Vpliv pogostosti ustne higiene ter uporabe antiseptičnih sredstev na preprečevanje ventilacijske pljučnice : diplomsko delo

Simonišek, Andreja (author), Djekić, Bernarda (mentor), Rozman, Suzana (comentor)

Uvod: Ventilacijska pljučnica je najpogostejša življenjsko nevarna bolnišnična okužba v enoti intenzivnega zdravljenja. Njeno pojavnost lahko z ustreznimi metodami in aktivnostmi zmanjšamo, vendar je ne moremo popolnoma preprečiti. Ena izmed teh aktivnosti je tudi ustrezno izvajanje ustne higiene. Namen: Namen diplomskega dela je predstaviti izvajanje ustne higiene pri intubiranih bolnikih v enoti intenzivnega zdravljenja pri preprečevanju ventilacijske pljučnice s stališča medicinske sestre. Ugotoviti smo želeli katere raztopine so z vidika preprečevanja ventilacijske pljučnice priporočene za ustno higieno intubiranega bolnika in kakšna je priporočena pogostost izvajanja ustne higiene. Metode dela: Uporabljena je bila deskriptivna metoda dela s kritičnim pregledom slovenske in tuje strokovne in znanstvene literature. Iskanje literature je potekalo prek spletnega portala Digitalne knjižnice Univerze v Ljubljani (DiKUL) v mednarodnih spletnih bazah CINAHL, Medline, Cochrane Library in Jstor ter s pomočjo vzajemne kataloške baze podatkov COBIB.SI. Iskanje literature je potekalo s pomočjo ključnih besed v slovenskem in angleškem jeziku: ustna higiena, ustna nega, ventilacijska pljučnica, preventiva, intenzivna zdravstvena nega, standard ustne higiene, klorheksidin, jod, fiziološka raztopina, raztopine, pogostost. Upoštevala se je literatura, ki je bila napisana med letoma 2009 in 2019. Za odgovore na raziskovalna vprašanja je bila uporabljena literatura, napisana med letoma 2012 in 2019. Narejena je vsebinska analiza 19-ih znanstvenih člankov. Rezultati: Najpogosteje uporabljena in v literaturi navedena kot raztopina, ki se je izkazala za najbolj učinkovito pri preprečevanju ventilacijske pljučnice, je klorheksidin v koncentraciji od 0,12 % do 2 %. Uporabljajo se tudi raztopine Echinacee, glutamina, povidon-joda in zeliščnih ustnih vod. Priporočena pogostost izvajanja ustne higiene je še vedno slabo raziskana. Poročana pogostost izvajanja ustne higiene je različna. Razprava in zaključek: Podatki za posamezne raziskave o pogostosti izvajanja ustne higiene so pridobljeni predvsem z anketiranjem medicinskih sester. V vseh analiziranih raziskavah priporočajo uporabo antiseptične raztopine klorheksidin, vendar bi bilo kljub temu potrebno raziskati uporabo drugih raztopin, ki so se v posameznih raziskavah izkazale za učinkovite pri preprečevanju ventilacijske pljučnice. Nekatere od njih bi lahko imele manj neželenih učinkov kot antiseptiki. Potrebne so natančno načrtovane klinične raziskave, na podlagi katerih bi se določil izbor raztopine in optimalna pogostost izvajanja posameznih aktivnosti ustne higiene. Zdravstvene ustanove bi morale oblikovati na dokazih utemeljene smernice in protokole, ki bi jih zdravstveni delavci upoštevali in izvajali.

• Language: Slovenian
• Keywords: ventilacijska pljučnica, ustna higiena, raztopine za ustno higieno, klorheksidin, pogostost izvajanja ustne higiene, zdravstvena nega
• Work type: Bachelor thesis/paper
• Organization: ZF - Faculty of Health Sciences
• Year: 2019
• PID: 20.500.12556/RUL-111558
• COBISS.SI-ID: 5703275
• Publication date in RUL: 03.10.2019

Secondary language

• Language: English
• Title: The influence of frequency of oral hygiene and the application of antiseptic agents to prevent ventilator associated pneumonia : diploma work

Abstract

Introduction: Ventilation associated pneumonia is the most common life-threatening hospital infection in the intensive care unit. Its occurrence can be reduced by appropriate methods and activities, but it cannot be completely prevented. One of these activities is the proper performing of oral hygiene. Purpose: The purpose of my final thesis is to present oral hygiene performing in intubated patients in the intensive care unit in prevention of ventilator associated pneumonia from the viewpoint of the nurse. We wanted to find out, which solutions are recommended for the intubated patient’s oral hygiene in terms of ventilator associated pneumonia prevention. Methods: A descriptive method of work was used with a critical review of Slovene and foreign professional and scientific literature. Literature was conducted via Digital Library of the University of Ljubljana portal (DiKUL) in the international online databases CINAHL, Medline, Cochrane Library and Jstor and with the help of shared catalogue database COBIB.SI. Literature search was conducted using keywords in Slovene and English language: oral hygiene, oral care, ventilator associated pneumonia, prevention, intensive care, oral hygiene standard, chlorhexidine, iodine, normal saline, solutions, frequency. The literature written between 2009 and 2019 was considered, whereas the literature between 2012 and 2019 was used to answer the research questions. Contents analysis of 19 scientific articles was made. Results: The most commonly used and reported in the literature as a solution, that has proven to be the most effective in preventing ventilator associated pneumonia, is chlorhexidine of 0.12% to 2% concentration. Echinacea, glutamine, povidone-iodine and herbal mouthwash solutions are used as well. Recommended frequency of oral hygiene performing is still poorly researched. Discussion and conclusion: Data for individual researches of oral hygiene frequency were obtained mainly by interviewing nurses. The frequency of oral hygiene performing varies. In all the studies analysed recommended the use of an antiseptic solution chlorhexidine, nevertheless, it would be necessary to research the use of other solutions, which have proven effective in the prevention of the ventilator associated pneumonia in individual studies. Some of them may have fewer side effects than antiseptics. Carefully planned clinical researches are necessary to determine the choice of solution and the optimal frequency of performing individual oral hygiene activities. Health-care institutions should develop evidence-based guidelines and protocols for health workface to follow and implement.

• Keywords: ventilator associated pneumonia, oral hygiene, oral hygiene solutions, chlorhexidine, oral hygiene frequency, health care