EVIDENCE BASED PRACTICE PROJECT: NUR 4169c

Evidence Based Practice Project: Oral Care and Prevention of Ventilator acquired Pneumonia
Mariam Hammed
University of South Florida
Date:
Introduction
The Project focuses on elderly patients in long-term care and how oral care affects their susceptibility to pneumonia within a period covering three to six months. Furthermore, the project will utilize evidence to show the impact of oral care versus patients not using daily oral care twice a day. The project hypothesizes that there will be change within the stipulated period, and evidence based research adds credibility to this. VAP is one of the major hospital acquired infections, and reducing the prevalence rates of VAP requires nursing intervention. Thus, this paper proposes to use oral care in preventing VAP among elderly patients, and integrating proposed changes in the health care setting, with results compared to cases where there is non intervention.
Infrastructure to support a change in the proposed setting
To achieve the targeted goal the project aims to look into changes that may affect the infrastructure and bring about the intended change for the patients. Thus, the setting needs to incorporate using toothbrushes in maintaining oral care, and this will involve recording and purchasing toothbrushes on a weekly basis with all medical staff being sensitized on how to use them. The need for isolation airborne rooms will be taken into account when designing extra care center areas, in accordance with the set health standards; this can be accompanied with extra sinks to facilitate better hygiene. Furthermore, there will be increased education of nurses on the role of good oral care, and this training should place emphasis on the patient’s role in reducing hospital-acquired infections.
Summary of synthesized literature review of best evidence
To carry out the research, it was necessary to consult electronic databases for literature review. Consequently, the research relied on material from PubMed, EBSCO and CINAHL. To narrow down the research terms, the research involved specific keywords including: oral health, oral hygiene, ventilator-associated pneumonia, and nosocomial pneumonia. Furthermore, due to limited knowledge of other languages, only those articles published in English were put into consideration. At the same time, the material had to be peer reviewed as well as being a recent publication. Thus, all the studies had to highlight on VAP for them to be considered as being relevant to the research. To further avoid credibility issues in the chosen materials, it was necessary to only consider peer-reviewed sources.
Synthesis
A review of related research supports the view that oral care is an important factor in reducing the prevalence of VAP. Labeau et al (2011) conducted randomized trials of oral care using chlorhexidine, which showed that it minimized the development of ventilator-associated pneumonia. In the study, the use of antiseptic was statistically significant having a P value of 0.004, and use of chlohexidine had a P value of 0.02 also being statistically significant. This view is supported by Andrea et al., (2011) who focus on reduction in VAP through decontamination. Nonetheless, too much dosage of this may be harmful to the patients because of browning of the teeth, but the intervention is also essential (Scannapeico, 2009). To compare results with the placebo group Scannapeico (2009) focused on mechanically ventilated patients through randomized trials of chlorhexidine. This intervention was then found to be effective in delaying the onset of VAP and a non significant reduction in VAP for the group using chlorhexidine at 95% CI: 0.23 to 1.25, P = 0.15.
Pablo et al., (2009) used a different approach highlighting on dental tooth brushing, starting with the hypothesis that electronic toothbrushes to improve oral care. Subsequently, the authors conducted a single-blind prospective randomized assessment using a standard oral care versus a standard oral care and electronic toothbrushes. The researchers found out that VAP mortality had fallen from 70% to 26.5% upon implementation of the oral health care program. Thus, all the studies conducted point out tat oral care is indeed a significant intervention strategy for mechanically ventilated patients. In particular, elderly patients have weaker immunity than the general population and more susceptible to hospital acquired infections, and hence using evidence based research highlights on the importance of oral care.
Proposed change in practice based on the evidence
Elderly people who are institutionalized are at higher risk of oral colonization than their non-institutionalized counterparts (El- Sohl, 2011).Consequently, it is essential to educate nurses through in service training, and particularly C.N.A through highlighting on the benefits of oral care. The Change in practice will incorporate brushing teeth and denture regularly for all elderly patients under care, as well as rinsing their mouths with mouthwash. Additionally, this will also incorporate using mouth swabs, for those patients who have difficulty taking care of themselves with regards to general hygiene and oral care. Although Snyder & Khondowe (2011) conducted systematic review, the review gives credence to nursing interventions. Hence, the education program to be implemented should also emphasize on the need to educate patients at least thrice a week focusing on the relationship between poor oral care and susceptibility to hospital acquired pneumonia. Soh et al., (2012) conducted a cross sectional survey on nurses and ward workers who indicated that oral care is important in preventing hospital acquired infections, with 56% of the respondents stating that they learned about oral care in basic training or during continuous programs.
Strategies to promote staff/team engagement
In every organization staff members have their own perceptions and o...