Study On The Application Of Improved Oral Care Process In Patients With Oral Intubation In ICU

Objective:There are some problems in the clinical practice of inconsistency,and the implementation is disjointed with the guide.So the oral care process need to be improved.With VAP prevention at domestic and abroad and Meta analysis as the basis,through the investigation,nurses literature research and expert discussion developing a modified version of intubated patients oral care which is suitable for current stage of development,and carry out the program into clinical validation.Methods:(1)Prevalence study: The high quality of oral care can effectively prevent the occurrence of VAP,the researcher found that different hospital and even different care unit,the oral care process of patients with intubation is different.And there exists a disconnected to guide.The researcher used self-designed questionnaires investigate intensive care nurses at 3-A hospitals in Shanxi.To learn about the intensive nurse oral knowledge,attitude and practices.A total of 400 questionnaires were distributed,364 questionnaires were taken back,and the recovery rate was 91%.(2)Build an improved oral care process(1)Literature research: through the retrieval of Chinese and English database to pick up the literatures about VAP prevention guides and Meta-analysis of oral care.To understand the current situation of oral care at domestic and abroad,and seek for improving basis.(2)Qualitative interview: Couducting a semi-structured interview with 9 ICU nurses in a 3-A hospital,to understand the views and suggestions from the clinical nursing staff.(3)Expert meeting: the theme of the meeting is modified the draft of oral care process.And developing a modified version of intubated patients oral care process.(3)Clinical intervention study: According to the results of the questionnaire investigation,the oral care process of patients with new tracheal intubation was designed.Choosing a 3A-levelgeneralized hospital neurology,neurosurgery and internal medicine ICU,surgical ICU ward.Unified training the nurses.62 orotracheal intubated patient on mechanical ventilated were recruited according to case exclusion and inclusion criteria from 4 ICU ward from November 2017 to February 2018.Among them,29 cases were treated with a new oral care process.In the control group,30 patients were treated with traditional oral care procedures.Both groups were used compound chlorhexidine as the standard oral care mouthwash solution.Both group's Beck oral assessment scores,oral odour scores,oral bleeding conditions,the number of days of hospital stay and the number of days of intubation,VAP incidence were compared.Results:(1)Questionnaire results: The scores of oral nursing knowledge,attitude,behavior score were separately(8.70±3.67),(39.27±3.86),(5.97±2.18).There are positive correlation between attitude and behavior.But there are no correlation between knowledge and attitude,knowledge and behavior.The knowledge,attitude and implementation of oral care in patients with endotracheal intubation in the intensive care unit were affected by monthly income,age and professional title.(2)On the basis of the preliminary investigation and research,through the literature analysis and the nurses' interview,the draft of oral care process was formed.After the experts meeting,the improved oral care process was finally designed.(3)Clinical intervention study: There was no statistically significant difference in the age,gender and other general data of tracheal intubation patients between intervention group and control group(p>0.05).There was no statistical difference in temperature,white blood cell count,procalcitonin and prothrombin time before intubation(p>0.05).There was no statistical difference in oral score on the first day(p>0.05),so the data of the two groups were comparable.During the intubation period,the oral score of the two groups showed statistical difference from the fifth day(p<0.05).Overall,the oral score of the intervention group was lower than the control group,and the difference was statistically significant(p<0.05).However,there was no statistical difference in the incidence of VAP in both groups(p>0.05).It shows that the improved oral care process is better than the traditional.Conclusion:(1)Improved oral care process can improve the oral condition of patients and improve the quality of oral care compared with traditional oral care.The number of patients with ICU and the number of tracheal intubation days were shortened.But it has not been proven to reduce the incidence of VAP.(2)The oral nursing process developed in this study is suitable for the use and promotion of ICU ward in Shanxi province.