Nurse-led intervention to improve oral mucosal health of intubated patients in the intensive care unit: A prospective study - 24/02/24

Doi : 10.1016/j.ajic.2024.01.014

Ching-Ching Lin, RN, MSN ^a,^b, Jen-Jiuan Liaw, RN, PhD ^a,^⁎,^{^{1
These authors have contributed equally to this work.}} , Chung-Hsing Li, DDS, DSc ^c,^d, Li-Chin Chen, RN, MSN ^b,^e, Chin-Yen Han, RN, PhD ^b,^e,^⁎
^a Graduate Institute of Medical Sciences, National Defense Medical Center, Taiwan (R.O.C.)
^b Department of Nursing, New Taipei Municipal TuCheng Hospital (Built and Operated by Chang Gung Medical Foundation), Taiwan (R.O.C.)
^c Division of Orthodontics and Pediatric Dentistry, Tri-Service General Hospital, Taiwan (R.O.C.)
^d School of Dentistry and Institute of Dental Science, National Defense Medical Center, Taiwan (R.O.C.)
^e Department of Nursing, Chang Gung University of Science and Technology, Taiwan (R.O.C.)

^⁎Address correspondence to Chin-Yen Han, RN, PhD, Department of Nursing, Chang Gung University of Science and Technology, No.261, Wenhua 1st Rd., Guishan Dist., Taoyuan City 33303, Taiwan (R.O.C.).Department of Nursing, Chang Gung University of Science and TechnologyNo.261, Wenhua 1st Rd., Guishan DistTaoyuan City33303Taiwan (R.O.C.)^⁎⁎Address correspondence to Jen-Jiuan Liaw, RN, PhD, School of Nursing, National Defense Medical Center, No. 161, Sec. 6, Minquan E. Rd., Neihu Dist., Taipei City 114201, Taiwan (R.O.C.).School of Nursing, National Defense Medical CenterNo. 161, Sec. 6, Minquan E. Rd., Neihu DistTaipei City114201Taiwan (R.O.C.)

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Résumé

Background

This prospective study aimed to explore the effectiveness of an oral care intervention with Tegaderm on the oral mucosal health of intubated patients.

Methods

A total of 70 intubated patients were included and randomly assigned to 1 of 3 groups, clean water brushing teeth (n = 23), brushing teeth combined with mouthwash (BTM) (n = 23), and brushing teeth combined with mouthwash and Tegaderm (BTMT) (n = 24). The Oral Mucositis Assessment Scale (OMAS) was applied to evaluate the patient’s oral mucosal health before and after oral care intervention.

Results

The BTMT group had lower OMAS scores in almost all regions of the oral cavity, compared to the brushing teeth and BTM groups. The general linear model for repeated measurement indicated the BTMT group had the lowest total OMAS scores from Day 2 to Day 4 after the initiation of baseline OMAS evaluation. Of the 3 intervention groups, the BTMT group had the shortest length of endotracheal intubation. The BTMT group had the lowest incidence rate of ventilator-associated pneumonia; however, no significant between-group differences were found.

Conclusions

BTMT effectively reduced the decline in oral mucosal health that was caused by endotracheal intubation and shortened the length of endotracheal intubation.

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Highlights

•	The effectiveness of a nurse-led oral care intervention in intubated patients was demonstrated.
•	The oral care intervention helps maintain integrity of oral mucosa in intubated patients.
•	The oral care intervention reduces the risk of VAP in intubated patients.

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Key Words : Endotracheal intubation, Oral care intervention, Oral Mucositis Assessment Scale, Tegaderm, Ventilator-associated pneumonia