[Oral care practice and procedures in intubated patients: an observational study]

Effective oral care improves patient comfort and prevents oral infection. While common in general nursing practice, administering oral care to intubated patients is particularly challenging.

This study investigated practices and factors associated with oral care of intubated patients in intensive care units (ICUs).

This study used a cross-sectional design and recruited nurses using purposive sampling. Data were collected with a structured observational checklist between January and April 2008 at a medical center in northern Taiwan. Observational data reflected oral care procedures performed by thirty-one ICU nurses on intubated patients in six ICUs.

Cotton and foam swabs were found to be the main oral care cleaning instruments used with intubated patients, with dilute mouthwash the primary cleaning solution. Nearly three-quarters (72.4%) of participants were found to employ proper oral care procedures. Participants selected different cleaning equipment, cleaning solutions, cleaning solution usage methods and oral endotracheal tube securement methods based on differing conditions. ICU nurse age was positively associated oral care completeness. The level of oral care completeness achieved by participants in medical ICUs was significantly higher those assigned to surgical ICUs.

Study findings showed that ICU nurses did not follow procedures and steps recommended by current evidence-based practice (e.g., brushing the teeth and gums; positioning patients in a side or semi- / high-fowlers position when providing oral care to intubated patients). ICUs must establish policies and procedures for oral care of intubated patients that reflect patient characteristics. Furthermore, ICUs should provide oral care related on-the-job training and education in order to improve the quality of oral care administered to critical care patients.