ventilated and non-ventilated. An effective oral care programme reduces the incidence of pneumonia and promotes patient comfort. RELEVANCE TO CLINICAL PRACTICE: Effective oral care is integral to safe patient care in critical care.
Authors: Lewis Winning; Fionnuala T Lundy; Bronagh Blackwood; Daniel F McAuley; Ikhlas El Karim Journal: Crit Care Date: 2021-10-01 Impact factor: 9.097