The relationship between oral health status and systemic diseases is well established, however, literature shows that there is still lack of awareness among individuals taking care of ICU patients. This work aims to explore if ICU nurses are aware of the relationship between oral health status and systemic diseases, whether they practice oral health care on their patients and if they do, what methods they use. A pre-validated questionnaire was used and distributed to all nurses practicing at KAUH Medical and Surgical ICU. All surveys were voluntary and anonymous. A total of 45 of questionnaires were distributed to ICU nurses with a response rate of 95.6% (T<i>n</i> = 43). Mean responses indicated that nurses recognize that micro-aspiration of contaminated oropharyngeal secretions is the most likely mechanism of transmission of bacteria into the lung of ventilated patients (mean = 5.6). Accordingly, our results also showed that oral care was perceived as a very high priority for mechanically ventilated patients by 95% of nurses. Mouthwash was the primary material used for oral care by the majority of nurses (n = 32; 74.4%), and chlorhexidine the most used one (n = 42; 98%). The use of manual toothbrushes was very low (n = 8; 23.5%) and not surprisingly, none of the nurses used electric toothbrushes to provide oral care for their ventilated patients. Finally, 86% of the respondents agreed on the need of better supplies and equipment to be provided by the hospital in order to perform better oral care in the ICU. Oral care provided in the ICU is not concordant with the global oral care protocols. Thus, the need for translation of oral care guidelines into clinical practice is of serious importance to improve the quality of care.
Patients in Intensive care units (ICUs) are 24-hour monitored by nurses and depend mostly on them for their daily needs including oral care [
Most commonly as some literature shows that nurses are focusing on doing all aspects of their role and finding it more important than performing frequently oral hygiene care [
Even though there are several evidence-based oral hygiene protocols published in the literature, oral care practices still varied among not only different hospitals but also among individual nurses within the same ICU [
Another barrier to oral care is the supply provided by the hospital which undoubtedly affects the oral hygiene provided to ICU patients [
Although there are a number of studies addressing the methods of oral care in ICUs worldwide, there is little information on the current practice and nurses’ attitude available for Jeddah, Saudi Arabia.
The objectives of this study was to determine whether ICU nurses in Saudi Arabia practice oral health care on their patients and to assess what methods are used.
The questionnaire used in this study was developed by Binkley et.al. [
Ethical approval for this survey was granted by the King Abdulaziz University (KAU) the Unit of Biomedical Ethics Research Committee, Jeddah, Saudi Arabia (Reference No.50-15).
The study was a cross-sectional survey conducted at ICUs of King Abdulaziz University Hospital (KAUH) between the period of September 2014 until May 2015. The study sample was conveniently drawn from all registered ICU nurses practicing in the medical and surgical ICU (excluding pediatric ICU and Neonatal ICU nurses). The demographic data of the nurses sampled is shown in
Among 45 of total questionnaires that were distributed to ICU nurses, only 2 nurses did not fill out the questionnaire resulting in a response rate of 95.6%.
The mean responses would indicate that nurses recognize that micro-aspiration of contaminated oropharyngeal secretions (mean = 5.6) and preadmission colonization (mean = 5.2) are the most likely mechanisms of transmission of bacteria into the lung of ventilated patients.
Oral care was perceived as a very high priority for mechanically ventilated patients by 95% of nurses. However, approximately 12% of the nurses responded that the oral cavity is a difficult body area to clean and that this procedure is unpleasant task.
Characteristics | Value |
---|---|
Age (in years) - Mean - Range | 34 (21 - 52) |
ICU experience (in years) - Mean - Range | 8.5 (2 - 26) |
Educational level (number of nurses) Nursing diploma program Bachelor’s degree Missing data | 34 8 1 |
1 | 2 | 3 | 4 | 5 |
---|---|---|---|---|
Strongly Agree | Agree | Neither Agree nor Disagree | Disagree | Strongly Disagree |
# Statement | Mean | |||
1) “I have adequate time to provide oral care at least once a day” | 1.49 | |||
2) “I have been given adequate training in providing oral care” | 1.02 | |||
3) “There are supplies readily available to provide oral care in our unit” | 1.35 | |||
4) “I prefer using an electric toothbrush to a manual toothbrush for cleaning patients’ teeth” | 3.95 | |||
5) “The toothbrushes provided by the hospital are suitable for our patients” | 2.28 | |||
6) “Oral care is a very high priority for mechanically ventilated patients” | 1.19 | |||
7) “I find cleaning the oral cavity to be an unpleasant task” | 4.44 | |||
8) “The oral cavity is a difficult area of the body to clean” | 4.37 | |||
9) “No matter what I do, the mouths of most of the ventilated patients seem to get worse the longer they are on the ventilator” | 3.28 |
of manual toothbrushes (n = 8; 23.5%).
Nurses attitudes is summarized in
86% of the respondents agreed regarding the need of better supplies and equipment to be provided by the hospital in order to perform a better oral care in ICU.
Finally, most of the participants (n = 42; 95%) were willing to learn more about the best way to provide oral care. Also, in response to the statement “I need more information on research-proven oral-care standards”, 93% responded affirmatively, and only 4.8% disagreed.
Aspiration of contaminated secretion from oropharynx was recognizes as the most likely mechanism of transmission of bacteria into the lung and causing pneumonia which may worsen the health condition of ICU patients who are already vitally threatened by their primary disease.
Our results showed that nurses consider oral care a high priority procedure for mechanically ventilated patients (95%) similar to other studies [
Although it is recommended to use manual brushing as a main method for plaque removal to decrease microbial colonization [
Oral care provided in the ICU were not concordant with the current oral care protocols. Thus, the need for translation of oral care guidelines into clinical practice is of serious importance to improve the quality of care.
Access to the ICU was a difficult process and there was a limited number of nurses working at KAUH which made the sample size small. Therefore, this study sheds light on KAUH ICU nurses only. Following the survey, we conducted a small workshop where we instructed the ICU nurses on the best practices for oral health care of ICU patients but due to time restraints we were unable to carry out a “post-workshop survey”. In addition, because of the nature of the ICU department, we had no access to the equipment.
We would like to thank Binkley and colleagues for allowing us to use their survey. Our appreciations are also extended to Dr. Saddig D. Jastaniah for his assistant in journal submission process.
Jastaniah, J.S., Almarhoumi, R.A. and Al-Hazmi, N.A. (2017) Exploring Oral Health Care Awareness among Intensive Care Units Nurses at KAUH. Open Journal of Stomatology, 7, 488-493. https://doi.org/10.4236/ojst.2017.711045