Nurse driven Synthesis Assignment

Synthesis Assignment
Name
Institution
Abstract
Nurse driven interventions to improve oral care and reduce hospital-acquired infections are important topics to nurses. Statistics from recent publications reveals that 10 to 30 percent of patients suffer from a hospital-acquired infection (associated with oral care). It is notable that multiple studies have proved that quality oral care can reduce the spread of hospital-acquired infections in oral care. This is the foundation of this paper because it examines recent publications on oral care with an objective of providing an evidence-based solution to nursing homes. Recent studies were analyzed for evidence-based solutions on the subject of oral care. As a result, the search was limited to academic databases such as PubMed, EBSCO, and CINAHL. It was also limited to publications in English because of a limited understanding of other languages.
Since the paper aimed to focus on the subject of Hospital-acquired oral infection, the keywords used to search for available literature on the topic were related to the topic. It follows that "oral health, oral hygiene, ventilator-associated pneumonia, and nosocomial pneumonia" were the keywords used for this paper. This paper analyzes three recent publications on hospital-acquired oral infections using a systematic review and meta-analysis as a guideline. To be specific, studies completed by Andrea et al., (2011), Scannapieco et al., (2009), and Pobo et al., (2009) were essential sources of information. All the three publications revealed that the use chlorhexidine gluconate is the best available remedy to the problem of hospital-acquired infections in oral care. It follows that this paper advocates for nursing homes to hire certified nursing assistants with adequate knowledge on the use of chlorhexidine gluconate to maintain oral hygiene in nursing homes.
Introduction
The topic of nurse driven interventions to reduce hospital-acquired infections on oral care is attracting a lot of attention from scholars and practitioners in the nursing industry. This owes to the reality that authors such as Andrea et al., (2011), Scannapieco et al., (2009), and Pobo et al., (2009) made randomized clinical trials on ventilator-associated Pneumonia. What is ventilator associated pneumonia? Labeau (2011) defines ventilator-associated pneumonia (VAP) as pneumonia in persons with a device to constantly control or aid in respiration via endotracheal intubation or tracheostomy within 48 hours prior to the onset of the infection, including the weaning period. The fact that multiple publications are present on the topic reveals that hospital-acquired-infections on oral care call for evidence-based care to patients.
Recent statistics reveals that this type of pneumonia affects 10 to 30 percent of mechanically ventilated patients. In fact, it is one of the recurrent "nosocomial infections in intensive care units" (Labeau et al., 2011). Pobo et al., (2009) further reveals that pneumonia is the second leading source of nosocomial infections because it accounts for 15 percent of the infections acquired from hospitals. Consequently, several remedies have been suggested to aid in the prevention of VAP. One of the common remedies is the use of antiseptics such as the chlorhexidine gluconate (CHX). In a different study, Pobo (2009) examined the use of dental brushing in preventing VAP. This paper examines available literature on the use of nurse driven interventions to reduce hospital-acquired infections in oral care by focusing on ventilator-associated Pneumonia.
Literature Search
Electronic databases acted as essential tools when searching for the relevant literature on the subject. This is highlighted by the fact that PubMed, EBSCO, and CINAHL were the only sources of literature in this paper. These sources were searched for keywords that were relevant to the topic under discussion. To be specific, the main keywords for used in the literature search were "oral health, oral hygiene, ventilator-associated pneumonia, and nosocomial pneumonia. The search was limited to English publications due to a limited understanding of other languages. In addition, the search was restricted to publications made within the last four years (from 2009 to 2013). The literature was narrowed to studies that met a predetermined inclusion criterion. It follows that all the studies that failed to discuss VAP were excluded from the study in order to focus on the aforementioned topic. It is significant to identify that the literature search was limited to peer reviewed sources owing to their credibility.
Literature Review
Pobo et al., (2009) completed a randomized clinical trial called "A Randomized Trial of Dental Brushing for Preventing Ventilator-Associated Pneumonia". From table 1 the study used a hypothesis, which stated that using electronic toothbrushes to improve oral care might aid in the reduction of VAP. The authors conducted a single-blind prospective randomized assessment of standard oral care using 0.12 percent chlorhexidne digluconate against the standard oral care and an additional use of electric toothbrushes. It is also crucial to point out that the main measurements used in the study were time in hours and temperature in degree Celsius. From table 1 a sample size of 200 patients was calculated using a 50% target for the reduction VAP based on a 20 percent standard rate. By the end of the study, it was established that the hospital ICU rate of mortality was 26.5 percent. This meant that there was no variance between the toothbrush group (21.6 percent) and the standard group (31.5 percent). It is evident that the study had strength of being objective owing to the reality that the authors reported the outcome devoid of becoming unbiased. However, the study used an optimistic sample size, did not rule out subjective differences, and was a single-centered study (weakness).
Scannapieco et al., (2009), also made a "randomized trial of chlorhexidine (CHX) gluconate on oral bacterial pathogens in mechanically ventilated patients". The objective for the study was to define the minimal occurrence of oral CHX use compared with placebo, which significantly lessens oral colonization. This study was limited to mechanically ventilated patients after approval from the University of Buffalo Institutional Review Board. From table 1 a sample size of 53 participants in every team was used because it was approximated that 50 percent of subjects admitted would be colonized by respiratory bacterial pathogens. From table 1 the study used methods such as the exclusion of patients who could not complete the study, used a trial design, CHX formulation, oral examination, and statistical tools. Time was the essential measurement for the study where the time spent in the ICU had to exceed 48 hours. Ultimately, the study revealed that the onset of pneumonia appeared to delay in treated categories when compared to the control group, but with statistically insignificant results. What were the strengths and weaknesses of the study? The strengths of the study are; it was randomized, well controlled, used a block design, blinded and well concealed. A major weakness for this study was the use of a sample size that resulted in statistically insignificant results.
Andrea et al., (2011) also conducted a randomized placebo-controlled trial with an objective of evaluating the impact of "oral hygiene with 0.12 percent chlorhexidine gluconate on the incidence of VAP and nosocomial pneumonia in children undergoing surgery". The authors used distinct methods that were randomized, prospective, placebo-controlled, and double-blind. The study also acquired written consents from the Institutional Research Ethics Board and the children`s parents. It is crucial to point out that the authors used one hundred and sixty children who were randomized into 87 children for the chlorhexidine group and 73 children for the control group. The rudimentary measure for the study was time where the time taken for the development of nosocomial pneumonia was measured in days. It was also used to measure the time for administering prophylactic antibiotics to patients (which was 48 hours). The main result for the study revealed that oral hygiene using chlorhexidine with 0.12 percent pneumonia did not lessen the incidence of nosocomial pneumonia in children under surgery. The main weakness for this study was the absence of teeth in children used for the study while its ...