Assessment of Nursing Staff's Knowledge, Attitude and Practice Regarding Oral Hygiene Care in Intensive Care Unit Patients: A Multicenter Cross-sectional Study
Keywords :
Critically ill, Intensive care unit, Nurses knowledge, Oral care, Oral hygiene, Ventilator-associated pneumonia
Citation Information :
Kumar S, Singh B, Mahuli AV, Kumar S, Jha AK. Assessment of Nursing Staff's Knowledge, Attitude and Practice Regarding Oral Hygiene Care in Intensive Care Unit Patients: A Multicenter Cross-sectional Study. Indian J Crit Care Med 2024; 28 (1):48-57.
Background: Oral care is one of the fundamental nursing care procedures used to decrease oral colonization, dental plaque, respiratory infections, patient stay, and cost. The importance of good oral hygiene for patients in intensive care units (ICUs) is well recognized, however, the most effective way to achieve good oral care in the ICU is unclear. Therefore, the aim of this study was to assess the knowledge, attitude, and practice of nursing professionals regarding oral healthcare in ICUs among various medical institutes across India.
Materials and methods: A questionnaire-based multicentric cross-sectional survey was conducted among registered nursing professionals employed at ICUs of three government tertiary healthcare centers (THC) of India: THC-I, THC-II, and THC-III located in the eastern and northern parts of India between February 2022 and July 2022.
Results: A total of 150 nurses completed the questionnaire form (response rate: 62.5%) comprised of 49 (32.7%) males and 101 (67.3%) females with a mean age of 35.69 ± 7.7 years. Nursing officers’ knowledge surpassed that of staff nurses regarding the duration of toothbrushing (p = 0.033). Among interinstitutional comparisons, THC-I nurses showed the greatest knowledge regarding the duration of toothbrushing and the mechanism of preventing saliva accumulation to reduce microbial growth (p = 0.013 and p = 0.003, respectively). Based on total work experience, participants were segregated into three groups: Group I (<7 years), group II (7.1–13.9 years), and group III (>14 years). Group II surpassed the knowledge of denture removal during sleep, cleaning after every meal, and storing in personalized air-tight containers (p = 0.001 and p = 0.036, respectively). The majority from group II recommended plain saline as the material for oral hygiene maintenance in ICU patients (p = 0.008). Group III predominantly practiced the ideal handwashing technique pre- and post-patient contact which was statistically significant (p = 0.001).
Conclusion: This study observed that a knowledge gap exists among the nurses of the three institutes across India pertaining to the oral hygiene care of ICU patients. Nurse's education and implementation of the proper oral hygiene measures for intubated patients in ICU setup is an essential need.
Furr LA, Binkley CJ, McCurren C, Carrico R. Factors affecting quality of oral care in intensive care units. J Adv Nurs 2004;48(5):454–462. DOI: 10.1111/j.1365-2648.2004.03228.x.
Loesche WJ. Association of the oral flora with important medical diseases. Curr Opin Periodontol 1997;4:21–28. PMID: 9655017.
Li X, Kolltveit KM, Tronstad L, Olsen I. Systemic diseases caused by oral infection. Clin Microbiol Rev 2000;13(4):547–558. DOI: 10.1128/CMR.13.4.547.
Scannapieco FA, Stewart EM, Mylotte JM. Colonization of dental plaque by respiratory pathogens in medical intensive care patients. Crit Care Med 1992;20(6):740–745. DOI: 10.1097/00003246-199206000-00007.
Berry AM, Davidson PM, Masters J, Rolls K. Systematic literature review of oral hygiene practices for intensive care patients receiving mechanical ventilation. Am J Crit Care 2007;16(6):552–562; quiz 563. PMID: 17962500.
Faragalla AI, Almaki EJ, Asiri HA. Knowledge, attitude and practice of nurses to oral health care for hospitalized patients in Abha city—Saudi Arabia. Acta Scientific Dental Sci 2018;2(5):16–23. Available from: https://actascientific.com/ASDS/pdf/ASDS-02-0115.pdf.
Ibrahim SM, Mudawi AM, Omer O. Nurses’ knowledge, attitude and practice of oral care for intensive care unit patients. Open J Stomatol 2015;5(7):179–186. DOI: 10.4236/ojst.2015.57023.
Javadinia SA, Kuchi Z, Saadatju A, Tabasi M, Adib–Hajbaghery M. Oral care in trauma patients admitted to the ICU: Viewpoints of ICU nurses. Trauma Mon 2014;19(2):e15110. DOI: 10.5812/traumamon.15110.
Cherian S, Karkada S. Effect of education related to oral care practices on nurses’ knowledge, practice and clinical outcomes of mechanically ventilated patients in Dubai. Int J Nurs Res 2015;2(1):9–14. Available from: https://www.researchgate.net/publication/280561131_Effect_of_education_related_to_oral_care_practices_on_nurses'_knowledge_practice_and_clinical_outcomes_of_mechanically_ventilated_patients_in_Dubai.
da Silva Rodrigues S, Caminha MD, Ferraz MG, de Arruda MA, da Rocha Kozmhinshy VM, de Moraes Guerra CA, et al. Knowledge, attitude and practice of the nursing team regarding oral health care in intensive care units in a reference hospital of Recife, Brazil. Pesqui Bras Odontopediatria Clin Integr 2016;16(1):129–139. DOI: 10.4034/PBOCI.2016.161.14.
Vilela MCN, Ferreira GZ, da Silva Santos PS, de Rezende NPM. Oral care and nosocomial pneumonia: A systematic review. Einstein (Sao Paulo) 2015;13(2):290–296. DOI: 10.1590/S1679-45082015RW2980.
