Oral care protocol

WOLFE, BSN, RN · May 22, 2005

Just wondering if anyone has an establised oral care protocol esp for vented pts...Trying to make some changes in our unit and lower VAP...Most nurses use the pink swabs.."Toothettes" and they don't really do well...Also wondering if anyone has any evidence based research on the subject..Thanks! :)

On my floor, when we have vented or trache collar pt's we use a green swab. It is designed with a hollow handle. toward the top is a an open space to place your thumb on, at the bottom the suction tubing is connected to prevent the solution from actually going down the throat...similar to suction equipment ...not a close system, but the open system.

lmpotter · May 24, 2005

Wendy,

Sage has a great product line and they also offer educational material with evidence based research and guidelines for protocols. Just go the their website at http://www.sageproducts.com Hope this is helpful.

Just wondering if anyone has an establised oral care protocol esp for vented pts...Trying to make some changes in our unit and lower VAP...Most nurses use the pink swabs.."Toothettes" and they don't really do well...Also wondering if anyone has any evidence based research on the subject..Thanks! :)

CC NRSE · May 24, 2005

actually, several of the hospitals I have worked have used the "oral protocol". This usually involves Peridex (a mixture of mouthwash and peroxide, also called cholrahexadine) every three hours. They did have evidence based studies that showed decreased hospital acquired pneumonia but I am not sure where they got the info.

Surgical Hrt RN · May 27, 2005

actually, several of the hospitals I have worked have used the "oral protocol". This usually involves Peridex (a mixture of mouthwash and peroxide, also called cholrahexadine) every three hours. They did have evidence based studies that showed decreased hospital acquired pneumonia but I am not sure where they got the info.

Peridex also decreases the chance of sternal infection and MRSA. It has many great uses! Another poster mentioned Sage products....I LOVE them. The Sage rep told us that oral needs to be done a minimum of every 4 hours, but 2 hours is ideal! It really decreases the incidence of VAP's.

bellehill, RN · May 29, 2005

We use Sage a minimum of q4h and whenever needed. I love it, the products are so easy to use.

hollyster · May 29, 2005

In our units mouth care is every two hours. We use a kit the has a soft toothbrush and two green swabs with peridex that connect directly to suction.

cbkrn · Jun 4, 2005

this year we started using sage toothettes with the suction attachment. they are more expensive but they come in a 24 hr package that has several different heads and a straw. they attached directly to suction. they work quite well for us.

heart queen · Jun 8, 2005

we too use the sage tooth brushes, which are more expensive than the green swabs. It comes in a kit, with a peroxide mix, that you break and the brush/swab is now wet. Per manufacturer recommendations, this is used to clean the mouth Q4 hrs. it is not only a tongue, but a tooth scrub wit a closed sealed suction that doesn't get drty in the bed, floor ect.

our VAP's have decreased 14% with only the oral kit and a refutable 35% with the addition of the hill rom pulmonary rotation /percussion beds.

Think of all your yankours laying on the floor :rolleyes: This kit has a sheath that protects it from that.

Utilize your clinical ladder folk to do an inhouse study if your manager hems and haws about the cost, but the literature is pretty sound from my look up's, it's the personall's lack of compliance, or faked compliance which sques the studies. our team taped 24 hrs. worth of supplies to the wall, mouth care was documented Q4hrs, yet there were remaining supplies.... an easy way to figure compliance ratios.

givadarn · Jun 28, 2005

My vote also goes to the Sage products... so easy to use, with the handy thin suction attachment to do deep suction once a shift down to the cuff of the ETT... lots of saliva and nasty stuff hangs out there and can give the patient the constant urge to cough. Can't do this deep suction to the cuff too often though, or else you'll traumatize those sensitive membranes at the back of the throat.

P.S. Also verifies gag reflex, much to the patient's dismay! (obviously, this long thin suction catheter is only for use on vented patients)