Awareness among intensive care nurses regarding oral care in critically ill patients

Oral health and general health are interdependent which influence each other through biological, psychological, emotional, and developmental factors. As patients in Intensive Care Unit (ICU) are completely dependent on the caregivers, the knowledge, attitude, and practices of the nurses influence the recovery of patients to a greater extent.

Unfortunately, oral health problems are usually overshadowed by other serious needs in critically ill patients. In addition, nursing staff appear to perceive oral health as the most difficult part of their work, hence been a low-priority intervention. Therefore, the aim of the study was to assess the knowledge, attitude, and practices of ICU nurses on oral care in critically ill patients.

A total of 200 nurses working in 21 different hospitals in Mysore, Karnataka, participated in the cross-sectional survey. The survey instrument included the demographic details, knowledge, attitude, and practice of oral care, complications in ICU due to lack of oral care, and educative programs attended.

Among the 200 ICU nurses, 67% had ICU experience of more than 5 years. About 94% were diploma candidates, 5% were graduates, and only 2% were postgraduates with a mean age of 27.5 years. All the participants were aware of the concept of focal infection theory and 93% knew about the potential complications associated with poor oral hygiene in ICU. About 95.5% of the nurses performed oral care after every shift change and used gauze soaked in chlorhexidine routinely. Nearly 76.5% of the participants stated mechanical obstruction as a main barrier toward oral care.

A variety of oral care practices exist for ventilated patients but, the majority of nurses used chlorhexidine with gauze. They failed to adhere to the latest evidence-based practice despite ranking oral care as a high priority. They need to be educated to improve clinical outcomes thereby reducing the hospital mortality and stay in ICU.