Oral Health and Ventilator Associated Pneumonia - Book Report/Review Example

Oral Health and Ventilator Associated Pneumonia Abstract Oral health serves as a mirror to your body, reflecting what is actually happening within. The oropharyngeal region is often linked with various systemic illnesses of the body such as stroke, cardiovascular diseases, diabetes and pneumonia. Most of these diseases often lead to dire consequences. Hence, everyone should pay attention to their oral health care. One of the most common diseases that occurs as a result of bad oral hygiene is pneumonia. People who are at risk of developing this disease include the elderly who are too lazy or too weak to maintain proper oral hygiene or who are dependent on others. A type of pneumonia, which is ventilator associated pneumonia, also develops in patients who are on mechanical ventilation. This is the leading cause of morbidity and mortality in critically ill patients. An effective method of reducing the development of VAP in patients is through the application of combination of pharmacological and mechanical methods. The mechanical method employed is tooth brushing whereas the pharmacological method involves the application of Chlorhexidine which is an effective bactericidal agent. The role of nurses in the application of good oral hygiene is also very essential especially in those who are in long term care facilities. There are various articles that discuss about the proper methods to assess, intervene the oral hygiene practices and most of these are performed by the nursing staff on duty. Introduction World Health Organization defined oral health as being free from any sort of chronic mouth and facial pain, oral and throat cancer, oral sores, birth defects like cleft palate or lips, periodontal gum disease, decay of tooth or loss of tooth and several other diseases and disorders that affect the oral and mouth cavity (Who.int, 2015). The oral health is not only healthy teeth; the mouth can be seen as the mirror which gives an insight to the general health of a human being. The appearance of gum tissues or tooth may indicate the existence of diseases, progress of disease or the risk to develop these diseases. Oral cells and fluids are growingly being utilized for the diagnosis of various diseases (Nidcr.nih.gov, 2014). The latest reports indicate a relationship between gum diseases and stroke, cardiac diseases and premature babies having low birth weight. Similarly, almost 90% of the disease show oral signs and symptoms (Knowyourteeth.com, 2012). HIV/AIDS and diabetes reduce the body’s immune system hence, increasing the severity of oral diseases. Endocarditis, a disease of the heart is caused when bacteria enters the bloodstream through the mouth, also, osteoporosis is thought to be linked with bone loss and tooth loss (Mayoclinic.org, 2013). When salivary secretions that contain bacteria are aspired into the lower respiratory tract then it may cause pneumonia. This aspiration of micro-organism occurs from the proximal site like the oroharyngeal cavity into the lower airway. The surfaces of the teeth are susceptible to the buildup of plaque which can lead to the colonization of respiratory pathogens. Hence, those who have poor oral hygiene are more prone to the development of lung infection (Burket, Greenberg, Glick & Ship, 2008). Ventilator associated pneumonia (VAP) may be defined as the type of pneumonia that occurs in patients that receive mechanical ventilations. The colonization of microorganism’s mostly Staph aureus and Strep Pneumoniae or other gram negative rods in the oropharyngeal region lead to the development of VAP (Munro, Grap, Jones, McClish & Sessler, 2009). An initiative; known as healthy people sets a 10 year objective to improve the health of Americans on a national level. The vision of this program is to develop a society where everyone lives a healthy and long life (Healthypeople.gov, 2015). The progress relating to Healthy People 2020 has been optimistic and a number of targets were achieved in the first third of the years. 15.4% have reached the healthy people 2020 target, whereas 38.5% are still on the road to achieve their goals, 30.8% are still where they were before the initiation of the program, 3% are declining whereas only 1% are on borderline data (Healthypeople.gov, 2015). Oral health is one of the indicators that is included in the category of getting worse, 44.5% of the people had regular dental visits to the dentist in 2007 whereas in 2011, this number decreased to 41.8% which shows that there has been a 6.1% decline in oral health (Healthypeople.gov, 2015).People who are at increased risk of developing VAP are those who require mechanical ventilation and have poor nutritional intake, immobility or underlying disease (Lewis, Dirksen, Heitkemper, Bucher, Camera, 2014). The deficient oral care given to patients who are in long term stays at hospital or nursing homes can have dire consequences such as stroke, cardiovascular diseases and pneumonia. A Canadian study suggests a direct link between respiratory