Araştırma Makalesi
BibTex RIS Kaynak Göster

The Effect Of Oral Care Given To Patients On Mechanical Ventilatory Support By Two Different Methods On Bacterial Colonization In Oral Mucosa And Oral Health

Yıl 2019, , 321 - 331, 31.12.2019
https://doi.org/10.16899/jcm.628392

Öz

Aim: The aim of the study was to
examine oral care given to the patients on mechanical ventilatory support by
two different methods on bacterial colonization and oral health.

Methods: This study had a design
including an experimental and a control group. Sample was composed of 30
patients who had mechanical ventilatory support less than 24 hours. Patients in
the experimental group were applied toothbrush and serum physiological; and
control group was applied oral care by abeslang and a sponge soaked with NaHCO3. Both groups were given
oral care four times a day for four days. Oral health was evaluated by “oral
assessment scale”, and bacterial colonization was assessed based on
bacteriological culture results of samples taken by cotton swab at days 1 and
4.

Results: It was found that almost
half of the patients in both groups had insufficient saliva that was more
viscous than normal; and dental plaques were decreased among the patients in
the experimental group. In terms of bacteria in the oral mucosa, no
statistically significant differences were found between the groups based on
the comparison of culture results from days 1 and 4. It was found that both
methods used for oral care were effective; and they had no superiority over
each other.









Conclusions: It was concluded that
application of regular oral care for the patients on mechanical ventilatory
support as part of care protocols decreased bacterial colonization and had a
protective and improving effect on oral health. 

