STUDI LITERATUR: UPDATE PELAKSANAAN ORAL CARE PADA PASIEN YANG TERPASANG VENTILASI MEKANIK DI RUANG ICU

Diah Tika Anggraeni

Sari


Latar belakang: Pasien dengan ventilasi mekanik akan mengalami stress oral seperti hilangnya substansi protektif gigi, gangguan fungsi mukosiliari dan perubahan komposisi flora oral. Masalah kesehatan mulut tersebut berpotensi terjadinya kolonisasi bakteri penyebab Ventilator-associated pneumonia(VAP), padahal VAP menjadi salah satu penyebab terbesar mortalitas di ICU. Tujuan: Untuk mengidentifikasi hasil penelitian terbaru tentang pelaksanaan oral care pasien terpasang ventilasi mekanik. Metode: Penelaahan dilakukan berdasarkan content analysis. Pencarian dibatasi pada artikel yang dipublish dari tahun 2009-2017 dengan jenis penelitian Randomised-controlled trial(RCT) maupun kuasi eksperimen dalam bahasa inggris. Database yang digunakan adalah CINAHL, pubmed, MEDLINE, Proquest dan Sciencedirect dengan kata kunci oral care, oral hygiene, mouth care, mechanically ventilated, intubated, critical care dan intensive care. Hasil: Didapatkan sepuluh artikel tentang efektifitas Chlorhexidine gluconate(CHX) sebagai agen antimikroba dengan konsentrasi dan volume yang bervariasi. Teknik pelaksanaan oral care yang paling efektif adalah dengan cara toothbrushing dengan frekuensi sesuai dengan skor pengkajian mulut. Selain itu, direkomendasikan pemberian moisturizer untuk menjaga integritas mukosa. Beberapa alat pengkajian kesehatan mulut yang dapat digunakan adalah Oral Assessment Guide(OAG), Beck Oral Assessment Scale(BOAS)  atau Mucosal-Plaque Score(MPS). Kesimpulan: Pelaksanaan oral care secara komprehensif dapat memperbaiki kesehatan mulut pasien dengan ventilasi mekanik, sehingga kolonisasi bakteri penyebab VAP dapat dicegah. Oleh karena itu, perawat perlu memahami dan mengaplikasikan instrumen pengkajian mulut sebagai dasar pemberian intervensi.      

Kata kunci :  ICU, intubasi trakea, oral care, oral hygiene


Kata Kunci


ICU, intubasi trakea, oral care, oral hygiene

Teks Lengkap:

PDF

Referensi


American Dental Association.Oral Health Topics: Cleaning your teeth and gums (oral hygiene) diakses dari http://www.ada.org/public/topics/cleaning.asp. Diakses pada 1 Januari 2016.

Ames, N. J., Sulima, P., Yates, J. M., McCullagh, L., Gollins, S. L., Soeken, K., & Wallen, G. R. (2011). Effects of systematic oral care in critically ill patients: a multicenter study. American Journal of Critical Care, 20(5), e103-e114.

Bagg, J., MacFarlane, T. W., Poxton, I. R., & Smith, A. J. (2006). Essentials of microbiology for dental students (No. Ed. 2). Oxford university press.

Berry, A. M. (2013). A comparison of Listerine® and sodium bicarbonate oral cleansing solutions on dental plaque colonisation and incidence of ventilator associated pneumonia in mechanically ventilated patients: A randomised control trial. Intensive and Critical Care Nursing, 29(5), 275-281.

Berry, A. M., Davidson, P. M., Masters, J., & Rolls, K. (2007). Systematic literature review of oral hygiene practices for intensive care patients receiving mechanical ventilation. American Journal of Critical Care, 16(6), 552-562.

Berry, A. M., Davidson, P. M., Masters, J., Rolls, K., & Ollerton, R. (2011). Effects of three approaches to standardized oral hygiene to reduce bacterial colonization and ventilator associated pneumonia in mechanically ventilated patients: a randomised control trial. International journal of nursing studies, 48(6), 681-688.

