The Effect of Implementing Oral Care Bundle on Critical Care Nurses' Practice and Mechanically Ventilated Patients' Outcomes

Oral care is a fundamental aspect of nursing that impact the health and comfort of patients over both the short and long term. Caring for very sick patients in a busy stressful environment may result in oral care having a lower priority for nurses than other aspects of care (Sarangi, Simon, & Sarangi, 2021). Negligence of these interventions can cause long-term oral problems and nosocomial diseases most notably VAP (Abd Alraheem, 2020).

A study conducted by Ayşe et al. (2019) reported that the application of regular oral care for the MV patients as a part of care protocols decreased bacterial colonization and had a protective and improving effect on oral health. A recent study conducted by Rizk, Saad-eldeen and Helmy (2020) concluded that VAP is a serious ICU acquired infection with significant impact and required effective preventive action. A systematic review conducted by Kharel, Bist and Mishra (2021) concluded that VAP is a critical issue in ICU with a high-cost burden and various interventional educational programs like staff training and hygiene awareness can reduce the future risk of VAP.

A recent study conducted by Abd Alraheem (2020) illustrated that 53.3% of the MV patients had average oral alteration. Asystematic review conducted by Kharel et al. (2021) to assess VAP among ICU patients in WHO South east Asian region illustrated that the VAP incidence rate ranged from 0.2% to 11.6% differing greatly between countries. The highest VAP prevalence rate was reported from the medical ICU, India, where as the lowest was from the palliative care ICU, South Korea.

In Egypt, analysis of VAP was done in some Egyptian University Hospitals by Fathy, Abdelhafeez, EL-Gilany and Abd Elhafez, (2013) who reported that the incidence of VAP ranged from 16% to 75%, the lowest ratio was in Alexandria University 16% and the highest one in Ain Shams University 75%. The incidence in Mansoura University Hospitals (MUH) was 22.6%. Another recent study conducted by Elkolaly, Bahr, El-Shafey, Basuoni, and Elber (2019) reported that the incidence of VAP in Tanta University Hospitals is still high (38.4%).

Many studies investigated the effect of oral care with chlorhexidine on the incidence of VAP and oral health in MV patients (Abd Alraheem, 2020; Collins et al., 2020; Heck, 2012; Moustafa, Tantawey, El-Soussi and Ramadan, 2016; Plantinga et al., 2016). However, the recent reappraisal of the evidence suggests that chlorhexidine does not reduce VAP, causes excess mortality in non-cardiac surgery patients (Dale et al., 2019) and unexpected high incidence of oral mucosal lesions (Plantinga et al., 2016).

Moreover, from my empirical experience, chlorhexidine is not available in all Egyptian hospitals because of its economic burden. A study conducted by Moustafa et al. (2016) recommended regular updates about evidence-based guidelines for oral care and its effect on VAP prevention and oral health. The debate of the literature about oral care inspired us to investigate this area.