Oral Care Intervention on Reducing Pneumonia - Literature review Example

Research Synthesis on the Oral Care Intervention on Reducing Pneumonia Reason and Purpose for Review In the recent decade, oral care interventions have been found to help reduce the incidence of pneumonia. However, up to now, many stakeholders observed that no data have yet been published from large, well-controlled clinical trials of oral care interventions in critical care patients. There are limited clinical reports of infection rates before and after changes in oral care procedures. The role of oral care in reducing nosocomial pneumonia is yet clearly established by previous researches conducted. Hence, a review of the available literature will be conducted to synthesize recent researches on the impacts of providing oral care intervention to patients suffering from pneumonia. It is aimed that after a conduct of thorough review of the recent advances in oral care interventions in the reduction of pneumonia, consolidated findings will lead to conclusive evidences of the effects of oral care intervention on minimizing the occurrence of pneumonia. Search and Review Process Used Search and review process is the strategy used to select documents. In this study, only the relevant and recent ones will be used for review. For a literature to be considered relevant, it has to have direct bearing on the problem/issue. For a literature to be considered current, it has to be published from the year 2004 onwards. Tabulated meta-analysis of the six literatures was conducted. In this way, ease in the comparison was successfully achieved. The literatures were efficiently synthesized since tabulated information can easily be compared and contrasted. Likewise, in the matrix form, all significant items can be completely filled up and analyzed. Critical Analysis Reliability To determine the reliability of the peer-reviewed researches, studies and meta-analysis, six literatures were selected and analyzed. Selection standards are based on the criteria of being the most recent and most relevant literatures. The information and data quality of each of the literatures were assessed. The content type of each literature indicates the reliability of the literatures. The large samples from sixty-six patients in the study by Munro, et al. (2006) gave rise to reliable results. This same is true with the paper by Pesola (2004) on the ventilator-associated pneumonia in institutionalized elders which makes use of big samples of literatures which makes this study reliable. Reliability of the research conducted by El-Solh, et al. (2004) was brought about by the efficiency of the molecular genotyping conducted by the researches. On the orther hand, the meta-analysis by Pineda, et al. (2006) on the effect of oral decontamination with chlorhexidine on the incidence of nosocomial pneumonia makes use of randomized controlled trials, inferences can be generated about whether incidence of pneumonia dropped after oral decontamination with chlorhexidine. The large samples used in this study makes findings reliable. Ohrui (2005) suggests preventive strategies for aspiration pneumonia in disabled persons as a result of his where nothing can be inferred about whether provision of oral care result to decrease incidence of pneumonia. The degree of Rate of Incidence of pneumonia was not mentioned, hence, reliability is low. The same can be said on the case of Varela (2006) in his paper on the help of oral care in preventing pneumonia. This was a cross sectional study where nothing can be inferred yet about whether provision of oral care dropped pneumonia incidence. Specific indicator on the reduced incidence of pneumonia was not clear. Degree of decrease in pneumonia incidence is not clear. All of these, aside from the fact that small sample was used, makes the findings of Varela (2006) not very reliable. Validity The construct and content of each of the literature indicates validity of the studies. Each study was reviewed in terms of its quality and contribution to knowledge regarding oral care intervention on reducing pneumonia. The findings presented confirmed the validity of each. With regard to analysis of each literature, there are evidences found that support their validity. The observational studies demonstrated good external and internal validity. Scientific Rigor The meta-analysis of Munro et al. (2006) provide scientific evidences. These authors were able to provide explanation on how microbial pathogens actually thrives in the dental plaque, translocated to the lung and eventually colonized it. This may lead to occurrence of ventilator-associated pneumonia. Most researches in oral care, according to Munro et al. (2006), have been directed toward patients’ comfort. Pesola (2004) is another author who conducted a meta-analysis of existing literatures on the ventilator-associated pneumonia in institutionalized elders. Pesola’s paper is in particularly based on the works of El Solh et al. (2004). Pesola (2004) reviews how the research conducted by of El Solh et al. (2004) have contributed to the advancement of knowledge on ventilator-associated pneumonia, the microbial pathogens causing it and the habitat of these microorganisms which is the dental plaque. Results of the study by Pineda et al. (2006) illustrated the relevance of oral care practices through the use of chlorhexidine. Results showed that this chemical treatment did not provide significant decrease in the occurrence pneumonia in patients. The putcome of this research by Pineda et al. (2006) also revealed no significant reduction in the mortality rate of patients. Based on the paper by Ohrui (2005), both swallowing and cough reflexes are mediated by endogenous substance P contained in the vagal and glossopharyngeal nerves. This indicates that treatment through angiotensin-converting enzyme inhibitors that lower substance