Oral Care in the Intensive Care Unit (ICU) Essay -- Preventing Ventila

In clinical experience, it is seen that many patients in the Intensive Care Unit (ICU) are on mechanical ventilation. These patients range from having head trauma, heart surgery and respiratory problems yet there is no clear, concise systematic standard oral care procedures noted on the different floors in the hospital. Oral care is a basic nursing care activity that can provide relief, comfort and prevention of microbial growth yet is given low priority when compared to other critical practices in critically ill patients. The Center for Disease Control reveals that Ventilator-Associated Pneumonia (VAP) is the second most common nosocomial infection that affects approximately 27% of critically ill patients (Koeman, Van der Ven & Hak, 2006). The purpose of this paper is to explore Lewin’s change theory in the clinical setting by implementing standard oral care on preventing VAP thereby improving patient care. According to the American Association of Critical Care Nurses, Ventilator-associated Pneumonia results in high mortality rates, increases the number of mechanical ventilation days, increases the number of additional days in the hospital and critical care by 4-9days and costs approximately $40,000 per VAP case (Ames, Sulima, Yates, McCullagh, Gollins, Soeken, Wallen, 2011). Munro, Grap, Jones and McClish & Sessler conducted a study in 2009 which collected data on oral interventions reported by nurses, the frequency and the documentation and found that despite the evidence that sponge toothettes are ineffective in plaque removal it remained the primary tool for oral care in intubated patients whereas the use of toothbrushes were used more in non-intubated patients. It was also found that nurses reported frequent oral care, y... ...J., McCurren, C., Carrico, R. (2004) Factors Affecting Quality of Oral Care in Intensive Care Units. Journal of Advanced Nursing, 48(5), 454-462. Institure for Healthcare Improvement (2011). Implement the IHI Ventilator Bundle. Retrieved from http://www.ihi.org/knowledge/pages/changes/implementtheventilatorbundle.aspx. Koeman, M., Van der Ven, A., Hak, E. (2006). Oral Decontamination with Chlorhexidine Reduces the Incidence of Ventilator-associated Pneumonia. American Journal of Respiratory and Critical Care Medicine, 173, 1348-1355. Munro, C.L., Grap, M.J., Jones, D.J., McClish, D.K, Sessler, C.N. (2009). Chlorhexidine, toothbrushing and preventing Ventilator Associated Pneumonia in Critically Ill Patients. American Journal of Critical Care, 18(5), 428-437. Yoder-Wise, P. S. (2010). Leading and managing in nursing. Philadelphia, PA: Mosby, Inc.