Oral care in the intensive care unit

13/04/20

Inter.med Laboratories involved in the prevention of pneumonias acquired under mechanical ventilation

All standards of French and international learned societies have, for more than 10 years, recommended mouth care in intensive care, and more particularly with patients under mechanical ventilation


In France, whether it is the SFAR (French Society of Anesthesia Resuscitation) or the SRLF (French Society of Resuscitation in French), these two organizations have taken positions to promote oral care (1), or even oropharyngeal disinfection (2), as preventive measures in the occurrence of pneumonias acquired under mechanical ventilation.


Thus, it is now established that mouth care carried out at a frequency of 6 treatments per 24 hours presents one of the best preventions to fight against Acquired Pneumonia under Mechanical Ventilation (APMV). One of the primary sources of nosocomial infections in intensive care is these lung diseases. They participate in the increase of the average length of stay in intensive care and present a significant financial burden for these care units..


A review of the scientific literature, carried out by the Inter.med and Didactic teams, gathers the data which justify these elements; this technical-scientific file is available on simple request by activating the link appearing at the end of this article.

Field investigation

Inter.med Laboratoires carried out a field survey of intensive care units in the public and private sectors of at least ten intensive care beds. In most cases, these were versatile resuscitation units.

The following items were collected from around 120 healthcare facilities across the country.

 

  • In 75% of the cases, the teams are well aware of the prevention of APMV. through the delivery of mouth care (I.D.E, Health executives, doctors).
  • Mouth care is most often carried out using simple devices, but not necessarily suitable for the best performance of care.
  • If specific sticks have largely replaced the compress and the tongue depressor, suction devices are only used in around 40% of cases. The kits mainly for economic reasons, but also because they are not always appreciated by their lack of flexibility (adaptation on a case-by-case basis), are only used in 35% of cases according to our study.

Caregivers' Objections Regarding Oral Care Kits for Resuscitation

In a number of testimonies, it was noted:



  • “If the kits are appreciated for their ease of use, they are relatively expensive. A number of devices are not in use. It would then be necessary to disinfect the devices not used when leaving the resuscitation boxes so as not to throw them away. ”

  • “We do not have suitable devices because of the costs of devices in kit form….

  • “We want to adapt and choose the devices to the clinical situation and the patient’s mouth…. “

  • “Budget restrictions do not allow us to have at least quality foam sticks suitable for each treatment…. “

  • “We only have compresses or cotton sticks that are not very effective…. “

  • Mouth care is mainly provided by caregivers and D.E in a team.

 

 

  • To perform mouth care, a solution of Chlorhexidine is mainly used

Inter.med Laboratories

Inter.med Laboratoires, the French benchmark in the production of devices for mouth care, has therefore taken all these observations into account to offer healthcare teams very high quality devices, made in France, adapted to the daily practices of caregivers.
Also as part of the development of this range, Inter.med laboratories pays particular attention to the impact on hospital waste in order to reduce packaging waste as much as possible (polyethylene bag, cardboard and recyclable boxes.)

To receive our technical-scientific file, contact us

Références citées dans l’article

• Source (1)

le métier d’IDE en réanimation Fiches techniques Fiche n°10 – Soin de bouche Fiche n°10 – Soin de bouche

https://www.srlf.org/metier-dide-reanimation/fiches-techniques/fiche-n10-soin-de-bouche/

Rédaction : E. BERTHOLET(1) et S. DÉRES(2)

1. CHU de Lyon – HFME – Département d’Anesthésie et Réanimation Pédiatrique

2. CHU de Poitiers – Service de Réanimation Médicale

Date de validation : V1 – août 2011

•Source(2)

Impact d’un programme multimodal de prévention de la pneumopathie associée à la ventilation incluant la décontamination oro-pharyngée

https://sfar.org/impact-dun-programme-multimodal-de-prevention-de-la-pneumopathie-associee-a-la-ventilation-incluant-la-decontamination-oro-pharyngee/ par Anne-Claire Lukaszewicz et Karim Asehnoune

« Le résultat principal de l’étude était la baisse majeure de la proportion de patients ayant présenté au moins une PAVM de 20.1% avant à 8,5% après la mise en place du programme multimodal sans la DOS, puis à 3% une fois la DOS introduite, tout comme l’incidence des PAVM ou leur fréquence. La comparaison des différentes périodes avant intervention, avec les mesures sans DOS, après l’introduction de la DOS puis au cours du suivi confirmait l’impact de l’intervention sur la survenue des PAVM quelle que soit l’approche statistique. Cette analyse longitudinale mettait en évidence en particulier l’impact de la DOS et le maintien du résultat positif qui perdurait au cours du suivi. Il n’y avait pas d’impact significatif de l’intervention sur l’émergence de résistances bactériennes ni sur la consommation d’ATB globale. En revanche les auteurs ont mesuré une diminution de la durée de la ventilation mécanique et de la mortalité en réanimation qui reste modeste dans cette étude. »

Impact of a multifaceted prevention program on ventilator-associated pneumonia including selective oropharyngeal decontamination Landelle, V. Nocquet Boyer, M. Abbas, E. Genevois, N. Abidi, S. Naimo, R. Raulais, L. Bouchoud, F. Boroli, H. Terrisse, J.-L. Bosson, S. Harbarth, J. Pugin Intensive Care Med (2018) 44:1777–1786. doi.org/10.1007/s00134-018-5227-4