Effect of oral care on bacterial colonization and Ventilator-Associated Pneumonia

Oral care is signi icant as it in luences both health and clinical consequences of escalated care patients. Oropharyngeal intrusion by microorganisms is basic being developed of nosocomial pneumonia (ventilator-associated pneumonia/VAP) in intensive care units. The present study aims to assess the effectiveness of nestingonposture comfort among lowbirthweight babies. Aquantitative quasi-experimental research design was conducted among 60ventilator supported patients in which 30 were allotted to experimental and 30 to control group. Observational samplingchecklist technique was used to select samples. A semi-structured interview was used to collect demographic data, and pneumonia checklist was assessed. Selected samples on 1 day of intubation in the experimental group and were provided oral care with 0.2% chlorhexidine every 6hourly till 3 day (72hours) and maintained pneumonia checklist respiratory rate, PaO2, BUN value, WBC count, platelet count and temperature. For the selected samples of the control group, oral care procedure was not applied. The study inding clearly infers that there was a signi icant difference in the Day 13 scores of pneumonia checklist variables except for temperature between the experimental and control group which proves the effectiveness of oral care on bacterial colonization and ventilatorassociated pneumonia in the experimental group than the patients in the control group who had undergone normal hospital routine measures.


INTRODUCTION
Oral care is a fundamental piece of your general well-being and well-being. (Safdar et al., 2005) Poor oral cleanliness can prompt dental depressions and gum illness and has likewise been connected to coronary illness, malignancy, and diabetes. (Munro and Grap, 2004) Maintaining sound teeth and gums is a deep-rooted commitment. (Scannapieco et al., 2001) The prior you learn appropriate oral cleanliness propensities, for example, brushing, lossing, and restricting your sugar intake. (Gupta et al., 2016) The simpler it'll be to dodge expensive dental techniques and long haul medical problem. Gum illness is very common. (Soh et al., 2011) Nursing care is taken as an essential function in oral cleanliness. Therefore, giving oral consideration and cleanliness should be considered as a central part of nursing care in ICUs. (Paju and Scannapieco, 2007) However, in spite of the signi icance of oral consideration in patients in ICUs, a few examinations primarily center around the pathophysiology of VAP and talk about the signi icance of oral consideration while inspecting the physiology of oral cavity. (Beck and Susan, 1979) Different examinations have evaluated medical caretakers' presentation in oral consideration through self-report polls and explored attendants' feeling on the quantity of oral consideration meetings through reports joined to records of patients in ICUs. (Solemdal et al., 2012) Some investigations have researched oralcare-related instruments, for example, toothbrush and mouthwashes. (Hixson et al., 1998) According to a meta-investigation, the utilization of chlorhexidine mouthwash in patients in ICUs fundamentally diminished the rate of VAP. A few investigations show that brushing is a viable method of decreasing dental plaque and VAP. (Garcia, 2005) Along these lines, contemplates have suggested that further explores be directed on oral consideration in patients in ICUs. Along these lines, the point of this examination was to assess the impact of an oral consideration on the rate of VAP in patients in ICUs. So the researcher felt the need to contribute newer practices among patients with ventilator in ICU. (Halm and Armola, 2009) The purpose of the study [1] to assess the effectiveness of oral care among ventilated patients in an experimental and control group, [2] to determine the effect of oral care among ventilated patients in an experimental and control group, [3] to compare the effectiveness of oral care among ventilated patients between an experimental and control group and [4] to associate the post-test level of oral care among ventilated patients in the experimental group.