Destekleyen Kurum

Zonguldak Bulent Ecevit University Scientific Research Projects Coordinator

Proje Numarası

2016-19093093-01

Kaynakça

  • 1. Kayış M. Effects of different concentrations of clorhexidine gluconate used for oral care on oral flora. Acıbadem University Health Sciences Institute. İstanbul 2014.
  • 2. Abidia R. Oral care in the intensive care unit: A review. The Journal of Contemporary Dental Practice. 2007; 8 (1):1-8.
  • 3. Dikmen Y. Oral care management in ıntensive care patient: literature review within the framework evidence based practices. Journal of Duzce University Health Sciences Institute. 2017; 7(1): 45-52.
  • 4. Özveren H, Uçar H. Effects of oral care provided with three different tools in patients receiving mechanical ventilation. Journal of Human Sciences. 2017; 14(4), 4507-4519. doi: 10.14687/jhs.v14i4.4948
  • 5. Malkin B. The importance of patient’s oral healt hand nurses’ role in assessing and maintaining it. Nursing Times. 2009: 105-17.
  • 6. Weber CD. Applying adult ventilator-associated pneumonia bundle evidence to the ventilated neonate. Advances in Neonatal Care. 2016; 16(3): 178-190. doi: 10.1097/ANC.0000000000000276.
  • 7. Grap MJ, Munro CL, Unoki T, Hamilton VA, & Ward KR. Ventilator-associated pneumonia: the potential critical role of emergency medicine in prevention. J Emerg Med, 2012; 42: 353-362. doi: 10.1016/j.jemermed.2010.05.042
  • 8. Berry AM, Davidson PM, Masters J, Rolls K, Ollerton R. Effects of three approaches to standardized oral hygiene to reduce bacterial colonization and ventilator associated pneumonia in mechanically ventilated patients: A randomised control trial. Int J Nurs Stud. 2011; 48(6): 681-8. doi: 10.1016/j.ijnurstu.2010.11.004
  • 9. Cutler C, Davis N. Improving oral care in patients receiving mechanical ventilation. American Journal of Critical Care. 2005; 14 (5), 389-394.
  • 10. Ali NS. Critical care nurses' knowledge and compliance with ventilator associated pneumonia bundle at cairo university hospitals. Journal of Education and Practice. 2013; 4(15): 66-78.
  • 11. Atay S, Karabacak Ü. Oral care in patients on mechanical ventilation in intensive care unit: literature review. Int J Res Med Sci. 2014; 2(3): 822-9. Doi: 10.5455/2320-6012.ijrms20140876
  • 12. Berry A, Davidson P, Rolls K, Masters J. Systematic literature review of oral hygiene practices for intensive care patients receiving mechanical ventilation. American Journal of Critical Care. 2007; 16 (6): 552-562.
  • 13. Ames NJ. Evidence to Support Tooth Brushing in Critically Ill Patients. American Association of Critical-Care Nurses. 2011; 20(3): 242-251. doi: 10.4037/ajcc2011120.
  • 14. Eilers J, Berger A, Petersen M. Development testing and application of the oral asssesment guide. Oncology Nursing Forum 1988; 15: 325-330.
  • 15. Yates J. The Rol of a Meticulous Oral Hygiene Program in Reducing Oral Assessment Scores, Mucosal Plaque Scores, Colonization of Dental Plaque And Exposotionto Pathogn Colonization That May Lead to Nosocomial Respiratory İnfections in A Selected ICU Patient Population, George Mason University, 2002
  • 16. Kohlerschmidt DJ, Musser KA, Dumas NB. Identification of aerobic gram- negative bacteria. Edit: Goldman E, Green HL. Practical Handbook of Microbiology 2nd ed. Taylor&Francis Group, 2009.
  • 17. Needleman IG, Hirsch NP, Leemans M, Moles DR, Wilson M, Ready DR, Ismail S, Ciric L, Shaw MJ, Smith M, Garner A, Wilson S. Randomized controlled trial of tooth brushing to reduce ventilator associated pneumonia pathogens and dental plaque in a critical care unit. Journal of Clinical Periodontology. 2011; 38(3): 246-52. doi: 10.1111/j.1600-051X.2010.01688.x.
  • 18. Marino PJ, Hannigan A, Haywood S, Cole JM, Palmer N, Emanuel C, Kinsella T, Lewis MA, Wise MP, Williams DW. Comparison of foam swaps and toothbrushes as oral hygiene interventions in mechanically ventilated patients: a Randomised split mouth. Study BMJ Open Resp Res. 2016; 14(3):1-10.
  • 19. Boop M, Darby M, Loftin K, Broscious S. Effect of daily oral care with 0.12% Chlorhexidine gluconate and a standart oral care protocol on the development of nosocomial pneumonia in intubated patients: A pilot study. J Dent Hygiene 2006; 80 (3): 1-13.
  • 20. Mori H, Hirasawa H, Oda S, Shiga H, Matsuda K, Nakamura N. Oral care reduces incidence of ventilator-associated pneumonia in ICU populations. Intensive Care Med. 2006; 32: 230-36. doi: 10.1007/s00134-005-0014-4.
  • 21. Alhazzani W, Smith O, Muscedere J, Medd J, Cook D. Tooth brushing for critically ill mechanically ventilated patients: a systematic review and meta analysis of randomized trials evaluating ventilator associated pneumonia. Crit Care Med. 2013; 41:646-55. doi: 10.1097/CCM.0b013e3182742d45.
  • 22. Munro CL, Grap MJ, Jones DJ, Mc Clish DK, Sessler CN. Chlorhexidine, tooth brushing, and preventing ventilator associated pneumonia in critically ill adults. Am J Crit Care 2009; 18(5):428-437. doi: 10.4037/ajcc2009792
  • 23. Roca Biosca A, Anguera Saperas L, García Grau N, Rubio Rico L, Velasco Guillén MC. Prevention of mechanical ventilator-associated pneumonia: A comparison of two different oral hygiene methods. Enferm Intensiva. 2011; 22:104–111. doi: 10.1016/j.enfi.2010.10.003
  • 24. Yao LY, Chang CK, Maa SH, Wang C, Chen CC. Brushing teeth with purified water to reduce ventilator associated pneumonia. J Nurs Res. 2011; 19:289-9. doi: 10.1097/JNR.0b013e318236d05f.
  • 25. Heo SM, Haase EM, Lesse AJ, Gill SR, Scannapieco FA. Genetic relationships between respiratory pathogens isolated from dental plaque and bronchoalveolar lavage fluid from patients in the intensive care unit undergoing mechanical ventilation. Clin Infect Dis 2008; 47(12):1562-1570. doi: 10.1086/593193

MEKANİK VENTİLATÖR DESTEĞİNDEKİ HASTALARA İKİ FARKLI YÖNTEMLE VERİLEN AĞIZ BAKIMININ ORAL MUKOZADAKİ BAKTERİYEL KOLONİZASYON VE AĞIZ SAĞLIĞI ÜZERİNE ETKİSİ

Yıl 2019, , 321 - 331, 31.12.2019
https://doi.org/10.16899/jcm.628392

Öz

Amaç: Mekanik ventilatör
desteğindeki hastalarda iki farklı yöntemle verilen ağız bakımının oral mukozadaki
bakteriyel kolonizasyon ve ağız sağlığı üzerine olan etkisininincelenmesidir.