Binkley, C., Furr, L. A., Carrico, R., & McCurren, C. (2004). Survey of oral care practices in US intensive care units. American journal of infection control, 32(3), 161-169.

Chastre, J., & Fagon, J. Y. (2002). Ventilator-associated pneumonia. American journal of respiratory and critical care medicine, 165(7), 867-903.

de Lacerda Vidal, C. F., de Lacerda Vidal, A. K., de Moura Monteiro, J. G., Cavalcanti, A., da Costa Henriques, A. P., Oliveira, M., ... & Gomes, B. (2017). Impact of oral hygiene involving toothbrushing versus chlorhexidine in the prevention of ventilator-associated pneumonia: a randomized study. BMC infectious diseases, 17(1), 112.

DeRiso AJ II., Ladowski JS., Dillon TA., Justice JW., Peterson AC. (1996). Chlorhexidine gluconate 0.12% oral rinse reduces the incidence of total nosocomial respiratory infection and nonprophylactic systemic antibiotic use in patients undergoing heart surgery. Chest.109(6):1556-1561.

Estaji, Z., Alinejad, M., Rakhshani, M. H., & Rad, M. (2016). The comparison of chlorhexidine solution and swab with toothbrush and toothpaste effect on preventing oral lesions in hospitalized patients in intensive care unit. Global journal of health science, 8(5), 211.

Feider, L. L., Mitchell, P., & Bridges, E. (2010). Oral care practices for orally intubated critically ill adults. American Journal of Critical Care, 19(2), 175-183.

Fitch, J. A., Munro, C. L., Glass, C. A., & Pellegrini, J. M. (1999). Oral care in the adult intensive care unit. American Journal of Critical Care, 8(5), 314.

Fourrier, F., Dubois, D., Pronnier, P., Herbecq, P., Leroy, O., Desmettre, T., ... & Roussel-Delvallez, M. (2005). Effect of gingival and dental plaque antiseptic decontamination on nosocomial infections acquired in the intensive care unit: a double-blind placebo-controlled multicenter study. Critical care medicine, 33(8), 1728-1735.

Ganz, F. D., Fink, N. F., Raanan, O., Asher, M., Bruttin, M., Nun, M. B., & Benbinishty, J. (2009). ICU nurses’ oral‐care practices and the current best evidence. Journal of Nursing Scholarship, 41(2), 132-138.

Gibbons, R. J. (1989). Bacterial adhesion to oral tissues: a model for infectious diseases. Journal of dental research, 68(5), 750-760.

Grap, M. J., Munro, C. L., Ashtiani, B., & Bryant, S. (2003). Oral care interventions in critical care: frequency and documentation. American Journal of Critical Care, 12(2), 113-118.

Grap, M. J., Munro, C. L., Hamilton, V. A., Elswick Jr, R. K., Sessler, C. N., & Ward, K. R. (2011). Early, single chlorhexidine application reduces ventilator-associated pneumonia in trauma patients. Heart & Lung: The Journal of Acute and Critical Care, 40(5), e115-e122.

Guide, H. T. (2012). Prevent ventilator-associated pneumonia. Cambridge, MA: Institute for Healthcare Improvement.

Haffajee, A. D., Thompson, M., Torresyap, G., Guerrero, D., & Socransky, S. S. (2001). Efficacy of manual and powered toothbrushes (I). Effect on clinical parameters. Journal of Clinical Periodontology, 28(10), 937-946.

Heanue, M., Deacon, S. A., Deery, C., Robinson, P. G., Walmsley, A. D., Worthington, H. V., ... & Shaw, B. C. (2003). Manual versus powered toothbrushing for oral health. Cochrane Database of Systematic Reviews, (1).

Houston, S., Hougland, P., Anderson, J. J., LaRocco, M., Kennedy, V., & Gentry, L. O. (2002). Effectiveness of 0.12% chlorhexidine gluconate oral rinse in reducing prevalence of nosocomial pneumonia in patients undergoing heart surgery. American Journal of Critical Care, 11(6), 567-570.

