It has taken me so long to learn how to carry out proper oral care on mechanically ventilated patients and am sure most of my colleagues have gone through the same challenge too or are still going through it.
Let us remind ourselves why and how should we perform oral hygiene to the patients under our care,
to start with, the most common nosocomial pneumonia in our settings is ventilator-acquired pneumonia and poor oral hygiene is one of the factors contributing to VAP. it is related to dental plague and oropharynx colonization in patients who are intubated on mechanical ventilation and septic procedure
After intubation, most defense mechanisms against pneumonia are impaired, this is because the endotracheal tube bypasses the upper airway tract thus exposing the lower respiratory tract and making it more susceptible to infections. The mucociliary defense mechanism is compromised. Also, normal mucus clearance is disrupted causing an accumulation of secretions above the cuff because the cough mechanism is inhibited by the endotracheal tube
Saliva contains an enzyme that inhibits bacteria growth, external stresses in ICU result in increased drying of the mucosa.
Nurses are in the best position to carry out a general assessment and proper oral care to prevent VAP.
Through experience have noted that we haven’t put much emphasis on proper oral care, mostly you will see us rap a gauze on tongue depressors pour mouthwash on it, and just pass it in patients’ mouths once or twice and we are done.
I know we can do better, patients who are orally intubated require oral care just as a normal person will.
Despite the shortage of staff and lack of resources am sure we can do better if we change our attitude.
HOW BEST CAN IT BE DONE?
If the patient is not able to buy chlorhexidine for oral care (with our economic status we cannot assume
anything, right!) get a toothbrush and toothpaste, and ensure the endotracheal tube is properly secured to avoid accidental extubation, set your suction machine ready, ensure you have a glass of clean water and a syringe, put some toothpaste on the toothbrush and thoroughly brush the teeth and tongue making sure you don’t leave any dental plague, rinse the mouth with water as you suction that water out, repeat the procedure until the mouth is clean, dry the patient out. And kindly, let’s not do it just once a day
We must use what we have to protect our patients’ from acquiring ventilator-acquired pneumonia that comes about as a result of poor oral hygiene
This will also shorten their stay in the hospital, and reduce the cost of treatment and mortality.
There are many ways of doing oral care, Have explained the simplest way, let’s improve on this.
Writer: Fridah Mburunga, Critical Care Nurse Student