Practice setting
I work at Integris Baptist in critical care as a monitor technician.
Clinical problem
We have had 4 patients in the past month who developed pneumonia within a week of being intubated.
PICO Question
Among adults who are intubated, is comprehensive oral care (chlorhexidine, tooth brushing, moisturizing gel) more effective than chlorhexidine alone in preventing ventilator-associated pneumonia?
P- Intubated adult
I – Oral care interventions
C – Prophylactic antibiotics
O – VAP
Reference: Provide the citation for the study in APA format. Include the DOI
Singh, P., Arshad, Z., Srivastava, V., Singh, G., & Gangwar, R. (2022) Efficacy of oral care protocols in the prevention of ventilator-associated pneumonia in mechanically ventilated patients. Cureus, 14(4). Artcile e23750. https://doi.org/10.7759/cureus.23750
Description: In your own words, describe the study in less than 200 words. Include study design, participants, intervention if there was one, and major conclusions. Description should be less than 200 words.
Singh et al. (2022) conducted a randomized control trial in India with 220 critically-ill patients receiving mechanical ventilation. No statistically significant differences were found in the demographic and clinical characteristics of the treatment and control groups at baseline. Routine oral care for intubated patients was the use of chlorhexidine in the oral cavity. In addition to the normal interventions used to prevent ventilator-associated pneumonia (VAP), the treatment group received toothbrushing and application of a mouth moisturizer. During the study, the frequency of oral care was determined by a standardized, scored oral assessment. Diagnosis of VAP was made based on fever, abnormal chest X-rays, and positive cultures of the endotracheal tube. The treatment group had lower prevalence of VAP, fewer days of mechanical ventilation, lower mortality, and shorter ICU stays. (129 words)
Strengths of the study (15 points)
The strengths of the study include the rigorous design with random assignment to groups, an adequate sample size, and a rigorous intervention. The study had no attrition.
Limitations of the study (15 points)
The study was conducted in one critical care unit in a different country. The researchers also noted that some patients were admitted from other hospitals and the care provided there was not known. Some of these patients may have received antibiotics. They also said that the diagnosis for VAP was non-invasive and thus possibly less accurate. The researchers did not discuss the fidelity of the intervention- was the intervention applied consistently with all patients in the treatment group.
How do you plan to use the study results in your practice? (15 points)
I plan to share the results of this study with the unit manager and one of the RNs I work with routinely. We already use chlorhexidine as part of the mouth care for intubated patients. Using the comprehensive oral care intervention would require additional nurse time and the purchase of toothbrushes, toothpaste, and moisturizer.