P catabolism may alleviate the condition of reflexes. Eventually, this may lead to decrease in the probability of acquiring pneumonia. Ohrui (2005) proposes that since the production of substance P is regulated by dopaminergic neurons in the cerebral basal ganglia, dopamine analogs can decrease the occurrence of pneumonia. Ohrui (2005) also emphasizes that interventions that reverse these age-associated changes in the immune system are efficient. The rationale for this is due to the finding that mortality from infections relates with cutaneous anergy, Varela (2006) published an article which mentions oral care as helping to prevent pneumonia. Varela mentions that providing oral care to ventilated patients should be considered a high priority. This study indicates that health care-associated pneumonia increases a patient’s length of stay in the Intensive Care Unit by approximately 6.1 days. However, ventilator-associated pneumonia accounts for sixty percent of all deaths due to hospital-associated infections. The CDC also suggests considering methods of non-invasive ventilation to reduce the risk of ventilator-associated pneumonia. Using oro-tracheal tubes rather than naso-tracheal tubes in patients who are mechanically ventilated has been found to reduce ventilator-associated pneumonia. Strengths The strength of the study by Munro, et al (2006) on the oral health status and development of ventilator associated pneumonia is that large samples, sixty-six patients, are used. Having large samples such as this would result to more accurate outcomes. The same is the case with the research conducted by Pesola (2004) on the ventilator-associated pneumonia in institutionalized elders which reveals that big samples of literatures used makes his findings reliable. The study by El-Solh, et al. (2004) was conducted by the use of molecular genotyping. The advances in technology like in molecular genotyping add credibility to the study. The research may lead the path for forthcoming researches to define whether every day oral sanitation in institutionalized aged would decrease danger of nosocomial pneumonia in hospitalized elders. The strength of the paper by Pineda, et al. (2006) on the effect of oral decontamination with chlorhexidine on pneumonia facilitate for inferences that can be made. Likewise, the large samples used in this study are the strengths of this paper. Large samples give ample amount of observations. The preventive strategies for aspiration pneumonia in disabled persons suggested by Ohrui (2005) makes this study strong. The same hold true in the case of the paper by Varela (2006) on oral care that helps prevent pneumonia. The sound recommendation given by Varela (2006) that providing oral care in the ventilated patient's teeth can actually help prevent them fro developing pneumonia. Weaknesses The weakness of the study by Munro, et al. (2006) on oral health status and development of ventilator associated pneumonia is that the relationship of oral health status with the degree of incidence of ventilator associated pneumonia was not clearly discussed. Similarly, the study of Pesola (2003) on ventilator-associated pneumonia in institutionalized elders, the weakness of this study is that it does not back up the study with sufficient quantitative analysis. The group of researchers, El-Solh, et al. (2004) study the colonization of dental plaques. The advancement of technology on molecular genotyping enhances the credibility of the study, however, this methodology does not define whether every day oral sanitation in institutionalized aged would decrease danger of nosocomial pneumonia in hospitalized elders. The meta-analysis by Pineda, et al. (2006) adopts randomized controlled trials. It is a weakness that the study employed only a single outcome measure. Future study related to that will include additional outcome data will give more credible results. It is also a weakness that the randomized trial was limited to a relatively short time. Ohrui (2005) provides some suggestions on decreasing the incidence of pneumonia. However, there is a weakness in terms of backing the recommendations with previously conducted experiments which resulted to significant quantitative data. This was a cross sectional study, however, so nothing can be inferred about whether provision of oral care result to decrease incidence of pneumonia. The degree of rate of incidence of pneumonia was not mentioned. Varela (2006) concludes that oral care helps prevent pneumonia. This was a cross sectional study, therefore, nothing can be inferred yet about whether provision of oral care dropped pneumonia incidence. Specific indicator on the reduced incidence of pneumonia was not clear. Since small sample was used, this makes findings unreliable. The degree of decrease in pneumonia incidence is not clear also. Relevance of Findings The findings by Munro et al. (2006) on the oral health status and development of ventilator associated pneumonia is relevant in this study since from their outcomes, inferences can be generated whether it will result to low or high Clinical Pulmonary Infection Score after provision of oral health measures. These inferences are relevant to current problem/issue. These can be a good support to the current study since large samples from sixty-six patients generated reliable findings by Munro et al. (2006). On the other hand, the results of Pesola (2004) study on the ventilator-associated pneumonia in institutionalized elders strengthened the current study since the meta-analysis conducted by this researcher generated reliable findings. The outcomes of the study by El-Solh, et al. (2004) have strong relevance to the current study. This research by El-Sohl et al. (2004) also lead the path for forthcoming researches like this current study to define whether every day oral sanitation in institutionalized aged would decrease danger of