OralCareStateoftheScience-TheHealthcareAssociationofNew.pptVIP

Oral Care: State of the Science Vicki J. Spuhler RN MS Nurse Manager RICU LDS Hospital Ventilator Associated Pneumonia In the US nosocomial pneumonia ranks 2nd in morbidity and 1st in mortality among nosocomial infections. Adds 5-7 days to a hospital stay Occurs in 9-24% of patients who are on ventilators Reported mortality of 54-71% Impact of Oral Health Oropharyngeal colonization impacts Cardiovascular disease COPD Endocarditis Bacteremia Important risk factor for Ventilator Associated Pneumonia “Bacterial colonization of the oropharynx with S aureus, S pneumoniae, or gram-negative rods is positiviely associated with the occurance of nosocomial pneumonia” Saliva- What’s that got to do with it anyway? Role of Saliva Provides significant antimicrobial activity for the oropharynx Contains a variety of specific innate and specific immune components Saliva flow is stimulated by eating- chewing Unstimulated flow .25-.35 ml/min Stimulated flow increases 4-6 ml/ min Role of Saliva Decrease flow or lack of salivary secretion can lead to changes in oropharyngeal colonization Teeth become more adherent to bacteria Antimicrobial effects of saliva are absent Oropharyngeal colonization takes place Impact of ICU Environment Xerostomia- chronic dry mouth Reduces the mouths defense mechanism Cause by tubes that transverse the oral cavity Stress and anxiety reduces slaivary stimulation Dehydration Impact of ICU Environment Within 48 hours of hospital admission oropharyngeal flora of critically ill patients undergoes a change to predominantly gram negative organisms. High colonization of MRSA and Pseudomonas on dental plaque of patients in the ICU. A reduction of microorganisms in the mouth decreases the pool of organisms available for translocation to and colonization of the lungs. Improving Health Care Performance Know what works Use what works Do well what works Evidence in Literature Definitive scientific studies relating oral care interventions to VAP have not yet be