Munro CL, Grap MJ, Jones DJ, McClish DK, Sessler CN. Chlorhexidine, toothbrushing, and preventing ventilator-associated pneumonia in critically ill adults. Am J Crit Care 2009;18(5):428–437; quiz 438. DOI: 10.4037/ajcc2009792.
DeKeyser Ganz F, Fink NF, Raanan O, Asher M, Bruttin M, Nun MB, et al. ICU nurses’ oral-care practices and the current best evidence. J Nurs Scholarsh 2009;41(2):132–138. DOI: 10.1111/j.1547-5069.2009.01264.x.
Pedreira ML, Kusahara DM, de Carvalho WB, Núñez SC, Peterlini MA. Oral care interventions and oropharyngeal colonization in children receiving mechanical ventilation. Am J Crit Care 2009;18(4):319–328; quiz 329. DOI: 10.4037/ajcc2009121.
Fields LB. Oral care intervention to reduce incidence of ventilator-associated pneumonia in the neurologic intensive care unit. J Neurosci Nurs 2008;40(5):291–298. DOI: 10.1097/01376517-200810000-00007.
Hajibagheri A, Fini IA. Mouth care in patients receiving mechanical ventilation: A systematic review. Nurs Midwifery Stud 2012;1(2):51–61. DOI: 10.5812/nms.8543.
Adib-Hajbaghery M, Ansari A, Azizi–Fini I. Intensive care nurses’ opinions and practice for oral care of mechanically ventilated patients. Indian J Crit Care Med 2013;17(1):23–27. DOI: 10.4103/0972-5229.112154.
Wei X, Jing M, Zhang X, Li C, Li L. Nurses’ practice and educational needs in oral care for postoperative patients with oral cancer in ICUs: A multicenter cross-sectional study. BMC Oral Health 2022;22(1):389. DOI: 10.1186/s12903-022-02426-5.
Zhang TT, Tang SS, Fu LJ. The effectiveness of different concentrations of chlorhexidine for prevention of ventilator-associated pneumonia: A meta-analysis. J Clin Nurs 2014;23(11–12):1461–1475. DOI: 10.1111/jocn.12312.
Zhao T, Wu X, Zhang Q, Li C, Worthington HV, Hua F. Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. Cochrane Database Syst Rev 2020;12(12):CD008367. DOI: 10.1002/14651858.CD008367.pub4.
Dale CM, Rose L, Carbone S, Smith OM, Burry L, Fan E, et al. Protocol for a multi-centered, stepped wedge, cluster randomized controlled trial of the de-adoption of oral chlorhexidine prophylaxis and implementation of an oral care bundle for mechanically ventilated critically ill patients: The CHORAL study. Trials 2019;20(1):603. DOI: 10.1186/s13063-019-3673-0.
Gu WJ, Gong YZ, Pan L, Ni YX, Liu JC. Impact of oral care with versus without toothbrushing on the prevention of ventilator-associated pneumonia: A systematic review and meta-analysis of randomized controlled trials. Crit Care 2012;16(5):R190. DOI: 10.1186/cc11675.
Yao LY, Chang CK, Maa SH, Wang C, Chen CC. Brushing teeth with purified water to reduce ventilator-associated pneumonia. J Nurs Res 2011;19(4):289–297. DOI: 10.1097/JNR.0b013e318236d05f.
Lorente L, Lecuona M, Jiménez A, Palmero S, Pastor E, Lafuente N, et al. Ventilator-associated pneumonia with or without toothbrushing: A randomized controlled trial. Eur J Clin Microbiol Infect Dis 2012;31(10):2621–2629. DOI: 10.1007/s10096-012-1605-y.
Robinson PG, Deacon SA, Deery C, Heanue M, Walmsley AD, Worthington HV, et al. Manual versus powered toothbrushing for oral health. Cochrane Database Syst Rev 2005;(2):CD002281. DOI: 10.1002/14651858.CD002281.pub2. Update in: Cochrane Database Syst Rev. 2014;6:CD002281. DOI: 10.1002/14651858.CD002281.pub2..
Khezri HD, Zeydi AE, Firouzian A, Baradari AG, Mahmoodi G, Kiabi FH, et al. The importance of oral hygiene in prevention of ventilator-associated pneumonia (VAP): A literature review. Int J Caring Sci 2014;7(1):12–23. Available from: http://internationaljournalofcaringsciences.org/docs/3.%20Darvishi-i-1.pdf.
Tablan OC, Anderson LJ, Besser R, Bridges C, Hajjeh R; CDC; Healthcare Infection Control Practices Advisory Committee. Guidelines for preventing health-care-associated pneumonia, 2003: Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep 2004;53(RR-3):1–36. PMID: 15048056.
Scannapieco FA, Wang B, Shiau HJ. Oral bacteria and respiratory infection: Effects on respiratory pathogen adhesion and epithelial cell proinflammatory cytokine production. Ann Periodontol 2001;6(1):78–86. DOI: 10.1902/annals.2001.6.1.78.
Miranda AF, de Paula RM, de Castro Piau CG, Costa PP, Bezerra AC. Oral care practices for patients in Intensive Care Units: A pilot survey. Indian J Crit Care Med 2016;20(5):267–273. DOI: 10.4103/0972-5229.182203.
Jablonski RA, Munro CL, Grap MJ, Schubert CM, Ligon M, Spigelmyer P. Mouth care in nursing homes: Knowledge, beliefs, and practices of nursing assistants. Geriatr Nurs 2009;30(2):99–107. DOI: 10.1016/j.gerinurse.2008.06.010.
Preston AJ, Punekar S, Gosney MA. Oral care of elderly patients: Nurses’ knowledge and views. Postgrad Med J 2000;76(892):89–91. DOI: 10.1136/pmj.76.892.89.