Oral care practices for orally intubated critically ill adults.

BACKGROUND: Ventilator-associated pneumonia is a major threat to patients receiving mechanical ventilation in hospitals. Oral care is a nursing intervention that may help prevent ventilator-associated pneumonia. OBJECTIVES: To describe oral care practices performed by critical care nurses for orally intubated critically ill patients and compare these practices with recommendations for oral care in the 2005 AACN Procedure Manual for Critical Care and the guidelines from the Centers for Disease Control and Prevention. METHODS: A descriptive, cross-sectional design with a 31-item Web-based survey was used to describe oral care practices reported by 347 randomly selected members of the American Association of Critical-Care Nurses. RESULTS: Oral care was performed every 2 (50%) or 4 (42%) hours, usually with foam swabs (97%). Oral care was reported as a high priority (47%). Nurses with 7 years or more of critical care experience performed oral care more often (P=.008) than did less experienced nurses. Nurses with a bachelor's degree in nursing used foam swabs (P=.001), suctioned the mouth before the endotracheal tube (P=.02), and suctioned after oral care (P<.001) more often than other nurses. Nurses whose units had an oral care policy (72%) reported that the policy indicated using a toothbrush (63%), using toothpaste (40%), brushing with a foam swab (90%), using chlorhexidine gluconate oral rinse (49%), suctioning the oral cavity (84%), and assessing the oral cavity (73%). Oral care practices and policies differed for all those items. CONCLUSIONS: Survey results indicate that discrepancies exist between reported practices and policies. Oral care policies appear to be present, but not well used.

Validity and reliability of an oral care practice survey for the orally intubated adult critically ill patient.

BACKGROUND: Oral care is proposed as key to preventing ventilator-associated pneumonia, yet little work has been done to measure reliably current oral care practices nationwide. Five critical care oral care surveys are described in the literature; however, their usefulness is diminished because of insufficient validity or reliability measures and sampling limitations that limit generalizability. OBJECTIVES: The aim of this study was to present a survey instrument for oral care practices for the orally intubated adult critically ill patient and the attendant psychometric properties. METHODS: The oral care survey items were designed to elucidate information on the type and frequency of each specific task for oral care (toothbrushes, foam swabs, suctioning, and chlorhexidine gluconate oral rinse). The oral care survey was evaluated for face validity, content validity, and stability reliability psychometric properties. RESULTS: Face validity was established by an expert panel. Content validity was assessed using content validity index (CVI) and pairwise comparison. The overall CVI score was 97.5% agreement. A pairwise comparison for the three raters was computed. The strongest rating agreements were between Rater 1 and Rater 2 (.86) and Rater 1 and Rater 3 (.83). Given these interrater reliability scores and the overall 97.5% CVI score, minor revisions were made for survey items as recommended by the reviewers' comments. Test-retest reliability (.82-.86) showed a less than 10% difference between all items from Time 1 and Time 2. IMPLICATIONS: This survey, tested for validity and reliability, can be used in future critical care settings as an audit tool for oral care practices performed by nurses.