Oral Chlorhexidine Against Ventilator-Associated Pneumonia and Microbial Colonization in Intensive Care Patients.

The aim of this systematic review was to determine the effect of chlorhexidine at different concentration and frequency on ventilator-associated pneumonia and microbial colonization in mechanically ventilated patients. Relevant studies in English language were identified by searching data bases between January 2010 and December 2017. Ten studies met the inclusion criteria. Chlorhexidine with 0.2% concentration was found to be more effective than the control group (placebo dental gel and normal saline) in preventing the development of ventilator-associated pneumonia in three of the eight studies. Twice-daily application was found to be effective reducing the rate of ventilator-associated pneumonia in three studies using 0.2% and 2% chlorhexidine. Microbial colonization was found to be less in 2% chlorhexidine group than herbal mouth wash 0.9% NaCl and 0.2% chlorhexidine in three studies. Chlorhexidine is an effective intervention in oral care for ventilator-associated pneumonia and microbial colonization.

Nurses can play an active role in the early diagnosis of exposure keratopathy in intensive care patients.

AIM: This study was conducted in order to determine nurses' ability to diagnose exposure keratopathy reliably in the early stage in intensive care patients. METHODS: This methodological and descriptive study was carried out between 2011 and 2012 in the Neurology and Anesthesiology and Reanimation Intensive Care Units of a teaching hospital in western Turkey. The sample consisted of 4354 ocular assessments in 156 corneas of 78 patients. A patient identification form and a fluorescein test patient tracking chart were used in the data collection. The corneas of the patients were checked by a fluorescein dye test by the same nurse and ophthalmologist. RESULTS: The mean age of the patients was 59 ± 15.5 years and 47.4% of them were female. The consistency between the nurse and the ophthalmologist was almost perfect in terms of determining the presence of exposure keratopathy, characteristics, and the grade of corneal staining. Exposure keratopathy was detected at a rate of 2% by the ophthalmologist. A significant relationship was found between the presence of lagophthalmos and the development of exposure keratopathy. A positive correlation was found between the grade of corneal staining and the degree of the eyelid position of the patients and the duration of mechanical ventilation therapy. CONCLUSION: After eye care and assessment training, intensive care nurses can play an effective role in detecting early-stage exposure keratopathy in intensive care patients.

Knowledge and practice of intensive care nurses for endotracheal suctioning in a teaching hospital in western Turkey.

OBJECTIVES: This study was conducted to determine intensive care nurses' knowledge and practice levels regarding open system endotracheal suctioning and to investigate if there is a relationship between nurses' demographic characteristics and their knowledge and practice. RESEARCH METHODOLOGY/DESIGN: The study was conducted as a cross-sectional and non-participant structured observational design. Data were collected using a 45-item structured and self-administered questionnaire and a 31-item observational checklist. The study sample included 72 nurses. SETTING: Three adult intensive care units in a teaching hospital. RESULTS: The nurses' mean scores of knowledge and practice were 23.79±3.83 and 12.88±2.53. Their level of knowledge was very good in 59.7%, good in 34.7%, and the level of practice was fair in 79.2% and good in 18.1%. The relationship between the type of unit and the nurses' knowledge scores was statistically significant (p=0.013). The correlation between the nurses' scores of knowledge and practice was not statistically significant (r=0.220; p=0.063). CONCLUSION: This study suggests that the knowledge level of most of the nurses was good and their practice level was fair. Intensive care nurses must perform suctioning procedures safely and effectively to ensure delivery of quality of care and eliminate complications.

Oral care practices of intensive care nurses: a descriptive study.

The aim of this study was to investigate intensive care unit (ICU) nurses' views and practices on oral care and to define the factors related to oral care measures. A study was carried out in eight ICUs of a teaching hospital in 2008. One hundred one nurses constituted the study sample. The data were collected using 'Oral Care Practices Survey' which included demographic characteristics (5 items) and current oral care practices (13 items). Oral care was given the highest priority by nearly 60% of the nurses. The most commonly used solution was sodium bicarbonate (79.2%), and the most frequently used equipment was foam swab (82.2%). Oral care was carried out less than every 4 h per day by 44.5% of the nurses. The oral care products and solutions were reported to be different in almost every unit. The relationship between the use of toothpaste and the place of employment was statistically significant (x(2) = 24.566, d.f. = 6, P = 0.000). There was a statistical significance between the clinics and frequency of oral care (x(2) = 81.486, d.f. = 42, P = 0.000). This study suggests that there is a wide variety of type and frequency of oral care measures among ICU nurses. Optimal oral care supported by evidence is an effective prevention method for eliminating oral complications.

Effectiveness of polyethylene covers versus carbomer drops (Viscotears) to prevent dry eye syndrome in the critically ill.

AIM: The purpose of this study was to compare the effectiveness of the polyethylene covers versus carbomer eye drops to prevent dry eye syndrome in intensive care unit patients. BACKGROUND: Concerns about eye care for critically ill patients remain an issue. Few studies have focused on the effect of polyethylene covers and eye drops. In addition, there are no studies comparing polyethylene covers and carbomer eye drops for critically ill patients. DESIGN: A prospective, randomised and contralateral eye study was conducted. METHODS: The study took place in an intensive care unit in 2007. Thirty-six eyes of 18 patients, who were under mechanical ventilation or unconscious for more than 24 hours in the intensive care unit, were studied. After examining the eyes of the patients with the Schirmer 1 test and fluorescein dye test, suitable patients were included in the study. One eye of the patient was randomly covered with a polyethylene cover every 12 hours, and carbomer drops were instilled on the other eye every six hours. All eyes were checked for an ocular surface abnormality by the same ophthalmologist everyday. The study interventions were continued until a defect was detected or for five days. Patients with a defect detected completed the study and were recorded as positive for the primary endpoint. Results. Carbomer drop was effective in prophylaxis of dry eye syndrome in only three of 18 patients, whereas polyethylene cover showed greater effect in 18 of 18 eyes at the end of the study (SD 0·3835, Z = -3·873, p < 0·001). A negative effect of greater rima palpebra in the resting position was observed in the efficacy of carbomer drop (r = -0·476, p < 0·05). CONCLUSION: This study suggests that a polyethylene cover is significantly effective in prevention of dry eye syndrome in intensive care patients. As an eye care intervention, the effectiveness of polyethylene cover should be supported by further studies. RELEVANCE TO CLINICAL PRACTICE: This study, which is an initial step in preventing dry eye syndrome in critically ill patients, also offers a new and effective eye care method in these patients.