Yöntem: Araştırma, deneysel
kontrollü çalışma tasarımı ile yürütülmüştür. Bir Sağlık Uygulama ve Araştırma
Merkezi’nin iki farklı yoğun bakımında 26.03.2017-20.02.2018 tarihleri arasında
gerçekleştirilmiştir. Örneklemi, mekanik ventilatör desteği başlangıcından 24
saat geçmemiş olan 30 hasta oluşturmuştur. Hastalar deney ve kontrol olmak
üzere iki gruba ayrılmıştır.  Deney
grubundaki hastalara serum fizyolojik ve diş fırçası ile kontrol grubundaki
hastalara NaHCO3 ile ıslatılmış spanç
ve abeslang yardımıyla ağız bakımı uygulanmıştır. Her iki gruba da dört gün
süreyle günde dört kez ağız bakımı verilmiştir. Ağız sağlığı “ağız
değerlendirme ölçeği” ile, bakteri kolonizasyonu ise 1. ve 4. gün pamuklu
eküvyon çubukla ağızdan alınan örneklerin bakteriyolojik kültür sonuçlarına
göre değerlendirilmiştir. Araştırmanın gerçekleştirilebilmesi için etik izin,
kurumdan yazılı izin, hasta vasisinden aydınlatılmış onam alınmıştır. Verilerin
değerlendirilmesinde Pearson Ki-Kare testi, t testi, Mann Whitney testi ve
FisherExact test; McNemar testi kullanılmıştır.  

Bulgular: Hastalara
verilen dört günlük ağız bakımı sonucunda her iki grupta da hastaların yarısına
yakınında tükürüğünün yetersiz ve normalden daha yoğun olduğu; deney grubundaki
hastaların diş plaklarında azalma olduğu görülmüştür. Ağız mukozasında bulunan
bakteriler bakımından, 1. ve 4. gün alınan kültür sonuçlarının
karşılaştırılmasına göre gruplar arasında istatistiksel olarak anlamlı
farklılığın olmadığı belirlenmiştir. Ağız bakımında kullanılan serum fizyolojik
ve diş fırçası ile NaHCO3 ile
ıslatılmış
spanç ve abeslang yöntemlerinin etkin ancak birbirine
üstünlüklerinin olmadığı saptanmıştır.







Sonuç: Mekanik ventilatör desteğindeki
hastalar için
bakım protokolleri çerçevesinde düzenli ağız bakımı
yapılmasının bakteri kolonizasyonunu azalttığı, ağız sağlığını koruyucu ve
geliştirici etkisi görülmüştür.

