Ory Jérôme, Raybaud Evelyne, Chabanne Russell, Cosserant Bernard, Faure Jean Sébastien, Guérin Renaud, Calvet Laure, Pereira Bruno, Mourgues Charline, Guelon Dominique, Traore Ousmane
Hygiène Hospitalière, CHU Clermont-Ferrand, Clermont-Ferrand, France.
Réanimation Neurochirurgicale, CHU Clermont-Ferrand, Clermont-Ferrand, France.
Am J Infect Control. 2017 Mar 1;45(3):245-250. doi: 10.1016/j.ajic.2016.09.006. Epub 2016 Oct 27.
The quality of oral care is important in limiting the emergence of ventilator-associated pneumonia (VAP) in intubated patients. Our main objective was to measure the quality improvement in oral care following the implementation of a new oral care protocol. We also monitored VAP rates.
MATERIAL/METHODS: This was a cohort study of patients in 5 adult ICUs covering different specialties. During period 1, caregivers used a foam stick for oral care and during period 2 a stick and tooth brushing with aspiration. Oral chlorhexidine was used during both periods. The caregivers rated improvement in oral health on the basis of 4 criteria (tongue, mucous membranes, gingivae, and teeth). Caregiver satisfaction was also assessed. The incidence of VAP was monitored.
A total of 2,030 intubated patients admitted to intensive care units benefited from oral care. The patient populations during the 2 periods were similar with regard to demographic data and VAP potential risk factors. Oral health was significantly better from the third day of oral care in period 2 onward (period 1, 6.4 ± 2.1; period 2, 5.6 ± 1.8; P = .043). Caregivers found the period 2 protocol easier to implement and more effective. VAP rates decreased significantly between the 2 periods (period 1, 12.8%; period 2, 8.5%; P = .002).
Our study showed that the implementation of a simple strategy improved the quality of oral care of patients in intensive care units, and decreased VAP rates.
口腔护理质量对于限制插管患者呼吸机相关性肺炎（VAP）的发生至关重要。我们的主要目标是评估实施新的口腔护理方案后口腔护理质量的改善情况。我们还监测了VAP发生率。
材料/方法：这是一项针对5个不同专科的成人重症监护病房（ICU）患者的队列研究。在第1阶段，护理人员使用泡沫棒进行口腔护理；在第2阶段，使用棒状工具并配合刷牙及吸引操作。两个阶段均使用口腔洗必泰。护理人员根据4项标准（舌头、黏膜、牙龈和牙齿）对口腔健康改善情况进行评分。同时评估护理人员的满意度。监测VAP的发生率。
共有2030名入住重症监护病房的插管患者接受了口腔护理。两个阶段的患者群体在人口统计学数据和VAP潜在风险因素方面相似。从第2阶段口腔护理第3天起，口腔健康状况明显改善（第1阶段，6.4±2.1；第2阶段，5.6±1.8；P = 0.043）。护理人员发现第2阶段的方案更易于实施且更有效。两个阶段之间VAP发生率显著下降（第1阶段，12.8%；第2阶段，8.5%；P = 0.002）。
我们的研究表明，实施一项简单的策略可改善重症监护病房患者的口腔护理质量，并降低VAP发生率。
