原始研究：口腔护理预防非呼吸机相关性医院获得性肺炎：一项四单元整群随机研究。
Original Research: Oral Care as Prevention for Nonventilator Hospital-Acquired Pneumonia: A Four-Unit Cluster Randomized Study.
机构信息
Karen K. Giuliano is an associate professor at the College of Nursing and the Institute for Applied Life Sciences, University of Massachusetts Amherst. Daleen Penoyer is the director of the Center for Nursing Research and Advanced Nursing Practice, Orlando Health, Orlando, FL. Aurea Middleton is the research coordinator for Orlando Health's Center for Nursing Research. Dian Baker is a professor at the School of Nursing, California State University, Sacramento. Financial support for this study was provided by Medline Industries (which supplied the kits used) and Orlando Health. Baker and Giuliano have also created a CE program on NV-HAP sponsored by Medline. An intervention toolkit is available from the authors. The authors acknowledge Joohyun Chung for her guidance and review of the statistical approach and analyses. Contact author: Karen K. Giuliano,
出版信息
Am J Nurs. 2021 Jun 1;121(6):24-33. doi: 10.1097/01.NAJ.0000753468.99321.93.
BACKGROUND
Nonventilator hospital-acquired pneumonia (NV-HAP) presents a serious and largely preventable threat to patient safety in U.S. hospitals. There is an emerging body of evidence on the effectiveness of oral care in preventing NV-HAP.
PURPOSE
The primary aim of this study was to determine the effectiveness of a universal, standardized oral care protocol in preventing NV-HAP in the acute care setting. The primary outcome measure was NV-HAP incidence per 1,000 patient-days.
METHODS
This 12-month study was conducted on four units at an 800-bed tertiary medical center. Patients on one medical and one surgical unit were randomly assigned to receive enhanced oral care (intervention units); patients on another medical and another surgical unit received usual oral care (control units).
RESULTS
Total enrollment was 8,709. For the medical control versus intervention units, oral care frequency increased from a mean of 0.95 to 2.25 times per day, and there was a significant 85% reduction in the NV-HAP incidence rate. The odds of developing NV-HAP were 7.1 times higher on the medical control versus intervention units, a significant finding. For the surgical control versus intervention units, oral care frequency increased from a mean of 1.18 to 2.02 times per day, with a 56% reduction in the NV-HAP incidence rate. The odds of developing NV-HAP were 1.6 times higher on the surgical control versus intervention units, although this result did not reach significance.
CONCLUSIONS
These findings add to the growing body of evidence that daily oral care as a means of primary source control may have a role in NV-HAP prevention. The implementation of effective strategies to ensure that such care is consistently provided warrants further study. It's not yet known what degree and frequency of oral care are required to effect favorable changes in the oral microbiome during acute care hospitalization.
背景
非呼吸机相关性医院获得性肺炎（NV-HAP）在美国医院对患者安全构成严重且在很大程度上可预防的威胁。目前有越来越多的证据表明口腔护理在预防 NV-HAP 方面的有效性。
目的
本研究的主要目的是确定通用标准化口腔护理方案在急性护理环境中预防 NV-HAP 的有效性。主要结局指标为每 1000 个患者日 NV-HAP 的发生率。
方法
这项为期 12 个月的研究在一家拥有 800 张床位的三级医疗中心的四个病房进行。一个内科和一个外科病房的患者被随机分配接受强化口腔护理（干预病房）；另一个内科和另一个外科病房的患者接受常规口腔护理（对照组）。
结果
总入组人数为 8709 人。对于内科对照组与干预组，口腔护理频率从平均每天 0.95 次增加到 2.25 次，NV-HAP 发生率显著降低 85%。与干预组相比，内科对照组发生 NV-HAP 的几率高 7.1 倍，这是一个显著的发现。对于外科对照组与干预组，口腔护理频率从平均每天 1.18 次增加到 2.02 次，NV-HAP 发生率降低 56%。与干预组相比，外科对照组发生 NV-HAP 的几率高 1.6 倍，尽管这一结果没有达到显著性水平。
结论
这些发现增加了越来越多的证据表明，作为主要源头控制手段的每日口腔护理可能在预防 NV-HAP 方面发挥作用。进一步研究实施有效的策略以确保始终提供这种护理是值得的。目前尚不清楚在急性住院期间，需要何种程度和频率的口腔护理才能使口腔微生物组发生有利的变化。
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