oral health in the ICU

[Zahrazhuang]

Hi, I am a newer in the ICU on this July. I find that in my workplace ICU we will have toothbrushing 3 times for the critially ill patient and they almost have the intubation,down to unconsciousness. In my workplace, we have two people finish it, one for push the water of syringe into the patient's mouth and the other one remove the water with suction catheter.I am confused that whether it will increasing the risk of VAP because you may cause the risk of aspiration when uncompleted suction. What do you think of it and how do your ICU help clean the bubble when finishing toothbrushing?

[iluvgusgus]

we have toothettes that attach to suction so as you're cleaning you're suctioning at the same time.

[applewhitern, BSN, RN]

We use the toothettes and toothbrushes that attach to suction, also. It comes with a packet of diluted hydrogen peroxide and a separate packet of mouth moisturizer. I can't imagine needing two people for this simple chore. Keep the head of the bed up at least 45 degrees; I don't think aspiration is much of an issue with an intubated patient.

[Double-Helix, BSN, RN]

Oral care decreases the risk of VAP as it helps remove bacteria from the mouth. There are several research studies to back this up. Here is one: http://www.gentoftehospital.dk/NR/rdonlyres/7B961701-75DB-4650-8032-126D0D99777B/0/JCartikelmaj2011.pdf

[CamillusRN, BSN]

A few of the studies submitted to the American Association of Critical Care Nurses (might look into a membership - reasonable price and tons of CE studies at no additional cost!) recommend a Chlorhexidine rinse using oral care sponges, a semi-fowler position, and H2-blockers to help decrease pneumonitis from possible aspirates. Please see the link below for one such study.

http://www.aacn.org/wd/Cetests/media/C1242.pdf

[Here.I.Stand, BSN, RN]

We too use the toothettes/toothbrushes that can be hooked to suction--we have the individual kits with the packet of mouthwash and moisturizer. We do oral care q 2 hrs, with tooth brushing every 3rd time. And then we always subglottic suction at the end.

[ashleigh_0804]

I'm sorry. But I don't even get this question. Two people to do oral care on intubated patients? If your cuff is properly inflated, cass tube hooked to suction, HOB elevated greater than 30 degrees...I don't even get how oral care would be an issue, even for micro-aspiration.

[whofan, ADN, BSN, RN]

Our RTs do it once per shift and the RN is required to the care the remaining 2 times. We use toothettes with suciotn and chlorohexidene gluconate mouthwash. Our unit has dropped its VAP rate since it started this. Why would it take 3 RNs to do oral care? Oral sponges with the mouthwash can be used between brushings as well. Then suction the patient.