diseases and periodontal diseases and that good practice of oral hygiene significantly reduces the occurrence of respiratory diseases among geriatric patients. In another study it was proved that those who have a periodontal disease eventually develop cardiovascular complication in the form of stroke, angina, myocardial infarction (Stein & Henry, 2009). As a person gets older their teeth become fragile and also darken in color. Older people tend to lose more teeth and the supporting tissues and bone may also be lost. With an increase in age, the number of illnesses also increase which are mostly due to bad oral hygiene practices. Dry mouth can lead to diabetes mellitus. Inability to swallow food may lead to aspiration pneumonia (Heath, 2011). The society for healthcare epidemiology of America and infectious diseases society of America practice recommendations, states that the prevention of infection and the control practices should be applied at all times possible; this includes hand hygiene, aseptic techniques during suctioning of fluids and while handling with the respiratory equipments. The oral care of a patient on ventilator requires assessment, both before and after the delivery of oral care. The assessment should be performed by a nurse when the patient is admitted into the unit and also with each oral care shift. Eventually a licensed practice nurse can carry out the task at hand under the supervision of a registered nurse (Booker, Murff, Kitko & Jablonski, 2013). The purpose behind the assessment is to check that the lips and the mucosa are neat, clean, soft, intact and moist. Assessment is required to identify and to intervene and then examine the progress. Assessment can be performed using various tools such as The Jenkins Oral calculator (Malkin, 2009). The role of nurses in maintaining a good oral hygiene is critically important as they are responsible to provide oral health care to patients of all types whether they are dependant, independent or unconscious. The nurses are well informed about the practice of maintaining good oral hygiene; they even know the protocol in maintaining good oral hygiene (Potter, P. & Perry, A.G., 2010). In order to increase awareness among people regarding good oral health Canada established the Office of the Chief Dental Officer in 2004. While nurses are completely aware of the protocols used to maintain good oral hygiene, the physicians were deficient in diagnostic awareness (Yoon, 2011). The new evidence based practice in order to prevent VAP involves two mechanisms; the first is direct intervention by using pharmacological agent that kill bacteria while the second method is to kill the bacteria via mechanical methods such as tooth brushing. The institute for Healthcare improvement recommended the use of daily oral care with chlorhexidine for patients who are on mechanical ventilation (Munro, 2014). The standard protocol for mechanical cleaning or tooth brushing of the mouth was developed with the help of a dental hygienist faculty and was recommended by American Dental Association. The mouth of the patient had to be divided in to 4 section or quadrants i.e. right upper, right lower, left upper and left lower. The tooth brushing pattern was specified. Each quadrant was brushed with five strokes on the lingual, biting surfaces and buccal side with a soft toothbrush and tooth paste. The palate and tongue should also be brushed. Ever area is then rinsed with a mouth wash preferably Biotene, 2.5ml for each area with the help of a transfer pipette and finally a moisturizing gel was applied on all the surfaces with the help of a green toothette swab. Chlorhexidine was also applied in a similar method using the green toothette swab in order to uniformly coat the tooth, tongue and palate (Munro, Grap, Jones, McClish & Sessler, 2009). Certain old techniques of EBP included the patient to remain in a supine position for the first 24 hours of mechanical ventilation but the compliance for this method is low. Certain researchers also encouraged the use of antibiotics in order to clear the stomach and oropharyngeal region, but this is now an outdated strategy since the use of antibiotic may lead to anti- microbial resistance. Apart from this diligent oral, ETT and suctioning of the Subglottic may also prevent the occurrence of VAP (O'Keefe-McCarthy, Santiago & Lau, 2008). CONCLUSION Chlorhexidine is the most effective technique that has an anti plaque action. It is a broad spectrum antiseptic agent that has a bactericidal effect. Studies show that it decreases the formation of plaque by 50 to 60% (Cappelli & Mobley, 2008). The common people who are more prone to developing bad oral health include unhealthy people, obese, stress, lack of exercise and smoking. It also has a relation with the status of the person. Dental caries usually occur in people who are socially deprived (Kirch, 2008). Children who are of low income are more prone to develop dental problems. If a child’s poor oral health is not properly addressed then it might lead to diminished growth in toddlers and a compromise