Hsu, S. P., Liao, C. S., Li, C. Y., & Chiou, A. F. (2011). The effects of different oral care protocols on mucosal change in orally intubated patients from an intensive care unit. Journal of clinical nursing, 20(7‐8), 1044-1053.

Ibrahim, S. M., Mudawi, A. M., & Omer, O. (2015). Nurses’ knowledge, attitude and practice of oral care for intensive care unit patients. Open Journal of Stomatology, 5(07), 179.

Jones, H. (2005). Oral care in intensive care units: a literature review. Special Care in Dentistry, 25(1), 6-11.

Liao,Yu-Mei.,Jung-Rung Tsai.,Fan-Hao Chou. (2014). The effectiveness of an oral health program for preventing ventilator-associated pneumonia.British Association of critical care nurses. 20(2): 89-97.

Lorente, L., Lecuona, M., Jiménez, A., Palmero, S., Pastor, E., Lafuente, N., ... & Sierra, A. (2012). Ventilator-associated pneumonia with or without toothbrushing: a randomized controlled trial. European journal of clinical microbiology & infectious diseases, 31(10), 2621-2629.

Luc, J., Mroz, C., Roques, C., & Ducani-Federlin, M. (1998). The bactericidal activity of mouthwashes containing 0.10%, 0.12% and 0.20% chlorhexidine digluconate. Bulletin du Groupement international pour la recherche scientifique en stomatologie & odontologie, 40(2-3), 102-108.

Miller, M. & Kearney, N. (2001). Oral Care for Patients With Cancer: A Review of the literature. Cancer Nursing. 24: 241-254.

Nerandzic, M. M., & Donskey, C. J. (2015). Induced sporicidal activity of chlorhexidine against Clostridium difficile spores under altered physical and chemical conditions. PloS one, 10(4), e0123809.

Pear, Suzanne., Kathleen Stoessel., Susan Shoemake. (2007).Oral care is critical care: the role of oral care in the prevention of hospital-acquired pneumonia.Registered Trademark or Trademark of Kimberly-Clark Worldwide, Inc.

Pobo, A., Lisboa, T., Rodriguez, A., Sole, R., Magret, M., Trefler, S., ... & RASPALL Study Investigators. (2009). A randomized trial of dental brushing for preventing ventilator-associated pneumonia. Chest, 136(2), 433-439.

Prendergast, V., Jakobsson, U., Renvert, S., & Hallberg, I. R. (2012). Effects of a standard versus comprehensive oral care protocol among intubated neuroscience ICU patients: results of a randomized controlled trial. Journal of Neuroscience Nursing, 44(3), 134-146.

Rello, J., Koulenti, D., Blot, S., Sierra, R., Diaz, E., De Waele, J. J., ... & Rodriguez, A. (2007). Oral care practices in intensive care units: a survey of 59 European ICUs. Intensive care medicine, 33(6), 1066-1070.

Sekino, S., Ramberg, P., Guzin Uzel, N., Socransky, S., & Lindhe, J. (2004). The effect of a chlorhexidine regimen on de novo plaque formation. Journal of clinical periodontology, 31(8), 609-614.

Soh, Kim Lam, et al. (2012). Oral care practice for ventilated patient in intensive care units : a pilot survey. J Infect Dev Ctries, 6(4), 333-339.

Tablan, O. C., Anderson, L. J., Besser, R. E., Bridges, C. B., & Hajjeh, R. A. (2004). Guidelines for preventing health-care-associated pneumonia, 2003; recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee;[pt. II-III].

Tuon, F. F., Gavrilko, O., de Almeida, S., Sumi, E. R., Alberto, T., Rocha, J. L., & Rosa, E. A. (2017). Prospective, randomised, controlled study evaluating early modification of oral microbiota following admission to the intensive care unit and oral hygiene with chlorhexidine. Journal of global antimicrobial resistance, 8, 159-163.

Yagmur, F. N. (2016). A recent view and evidence-based approach to oral care of intensive care patient. International Journal of Caring Sciences, 9(3), 1177.


Article Metrics

Sari view : 192 times
PDF - 133 times

Refbacks

  • Saat ini tidak ada refbacks.


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.