Abstract
Nosocomial infections in critically ill/ventilated patients result from bacterial load in oropharyngeal regions. Oral decontamination serves as the easiest effective means of controlling infections. Knowledge, attitude, and practices followed by healthcare personnel in intensive care settings need to be assessed to implement concrete measures in health-care. Survey questionnaire was constructed and implemented following its validation on seventy nursing and paramedical staff working in government and private intensive care units throughout Lucknow city. 21-item questionnaire consisted of three parts of seven questions each. 78% of respondents had knowledge regarding oral care and its importance in critical settings but 44% of respondents considered it to be unpleasant task. 36% of respondents claimed to have provided oral care to all patients in ICU. Uniform guidelines for translation of oral healthcare in ICU settings are not being implemented. Previous studies in literature from various geographic diverse regions also point out to similar lacunae. Based on present survey, most respondents were aware of importance of oral care with protocols covered in academic curriculum. Attitude towards oral care is positive but respondents feel a need for specialised training. Practice for oral care is not sufficient and needs improvement and proper implementation.
Highlights
Hospital acquired infections (HAI) and nosocomial pneumonia results from colonisation of bacteria in the oral habitat of intensive care unit (ICU) patients
Oral decontamination requires only a fraction of the antibiotics used in selective decontamination of the digestive tract and may be more useful in containing infection
(1) Oral care important for patients in ICU (2) Nursing students adequately trained in oral care (3) Oral care important only for ventilated patients (4) Protocols for oral care clearly outlined in ICU care manuals (5) Electronic brushes are better than conventional cleaning methods (6) Periodical updating on recent advances in oral care (7) Adequate knowledge about oral antiseptic use, its frequency and concentration
Summary
Hospital acquired infections (HAI) and nosocomial pneumonia results from colonisation of bacteria in the oral habitat of intensive care unit (ICU) patients. The two main interventions for decreasing bacterial load are selective decontamination of the digestive tract with administration of either oral antibiotics or through nasogastric tube and secondly oral decontamination through topical application of antiseptics or antibiotics. Meta-analyses of decontamination of the digestive tract were found to be successful in reduction of ventilator associated pneumonia [9, 10]. Its use is limited due to the emergence of antibiotic resistant bacteria. Oral decontamination requires only a fraction of the antibiotics used in selective decontamination of the digestive tract and may be more useful in containing infection. Alternative to oral antibiotics is use of antiseptics, that is, chlorhexidine gluconate or povidone iodine. Antiseptics act rapidly at multiple target sites and are less prone to induce drug resistance
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