INTRODUCTION Nosocomial infections are those infections acquired by a patient in the hospital or health care environment during his stay. Nosocomial infections occur due to various factors like fomites, improper hand washing, not changing the gloves from patient to patient, and contamination of respiratory devices like nebulizers, Spiro meters, oxygen sensors, bag-valve mask devices, and suction catheters (Shelby Hixson, 1998). The most common bacterial pathogen encountered in hospital environment is P. aeruginosa.
Oral hygiene is often neglected in intubated patients especially in ICU. Oral care includes brushing the patient’s teeth, use of solutions and mouthwash to cleanse the mouth, and periodical suctioning of oral secretions. Ventilator-Associated Pneumonia is a common nosocomial infection in the ICU accounting for 13% to 18% of all nosocomial infections. Critically ill patients supported by mechanical ventilation are especially vulnerable to ventilator-associated pneumonia, leading to increased mortality and morbidity and prolonged hospital stay.
Because of intubations, bacteria have direct access to the lower airways and the endotracheal tube allowing them to bypasses normal filtration mechanisms and the epiglottis . The endotracheal tube serves as a route for inoculation of the bacteria such as P. aeruginosa. Infection due to intubation affects and alters the natural host mechanisms by reducing the cough effort, interfering the mucociliary clearance, and damaging the epithelial layer exposing the basement membrane allowing bacterial colonization.
Intubation also results in increased mucus production to trap bacteria, which results in accumulation of mucus in the respiratory tract. Proper hand washing, use of fresh gloves when suctioning patients orally or through the endotracheal tube helps in reducing such infections. (American Thoracic Society,1998). Streptococcal pharyngitis is another important infection that occurs due to improper oral care. Various Streptococcal species have been identified that are capable of causing oral infections apart from Streptococcal pyogenes.
Such infections also give rise to secondary, cross and opportunistic infections due to the poor immune status of the patient. Oral care, thus promotes well being of the patient. IMPLICATIONS IN NURSE CARE Dorothea Orem (1971) defined nursing with emphasis on client’s self-care needs. Self-care, according to the theory, is a learned, goal-oriented activity directed towards the self in the interest of maintaining life, health, development and well-being. The ultimate emphasis of Orem’s theory is on client’s self care.
Accordingly, nursing care is needed when the client is unable to fulfill biological, psychological, developmental or social needs and the nurse determines by duty why a client is unable to meet the needs or what must be done to enable the client to meet them. Thus, Orem defines the goal of nursing as to increase the client’s ability to independently meet their needs i. e. , the self care of the client. Nursing care especially, Intensive Care Unit (ICU) nursing commonly referred to as critical care nursing deals specifically with the human response to life threatening conditions.
Critical care nursing is challenging due to the nature of life-threatening health situations in the ICU. Critical care nursing demands complex assessments, high-intensity therapies and interventions and continuous vigilance based on evidence-based practice. Oral care in such situations can save the nurse from a lot of stressful events like respiratory distress especially with patients with cardiac complications and acute exacerbations like COPD complications of Atelectasis and Cor pulmonale who have been found to be susceptible to bacterial endocarditits.
REFERENCE • American Thoracic Society, “Research Priorities in Respiratory Nursing”, Am. J. Respir. Crit. Care Med. , Volume 158, Number 6, 2006-2015. December 1998 • Shelby Hixson, Tracey King, Nursing Strategies to Prevent Ventilator-Associated Pneumonia, “AACN Clinical Issues: Advanced Practice in Acute and Critical Care, Vol 9, No 1. Feb 1998.