nosocomial pneumonia in hospitalized elders. Pineda, et al. (2006) also give strength to the current study since the meta-analysis of randomized controlled trials conducted by Pineda et al. (2006) gives rise to inferences about whether incidence of pneumonia dropped after oral decontamination with chlorhexidine. Degree on the incidence of nocosomial pneumonia, mortality rate and the population of microorganisms found in pneumonia-inflicted patients were measured and duration of mechanical ventilation and intensive care unit length of stay controlled for. The cross-sectional study facilitated by Ohrui (2005) provided sound assessment of pneumonia. The preventive strategies that Ohrui (2005) mentions may contribute a great deal in the treatment of pneumonia. This author’s findings are strongly relevant, the same as in the outcomes of the study by Varela (2006). Further Research However, despite the extensive contributions of the above literatures on oral care intervention on reducing pneumonia, there are additional knowledge that are still needed in order to more comprehensively address the problem/issue. Discussed below are the relevant topics to be considered in this study for a broader literature search. These studies could also shed light on the problem/issue. Grap and Munro (2003) found that despite evidence that they are ineffective for plaque removal, sponge toothettes remain the primary tool for oral care, especially in intubated patients in intensive care units. This study will support the preventive strategies mentioned by Ohrui (2005). As a result of the findings by Grap and Munro (2003), the preventive strategy to support the suggestions of Ohrui (2005) should be to use the effective tool in plaque removal to better decrease the pneumonia incidence. Another study is by Schleder, et al. (2002) on the effect of a comprehensive oral care protocol on patients at risk for ventilator-associated pneumonia. Since other relevant studies were notably conducted below 2004, the year range of the publications to be considered in the current study will be adjusted to 2002 to present. Conclusions and Recommendation Munro et al. (2006) study on the oral health status and the development of ventilator associated pneumonia was based on the vast examination of literatures. Munro et al. (2006) concluded that oral health is influenced by the population of microorganisms in the dental plaque. The same conclusion was reached by Pesola (2006), who specifically notes that the research by El Solh et al. (2004) provided relevant outcomes. El Solh et al. (2004) proved that ventilator-associated pneumonia was brought about by the pathogenic microorganisms in dental plaque of patients. On the other hand, Ohrui (2005) notes that difficulty in swallowing as well as cough reflexes result to alleviated incidence of pneumonia. Thus, numerous preventive strategies were generated to address decrease in the pathogenicity of the microbial flora. According to Ohrui (2005), a strategy that can be adapted is pharmacologic therapy. This pharmacologic therapy makes use of angiotensin-converting enzyme inhibitors that lower substance P catabolism. As a result, this type of treatment can enhance reflexes and decrease the incidence of pneumonia. Ohrui (2005) also suggests treatment with potentiating drugs like amantadine that can reduce the occurrence of pneumonia. Production of substance P is regulated by dopaminergic neurons in the cerebral basal ganglia, hence the potentiating drug may improve the health condition of the ill patients. On the other hand, mortality from infections correlates with cutaneous anergy, hence, according to Ohrui (2005), oral interventions can reverse these age-associated changes in the immune system. In the paper by Varela (2006), the author concludes that oral care helps prevent pneumonia as indicated by studies revealing that health care-associated pneumonia increases a patient’s length of stay in the Intensive Care Unit by approximately 6.1 days. Varela (2006) further specifies that using oro-tracheal tubes rather than naso-tracheal tubes in patients who are mechanically ventilated has been found to reduce ventilator-associated pneumonia. In the future, advancement in this study should geared towards enhancement of several strategies of mechanical as well as pharmacological interventions. More researches can be towards more relevant best practices for oral care intervention in pneumonia patients. It is essential that the follow-up researches to be facilitated will provide indications that oral intervention in patients would reduce the incidence of pneumonia in the large number of patients. Bibliography El-Solh, A.A., Pietrantoni, C., Bhat, A., Okada, M., Zambon, J., Aquilina, A. and Berbary, E. 2004. Colonization of dental plaques. Chest, 126, 1575-1582. Grap, Mary Jo and Munro, Cindy L. 2003. Oral Care Interventions in Critical Care: Frequency and Documentation. Am. J of Crit. Care, 12: 113-118 Munro, C.L., Elswick, R.K., McKinney, J., Sessler, C.N. and Hummel, R.S. 2006. Oral health status and development of ventilator associated pneumonia. Am J of Crit Care, 15, 453-460. Ohrui, T. 2005. Preventive strategies for aspiration pneumonia in disabled persons. Exp Med, 207, 3-12. Pesola, G.R.2004. Ventilator-associated pneumonia in Institutionalized elders. Chest, 126: 1401-1403. Pineda, L.A., Saliba, R.G. and El Solh, A.A. 2006. Effect of oral decontamination with chlorhexidine on the incidence of nosocomial pneumonia. Critical Care, 10, R35. Varela, R. 2006. Oral care helps prevent pneumonia. RN.com., AMN Healthcare, Inc. Pesola, G.R.Ventilator-associated pneumonia in Institutionalized elders. Chest, 126: 1401-1403. Schleder, B., Stott, K and Lloyd, R.C. 2002. The effect of a comprehensive oral care protocol on patients at risk for ventilator-associated pneumonia. Journal of Advocate Health Care, Spr/Sum, 4(1):27-30. Read More