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The Adequacy Of Oral Care Performed For Critically-ill Patients In Intensive Care Units

Updated: May 14

A Thesis Submitted in Partial Fulfillment of the Requirements for the Degree of Master of Science in Dental Hygiene Education Bridgeport, Connecticut 2012.
Copyright 2012 by B. Michelle Strange, RDH, BHS

A Thesis Submitted in Partial Fulfillment of the Requirements for the Degree of Master of Science in Dental Hygiene Education Bridgeport, Connecticut 2012.


The goal of this study was to investigate the quality of oral care in hospitalized patients leading to the promotion of oral healthcare in the Charleston area. Oral care is a necessary procedure to maintain the patient’s oral health and to prevent infections. The importance for all professionals working within the two health professions to understand and to practice the discoveries from evidence-based research is crucial to improved patient care. By healthcare professionals controlling oral bacteria, the patient may exhibit fewer nosocomial infections, which can develop from aggressive types of bacteria that can be found in the mouth. It is the intention of this study to examine the oral care techniques performed by healthcare professionals and to what extent oral health education is being taught in nursing education programs, based on the standard of care stated by the American Association of Critical-Care Nurses (AACN). This study also may identify the need for positions for dental hygienists who are interested in branching out of private clinical practice and entering hospitals, nursing homes and assisted living facilities. Specifically, this research study examined: 1) the proportion of healthcare professionals at one local hospital’s ICU that are performing oral care practices that meet the standards of care recommended by the AACN, 2) if the documentation of one local hospital’s ICU policy and procedure manual meets the recommendations from the AACN and 3) if the three local nursing programs education criteria, specifically the syllabus and textbooks, follow the recommendations from the AACN.

The University of Bridgeport’s Institutional Review Board granted permission for this research topic “Adequacy of oral care performed on critically-ill patients in the ICU’s.” This study used survey to obtain information on current oral healthcare practices and on attitudes regarding oral care from registered nurses and any healthcare professional at that care for critically-ill hospitalized patients in the ICU. The results were reported as descriptive statistics. Policy and procedures manuals for MUSC’s ICU’s with stated oral care protocol were obtained and compared to the standard of care stated by the AACN. Curricula, specifically syllabi and textbooks, incorporating oral care for critically ill patients and taught in nursing education programs were reviewed.

Survey results found that health professionals at in the 6 ICU’s that were surveyed are mostly following the recommendations from the AACN. However, non-responder bias and the survey’s low return rate of 26% does not give a complete understanding of the adequacy of oral care procedures being performed on critically-ill patients. Other findings from the survey found that nurses do not feel a need to have a dental hygienist within their units. However, they also do not feel comfortable identifying abnormalities in the mouth and find the oral cavity at times difficult and unpleasant to clean. It is possible, due to fear of job security and a misunderstanding of the purpose for incorporating a dental hygienist into the ICU, participants answered with a negative opinion of bringing another health professional such as a dental hygienist into the hospital. The policy and procedure manual that was examined did follow the recommendations from the AACN very closely. It would be recommended, though, to further investigate when the oral care procedures within the policy and procedure manual are taught. If it is during the new hire’s orientation, then having a dental hygienist present to explain the connection of oral health to overall health in a critically-ill patient may be advantageous. Nursing education program’s syllabi were lacking regarding oral care procedures for critically-ill patients. Textbooks used to teach oral care procedures have minimal recommendations for critically-ill patients. Though, it is more difficult to have the most current evidence-based research in textbooks, the syllabus within programs could be updated more frequently. Also, because the syllabus and textbooks for each program were looked at and not the lectures or teachings during clinical rotations, further research to investigate if oral care is taught during these times would be beneficial. Though, educators were happy to help with providing the textbooks and syllabus for their programs for this research project, verbal discussions did not provide positive attitudes regarding incorporating a dental hygienist to help teach oral care procedures. Integrating interdisciplinary collaboration within the hospital setting and educational settings may prove to be more difficult and will need to have more research to show its benefits for the standard of care provided to critically-ill patients.

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