ABSTRACT
Ventilator-associated pneumonia (VAP) is one of the major nosocomial infections in the intensive care unit (ICU), contributing to increased mortality and morbidity. Studies have shown that oral decontamination through the use of mechanical and pharmacological agents significantly reduces the incidence of VAP, but oral care practices in ICUs are not consistent. A double-blind randomised controlled trial was undertaken in the medical ICU of a tertiary care centre in India, to assess the efficacy of a toothbrush-based oral care technique in reducing incidence of VAP. Tooth-brushing with concurrent suctioning technique was not proved to be superior to mouth-swabbing. The greatest risk factor for developing VAP was the number of ventilator days (length of time on a ventilator). There was a statistical association between gender and presence of antibiotics with VAP.
Subject(s)
Anti-Infective Agents, Local/therapeutic use , Chlorhexidine/therapeutic use , Cross Infection/drug therapy , Cross Infection/prevention & control , Pneumonia, Ventilator-Associated/drug therapy , Pneumonia, Ventilator-Associated/prevention & control , Respiration, Artificial/adverse effects , Adult , Aged , Decontamination/methods , Double-Blind Method , Female , Humans , Incidence , India/epidemiology , Intensive Care Units , Male , Middle Aged , Oral Hygiene/methods , Pneumonia, Ventilator-Associated/epidemiologyABSTRACT
AIM: This descriptive study set out to explore the end-of-life care perspectives both of patients with advanced carcinoma and of health-care professionals in a tertiary health-care setting in India. METHOD: A descriptive approach was undertaken to assess the end-of-life care perspectives from a sample of 140 patients and 40 health-care professionals. Data was collected through structured interviews with the patients and by self-administered questionnaire from the health-care professionals. RESULTS: There was a significant association in attitudes to artificial prolongation of life with age and religion. Patients placed a higher degree of importance on emotional, social, physical and spiritual dimensions of care compared to the health-care professionals. CONCLUSION: There is an urgent call for formulating an end-of-life care policy and advance directives for patients with terminal illness in India. Nurses and physicians should be proactive in offering key supportive services to ensure patient autonomy and facilitate good death.
