Definition of area of practice
Oral care is a fundamental aspect of nursing care (DOH, 2001). The principle objective of mouth care is to maintain the mouth in good oral condition that is comfortable, clean, moist and free of infection (Watson, 1989). Oral care has been highlighted as an important factor in the prevention of ventilator associated pneumonia (VAP) (DoH, 2011). Providing adequate oral care for patients in ICU can be challenging (Jones et al 2004) due to the patient’s condition, drugs and the effects of intubation (Hsu et al 2010: Jones et al, 2004)
Risk factors for patients in ICU
- Patient condition –patients who are anaemic, have diabetes, chrons disease, leukemia and any immuno-compromised patients are all at increased risk for developing oral problems
- Drugs –Antidepressants; antibiotics; steroids; antihistamines; antispasmodics can alter oral flora, ph or salivary gland activity. Antibiotics will also increase the risk of developing an opportunistic pathogen such as candida or herpes.
- Intubation – this can cause xerostomia (dry mouth), mucotis, and a bacterial shift from mainly gram +ve to gram –ve bacteria, impaired access for oral care and the development of oral lesions from pressure.
Recommendations for Practice
- Daily oral assessment
- The mouth is cleaned with chlorhexidine gluconate (≥1-2% gel or liquid) 6 hourly (as chlorhexidine can be inactivated by toothpaste, a gap of at least 2 hours should be left between its application and tooth brushing).
- Teeth are brushed 12 hourly with standard toothpaste.
- Oral secretions suctioned and a SACETT (Suction above the cuff endotracheal tube) be used in all intubated patients
- Water based lubrication used on lips
NB. Foam sticks are NOT recommended for oral care in ICU
Aims of good mouth care
Indicators of a healthy mouth
(Jenkins, 1989; Mallett, Dougherty 2000)