title: Outcomes of an Oral Care Protocol in Postmechanically Ventilated Patients.
abstract: BACKGROUND
  Oral care is standard practice to prevent hospital-associated infections while patients are intubated and in the intensive care unit. Following extubation and transfer, infections remain an important risk for patients, but less attention is paid to oral care. Few studies have assessed the impact of oral care in recently extubated acutely ill patients.
  
  
  OBJECTIVE
  To develop an evidence-based oral care protocol for hospitalized patients and determine the impact of this protocol on health outcomes in recently extubated patients.
  
  
  METHODS
  In this randomized controlled trial, subjects were randomized to usual care or an intervention protocol that included tooth brushing, tongue scraping, flossing, mouth rinsing, and lip care. Major outcome measures were the revised THROAT (R-THROAT; oral cavity assessment) and overall prevalence of methicillin-sensitive Staphylococcus aureus and methicillin-resistant S. aureus on oral cultures.
  
  
  RESULTS
  Seventy-four subjects were randomized. As measured by the R-THROAT, oral cavity health improved over time in both groups, but the intervention group demonstrated significantly more improvement than the control group (R-THROAT score improved by 1.97 intervention vs. 0.87 control; p = .04). Two categories, tongue and mouth comfort, demonstrated the most significant improvement. There was no difference in MSSA/MRSA colonization between the groups at the conclusion of the study. Overall, subjects in the intervention group were more satisfied with their protocol than subjects in the usual care group.
  
  
  CONCLUSIONS
  This study offers an important evaluation of an oral care protocol after extubation. Results demonstrated improvement in the oral cavity assessment with the designed oral care protocol. Patients expressed a preference for the intervention protocol, which included a battery-operated toothbrush, higher-quality toothpaste and mouth rinse, tongue scraper, floss, and lip balm. The implementation of an oral care protocol specifically addressing patients in the immediate postintubation is essential.
authors.affiliation: Clinical Nurse Scientist, Wexner Medical Center, Clinical Associate Professor, College of Nursing, The Ohio State University, Columbus, OH.
authors.forename: Esther M
authors.initials: EM
authors.lastname: Chipps
authors.affiliation: Associate Professor, College of Dentistry, The Ohio State University, Columbus, OH.
authors.forename: Michele
authors.initials: M
authors.lastname: Carr
authors.affiliation: Assistant Professor-Dental Hygiene, The Ohio State University, Columbus, OH.
authors.forename: Rachel
authors.initials: R
authors.lastname: Kearney
authors.affiliation: Clinical Nurse Specialist, Wexner Medical Center, The Ohio State University, Columbus, OH.
authors.forename: Jennifer
authors.initials: J
authors.lastname: MacDermott
authors.affiliation: Clinical Nurse Specialist, Wexner Medical Center, The Ohio State University, Columbus, OH.
authors.forename: Tania
authors.initials: T
authors.lastname: Von Visger
authors.affiliation: Clinical Nurse Specialist, Wexner Medical Center, The Ohio State University, Columbus, OH.
authors.forename: Kristin
authors.initials: K
authors.lastname: Calvitti
authors.affiliation: Nursing Education Assistant Professor-Practice, College of Nursing, Wexner Medical Center, The Ohio State University, Columbus, OH.
authors.forename: Brenda
authors.initials: B
authors.lastname: Vermillion
authors.affiliation: Clinical Nurse Specialist, Clinical Assistant Professor, Wexner Medical Center, The Ohio State University, Columbus, OH.
authors.forename: Michele L
authors.initials: ML
authors.lastname: Weber
authors.affiliation: Clinical Nurse Specialist, Wexner Medical Center, The Ohio State University, Columbus, OH.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Newton
authors.affiliation: Clinical Nurse Specialist, Wexner Medical Center, The Ohio State University, Columbus, OH.
authors.forename: Jamie
authors.initials: J
authors.lastname: St Clair
authors.affiliation: Clinical Nurse Specialist, Wexner Medical Center, The Ohio State University, Columbus, OH.
authors.forename: Dorina
authors.initials: D
authors.lastname: Harper
authors.affiliation: Clinical Nurse Specialist, Richard M. Ross Heart Hospital, The Ohio State University, Columbus, OH.
authors.forename: Todd
authors.initials: T
authors.lastname: Yamokoski
authors.affiliation: Clinical Nurse Specialist, Richard M. Ross Heart Hospital, The Ohio State University, Columbus, OH.
authors.forename: Marcia
authors.initials: M
authors.lastname: Belcher
authors.affiliation: Associate Professor-Clinical, Wexner Medical Center, The Ohio State University, Columbus, OH.
authors.forename: Naeem
authors.initials: N
authors.lastname: Ali
authors.affiliation: Department of Veterinary Preventive Medicine, College of Veterinary Medicine, College of Public Health, The Ohio State University, Columbus, OH.
authors.forename: Armando E
authors.initials: AE
authors.lastname: Hoet
authors.affiliation: Department of Veterinary Preventive Medicine, College of Veterinary Medicine, The Ohio State University, Columbus, OH.
authors.forename: Joany
authors.initials: J
authors.lastname: Van Balen
authors.affiliation: Department of Statistics, The Ohio State University, Columbus, OH.
authors.forename: Christopher
authors.initials: C
authors.lastname: Holloman
authors.affiliation: Assistant Professor, College of Nursing, The Ohio State University, Columbus, OH.
authors.forename: Timothy
authors.initials: T
authors.lastname: Landers
mesh_terms: D002985:Clinical Protocols; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000472:pathogenicity; D009909:Oral Health / Q000592:standards*; D063868:Patient Outcome Assessment; D012121:Respiration, Artificial / Q000009:adverse effects* / Q000451:nursing*; D013203:Staphylococcal Infections / Q000628:therapy
keywords: Staphylococcus aureus; critical illness; evidence-based nursing care; extubation; hospital-acquired infections; intubation; oral care; randomized controlled trial