Proje Numarası

2016-19093093-01

Kaynakça

  • 1. Kayış M. Effects of different concentrations of clorhexidine gluconate used for oral care on oral flora. Acıbadem University Health Sciences Institute. İstanbul 2014.
  • 2. Abidia R. Oral care in the intensive care unit: A review. The Journal of Contemporary Dental Practice. 2007; 8 (1):1-8.
  • 3. Dikmen Y. Oral care management in ıntensive care patient: literature review within the framework evidence based practices. Journal of Duzce University Health Sciences Institute. 2017; 7(1): 45-52.
  • 4. Özveren H, Uçar H. Effects of oral care provided with three different tools in patients receiving mechanical ventilation. Journal of Human Sciences. 2017; 14(4), 4507-4519. doi: 10.14687/jhs.v14i4.4948
  • 5. Malkin B. The importance of patient’s oral healt hand nurses’ role in assessing and maintaining it. Nursing Times. 2009: 105-17.
  • 6. Weber CD. Applying adult ventilator-associated pneumonia bundle evidence to the ventilated neonate. Advances in Neonatal Care. 2016; 16(3): 178-190. doi: 10.1097/ANC.0000000000000276.
  • 7. Grap MJ, Munro CL, Unoki T, Hamilton VA, & Ward KR. Ventilator-associated pneumonia: the potential critical role of emergency medicine in prevention. J Emerg Med, 2012; 42: 353-362. doi: 10.1016/j.jemermed.2010.05.042
  • 8. Berry AM, Davidson PM, Masters J, Rolls K, Ollerton R. Effects of three approaches to standardized oral hygiene to reduce bacterial colonization and ventilator associated pneumonia in mechanically ventilated patients: A randomised control trial. Int J Nurs Stud. 2011; 48(6): 681-8. doi: 10.1016/j.ijnurstu.2010.11.004
  • 9. Cutler C, Davis N. Improving oral care in patients receiving mechanical ventilation. American Journal of Critical Care. 2005; 14 (5), 389-394.
  • 10. Ali NS. Critical care nurses' knowledge and compliance with ventilator associated pneumonia bundle at cairo university hospitals. Journal of Education and Practice. 2013; 4(15): 66-78.
  • 11. Atay S, Karabacak Ü. Oral care in patients on mechanical ventilation in intensive care unit: literature review. Int J Res Med Sci. 2014; 2(3): 822-9. Doi: 10.5455/2320-6012.ijrms20140876
  • 12. Berry A, Davidson P, Rolls K, Masters J. Systematic literature review of oral hygiene practices for intensive care patients receiving mechanical ventilation. American Journal of Critical Care. 2007; 16 (6): 552-562.
  • 13. Ames NJ. Evidence to Support Tooth Brushing in Critically Ill Patients. American Association of Critical-Care Nurses. 2011; 20(3): 242-251. doi: 10.4037/ajcc2011120.
  • 14. Eilers J, Berger A, Petersen M. Development testing and application of the oral asssesment guide. Oncology Nursing Forum 1988; 15: 325-330.
  • 15. Yates J. The Rol of a Meticulous Oral Hygiene Program in Reducing Oral Assessment Scores, Mucosal Plaque Scores, Colonization of Dental Plaque And Exposotionto Pathogn Colonization That May Lead to Nosocomial Respiratory İnfections in A Selected ICU Patient Population, George Mason University, 2002
  • 16. Kohlerschmidt DJ, Musser KA, Dumas NB. Identification of aerobic gram- negative bacteria. Edit: Goldman E, Green HL. Practical Handbook of Microbiology 2nd ed. Taylor&Francis Group, 2009.
  • 17. Needleman IG, Hirsch NP, Leemans M, Moles DR, Wilson M, Ready DR, Ismail S, Ciric L, Shaw MJ, Smith M, Garner A, Wilson S. Randomized controlled trial of tooth brushing to reduce ventilator associated pneumonia pathogens and dental plaque in a critical care unit. Journal of Clinical Periodontology. 2011; 38(3): 246-52. doi: 10.1111/j.1600-051X.2010.01688.x.
  • 18. Marino PJ, Hannigan A, Haywood S, Cole JM, Palmer N, Emanuel C, Kinsella T, Lewis MA, Wise MP, Williams DW. Comparison of foam swaps and toothbrushes as oral hygiene interventions in mechanically ventilated patients: a Randomised split mouth. Study BMJ Open Resp Res. 2016; 14(3):1-10.
  • 19. Boop M, Darby M, Loftin K, Broscious S. Effect of daily oral care with 0.12% Chlorhexidine gluconate and a standart oral care protocol on the development of nosocomial pneumonia in intubated patients: A pilot study. J Dent Hygiene 2006; 80 (3): 1-13.
  • 20. Mori H, Hirasawa H, Oda S, Shiga H, Matsuda K, Nakamura N. Oral care reduces incidence of ventilator-associated pneumonia in ICU populations. Intensive Care Med. 2006; 32: 230-36. doi: 10.1007/s00134-005-0014-4.
  • 21. Alhazzani W, Smith O, Muscedere J, Medd J, Cook D. Tooth brushing for critically ill mechanically ventilated patients: a systematic review and meta analysis of randomized trials evaluating ventilator associated pneumonia. Crit Care Med. 2013; 41:646-55. doi: 10.1097/CCM.0b013e3182742d45.
  • 22. Munro CL, Grap MJ, Jones DJ, Mc Clish DK, Sessler CN. Chlorhexidine, tooth brushing, and preventing ventilator associated pneumonia in critically ill adults. Am J Crit Care 2009; 18(5):428-437. doi: 10.4037/ajcc2009792
  • 23. Roca Biosca A, Anguera Saperas L, García Grau N, Rubio Rico L, Velasco Guillén MC. Prevention of mechanical ventilator-associated pneumonia: A comparison of two different oral hygiene methods. Enferm Intensiva. 2011; 22:104–111. doi: 10.1016/j.enfi.2010.10.003
  • 24. Yao LY, Chang CK, Maa SH, Wang C, Chen CC. Brushing teeth with purified water to reduce ventilator associated pneumonia. J Nurs Res. 2011; 19:289-9. doi: 10.1097/JNR.0b013e318236d05f.
  • 25. Heo SM, Haase EM, Lesse AJ, Gill SR, Scannapieco FA. Genetic relationships between respiratory pathogens isolated from dental plaque and bronchoalveolar lavage fluid from patients in the intensive care unit undergoing mechanical ventilation. Clin Infect Dis 2008; 47(12):1562-1570. doi: 10.1086/593193
Toplam 25 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Orjinal Araştırma
Yazarlar

Ayşe Tali Bu kişi benim 0000-0003-2340-473X

Elif Karahan 0000-0002-6371-871X

Füsun Cömert Bu kişi benim

Proje Numarası 2016-19093093-01
Yayımlanma Tarihi 31 Aralık 2019
Kabul Tarihi 3 Aralık 2019
Yayımlandığı Sayı Yıl 2019

Kaynak Göster

AMA Tali A, Karahan E, Cömert F. The Effect Of Oral Care Given To Patients On Mechanical Ventilatory Support By Two Different Methods On Bacterial Colonization In Oral Mucosa And Oral Health. J Contemp Med. Aralık 2019;9(4):321-331. doi:10.16899/jcm.628392