Hospital-acquired infections (HAI) are preventable and pose a threat to hospitals and patients; increasing the cost, nominally and physically, for both. Pneumonia makes up approximately 15% of all HAI and is the leading cause of nosocomial deaths. Pneumonia is most frequently caused by bacterial microorganisms reaching the lungs by way of aspiration, inhalation or the hematogenous spread of a primary infection. There are two categories of Hospital-Acquired Pneumonia (HAP); Health-Care Associated Pneumonia (HCAP) and Ventilator-associated pneumonia (VAP).
VAP develops in a patient after 48 hours or more of endotracheal intubation. According to a study by Relio et al. (as citied in Fields, L.B., 2008, Journal of Neuroscience Nursing, 40(5), 291-8) VAP adds an additional cost of $29,000-$40,000 per patient and increases the morality rate by 40-80%. Mechanically ventilated patients are at an increased risk in developing VAP due to factors such as circumvention of body’s own natural defense mechanisms in the upper respiratory tract (the filtering and protective properties of nasal mucosa and cilia), dry open mouth, and aspiration of oral secretions, altered consciousness, immobility, and possible immunosuppression. Furthermore, the accumulation of plaque in the oral cavity creates a biofilm that allows the patient’s mouth to become colonized with bacteria.
Many interventions are already in place to improve patient outcomes while on a ventilator. For example, elevating the head of the bed to 30 degrees, preventing venous thrombus via sequential compression devices or anticoagulant drugs, initiating early mobilization and practicing good hand hygiene were among the interventions listed by Fields, L.B., 2008. However, oral care was not on the commonly practiced list.
According to separate studies by Munro, Grap, 2004 and Cutler, Davis, 2005 (as cited in Ross, Crumpler. Intensive & Critical Care Nursing23.3 (Jun 2007): 132-6) nurses continue to believe oral care is a comfort measure and in turn prioritize as such. Furthermore, despite the evidence that toothbrushes are superior in the removal of dental plaque, nurses still prefer to use foam swabs. Grap et al., 2003 reported foam swabs to be used to provide mouth care for 91.5% of intubated patients (as cited in Jones, Munro, Grap. Intensive & Critical Care Nursing27.6 (Dec 2011): 299-304). This creates a cause for concern when health care professionals consider that dental plaque tends to accumulate more in the posterior teeth (molars and premolars) and the proximity of those teeth to the trachea and lungs. In the study by Jones, Munro, Grap, 2011, these hard to visualize and reach teeth, had the most dental plaque (greater than 70%) when compared to...