South East Critical Care Network, Kent, UK.
East Kent Hospitals University NHS Foundation Trust, UK.
Nurs Crit Care. 2021 Jul;26(4):224-233. doi: 10.1111/nicc.12570. Epub 2020 Oct 29.
Patients who are critically ill are at increased risk of hospital acquired pneumonia and ventilator associated pneumonia. Effective evidence based oral care may reduce the incidence of such iatrogenic infection.
To provide an evidence-based British Association of Critical Care Nurses endorsed consensus paper for best practice relating to implementing oral care, with the intention of promoting patient comfort and reducing hospital acquired pneumonia and ventilator associated pneumonia in critically ill patients.
A nominal group technique was adopted. A consensus committee of adult critical care nursing experts from the United Kingdom met in 2018 to evaluate and review the literature relating to oral care, its application in reducing pneumonia in critically ill adults and to make recommendations for practice. An elected national board member for the British Association of Critical Care Nurses chaired the round table discussion.
The committee focused on 5 aspects of oral care practice relating to critically ill adult patients. The evidence was evaluated for each practice within the context of reducing pneumonia in the mechanically ventilated patient or pneumonia in the non-ventilated patient. The five practices included the frequency for oral care; tools for oral care; oral care technique; solutions used and oral care in the non-ventilated patient who is critically ill and is at risk of aspiration. The group searched the best available evidence and evaluated this using the Grading of Recommendations Assessment, Development, and Evaluation system to assess the quality of evidence from high to very low, and to formulate recommendations as strong, moderate, weak, or best practice consensus statement when applicable.
The consensus group generated recommendations, delineating an approach to best practice for oral care in critically ill adult patients. Recommendations included guidance for frequency and procedure for oral assessment, toothbrushing, and moisturising the mouth. Evidence on the use of chlorhexidine is not consistent and caution is advised with its routine use.
Oral care is an important part of the care of critically ill patients, both ventilated and non-ventilated. An effective oral care programme reduces the incidence of pneumonia and promotes patient comfort.
Effective oral care is integral to safe patient care in critical care.
危重症患者发生医院获得性肺炎和呼吸机相关性肺炎的风险增加。有效的循证口腔护理可能会降低此类医源性感染的发生率。
提供一份经过英国重症监护护理协会认可的循证共识文件，说明实施口腔护理的最佳实践，旨在促进患者舒适度并降低重症患者的医院获得性肺炎和呼吸机相关性肺炎的发生率。
采用名义群体技术。2018 年，来自英国的成人重症护理护理专家共识委员会开会，评估和审查与口腔护理相关的文献，评估其在降低成人重症患者肺炎中的应用，并提出实践建议。英国重症监护护理协会的一名全国委员会成员担任圆桌讨论的主席。
委员会重点关注与重症成人患者口腔护理实践相关的 5 个方面。在机械通气患者或非通气患者肺炎减少的背景下，评估了每种实践的证据。这 5 项实践包括口腔护理的频率；口腔护理工具；口腔护理技术；使用的溶液和有发生误吸风险的非机械通气的危重症患者的口腔护理。该小组搜索了最佳可用证据，并使用推荐评估、制定与评价系统对其进行评估，以评估证据质量，从高到极低，并在适用时制定强、中、弱或最佳实践共识声明的建议。
共识小组提出了建议，为重症成人患者的口腔护理制定了最佳实践方法。建议包括口腔评估、刷牙和口腔保湿的频率和程序指南。关于洗必泰使用的证据并不一致，因此建议谨慎使用。
口腔护理是重症患者（包括通气和非通气患者）护理的重要组成部分。有效的口腔护理方案可降低肺炎的发生率并促进患者舒适度。
有效的口腔护理是重症护理安全患者护理的重要组成部分。