in nutrition. They are also more prone to develop infection like the common cold or ear infections. If the risk factors are not assessed or diagnosed in proper time then it may lead to serious health consequences in the form of chronic diseases (Nidcr.nih.gov, 2014). When the risk factors are not assessed in the elderly people, it may lead to dental caries, gingivitis, periodontitis, xerostomia, candidiasis and oral cancer (GONSALVES, WRIGHTSON & HENRY, 2008). The nurses are not only responsible for maintaining good oral hygiene but they are also responsible for designing and implementing interventions that are used to maintain good oral hygiene such as exercise for obese patients, older patients however, may require a longer warm up session before exercise, such as quitting of smoking . The nurses have to guide the patient while setting goals and informing the patient of various appropriate resources that the patient can utilize in order to achieve these objectives (Martucci & Gulanick, 2012). The article, Evidence based nursing strategies to prevent ventilator- acquired pneumonia discusses about the risk that the mechanically ventilated patients develop the ventilator acquired pneumonia. The critical care nurses who work with intubated patients should adopt tactics in order to avoid the occurrence of ventilator acquired pneumonia. VAP results from aspiration of secretion containing micro organisms. The use of chlorhexidine tends to reduce the occurrence of VAP in intubated patients (O'Keefe-McCarthy, Santiago & Lau, 2008). The article Oral Health: Something to smile about! Discusses about the link between oral health and general health of a human being and how poor oral health can cause a variety of chronic systemic illnesses. The article is based on descriptive and observational researches that tell the importance of dental plaque and its relation with ventilator associated pneumonia. The study conducted proved efficient in reducing the occurrence of VAP among mechanically intubated patients. The use of chlorhexidine after intubation was very successful in avoiding VAP in intubated patients (Munro, 2014). The third and last article Chlorhexidine, toothbrushing and preventing ventilator associated pneumonia in critically ill adults discusses the various methods of maintaining oral hygiene’s and the efficiency of mechanical and pharmacological cleaning in oral care in patients who are receiving mechanical ventilation. The research concluded that pharmacological method of maintaining oral hygiene was more effective in avoiding VAP whereas the mechanical method of tooth brushing was not as effective (Munro, Grap, Jones, McClish, & Sessler, C. 2009). References Jarvis, C. (2012). Physical Examination and Health Assessment (6th ed.). St Louis, Mo: Elsevier: Saunders. Lewis, S., Dirksen, S., Heitkemper. M., Bucher, L., and Camera, I. (2014).  Medical surgical nursing (9th ed.). St. Louis: Mosby. Potter, P. & Perry, A.G. (2010). Fundamentals of Nursing (8th ed.), Philadelphia, PA: Mosby, Inc. Who.int,. (2015). WHO | Oral health. Retrieved 4 April 2015, from http://www.who.int/topics/oral_health/en/ Nidcr.nih.gov,. (2014). Chapter 1: The Meaning of Oral Health. Retrieved 4 April 2015, from http://www.nidcr.nih.gov/DataStatistics/SurgeonGeneral/sgr/chap1.htm#relation Knowyourteeth.com,. (2012). Know Your Teeth - Infobites - Importance of Oral Health to Overall Health -- Search By Keyword, Letter or Phrase - 1-877-2X-A-YEAR (1-877-292-9327). Retrieved 4 April 2015, from http://www.knowyourteeth.com/infobites/abc/article/?iid=320&aid=1289& Mayoclinic.org,. (2013). Oral health: A window to your overall health - Mayo Clinic. Retrieved 4 April 2015, from http://www.mayoclinic.org/healthy-living/adult-health/in-depth/dental/art-20047475?pg=2 Burket, L., Greenberg, M., Glick, M., & Ship, J. (2008). Burket's oral medicine. Hamilton, Ont.: BC Decker. Munro, C., Grap, M., Jones, D., McClish, D., & Sessler, C. (2009). Chlorhexidine, Toothbrushing, and Preventing Ventilator-Associated Pneumonia in Critically Ill Adults. 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American Journal Of Critical Care, 18(5), 428-437. doi:10.4037/ajcc2009792 O'Keefe-McCarthy, S., Santiago, C., & Lau, G. (2008). Ventilator-Associated Pneumonia Bundled Strategies: An Evidence-Based Practice. Worldviews On Evidence-Based Nursing, 5(4), 193-204. doi:10.1111/j.1741-6787.2008.00140.x Cappelli, D., & Mobley, C. (2008). Prevention in clinical oral health care. St. Louis, Mo.: Mosby Elsevier. Kirch, W. (2008). Encyclopedia of Public Health. 2 Vol.. New york: Springer. Nidcr.nih.gov,. (2014). Chapter 10: Factors Affecting Oral Health over the Life Span. Retrieved 5 April 2015, from http://www.nidcr.nih.gov/DataStatistics/SurgeonGeneral/sgr/chap10.htm GONSALVES, W., WRIGHTSON, A., & HENRY, R. (2008). Common Oral Conditions in Older Persons. American Family Physician, 78(7). Martucci, S., & Gulanick, M. (2012). EHS: Nursing Diagnosis Care Plans, 4/e - Health-Seeking Behaviors. Www1.us.elsevierhealth.com. 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