MATERIALS AND METHODS
A quantitative approach with quasi-experimental research design was used to conduct the study in ICU at Saveetha Medical College Hospitals, Thandalam, Chennai. 60 samples were selected by using an Observational sampling-checklist method. The criteria for sample selection are patients with ventilator support at ICU, patients from 1 st day of intubation, both male and female, patients with any cause of ventilator and with both volume and pressure control ventilator mode and with any GCS score. The exclusion criteria for the samples are patients who were assessed after 24 hours of ventilator support, previous infected with VAP and known history of pneumonia and patients with continuous positive airway pressure (CPAP) mode of a ventilator. The data collection period was done with prior permission from the Saveetha Medical College and Hospital, Chennai. The purpose of the study was explained to the samples and written informed consent was obtained from them. A semi-structured interview was used to collect demographic data, and pneu-monia checklist was assessed. Selected samples on 1 st day of intubation in the experimental group and were provided oral care with 0.2% chlorhexidine every 6 th hourly till 3 rd day (72hours) and maintained pneumonia checklist respiratory rate, PaO 2 , BUN value, WBC count, platelet count and temperature. For the selected samples of the control group, oral care procedure was not applied. The data were analyzed using descriptive and inferential statistics. The sample characteristics were described using frequency and percentage. Student independent 't' test was used to assess the effectiveness of oral care between the two groups. Chi-square was used to associate the post-test level of oral care with the selected demographic variables.
Assessment of level of pneumonic checklist variables among mechanical ventilator patients in the experimental and control group.
With respect to the experimental group in Day 1, most of the patients 21(70%) had a respiratory rate of >30/min, 18(60%) had PaO 2 value of <150 mmHg, 20(66.66%) had a BUN value of >20mg/dl, 12(40%) had a WBC count of <10000, 25(83.34%) had a platelet count of 100000 -500000/lakh, and 22(73.33%) had a temperature of >36 • C. Whereas in the Day 3 most of the patients 23(76.66%) had a respiratory rate of <20/min, 17(56.67%) had PaO 2 value of >250 mmHg, 25(83.33%) had a BUN value of 10-20mg/dl, 15(50%) had a WBC count of <10000 and 10000 -15000 respectively, 30(100%) had a platelet count of 100000 -500000/lakh, and 15(50%) had a temperature of >36 • C. In the control group on Day 1, most of the patients 22(73.34%)   .05 level respectively. Regarding platelet count (t=0.769, p = 0.448) was not found to be statistically signi icant. These inding clearly infers that there was a signi icant difference in the Day 1 and Day 13 scores of pneumonia checklist variables except platelet count in the experimental group which clearly proves the effectiveness of oral care on bacterial colonization and ventilator-associated pneumonia in the experimental group. (Table 2) The comparison of pneumonia checklist among ventilator patients between the experimental and control group in Day 3 using the student independent 't' test. The calculated value of unpaired 't' test value of respiratory rate (t=6.527, p=0.0001), PaO 2 (t=7.042, p = 0.0001), BUN Value (t=3.263, p = 0.002), WBC count (t=5.084, p = 0.0001), platelet count (t=3.974, p=0.0001) was found to statistically signi icant at p<0.001 level. Regarding temperature (t=0.521, p = 0.605) was not found to be statistically signi icant. These inding clearly infers that there was a significant difference in the Day 13 scores of pneumonia checklist variables except temperature between the experimental and control group which clearly proves the effectiveness of oral care on bacterial colonization and ventilator-associated pneumonia in the experimental group than the patients in the control group who had undergone normal hospital routine measures. (Table 3) Another study was also supported by Fourrier et al. (2000) who conducted a study on Dental status was surveyed by the Caries-Absent-Occluded ile; the measure of the dental plaque was evaluated by a semi-quantitative plaque record. Bacterial testing of dental plaque, nasal and tracheal suction, blood, and pee societies were done on days 0, 5, 10, and consistently. Sixty patients were incorporated; 30 in the treated gathering and 30 in the control one (mean age: 51±16 years; mean Simpli ied Acute Physiological Score II: 35±14 focuses). On af irmation, no critical contrasts were found between the two gatherings for all clinical and dental information.
Contrasted and the benchmark group, the nosocomial disease rate and the occurrence densities identi ied with hazard piece were essentially lower in the treated gathering (18 versus 33‰ days in the ICU and 10.7 versus 32.3‰ long stretches of mechanical ventilation; P<0.05). These outcomes were predictable with a critical preventive impact of the sterile disinfecting (Odds Ratio: 0.27; 95% CI: 0.09; 0.80) with a 53% relative danger decrease. There was a pattern to a decrease of mortality, length of remain, and span of mechanical ventilator.
The present study also depicts that in the experimental group the demographic variable cause of ventilator had shown statistically signi icant association with a platelet count of the patients at p<0.001 level The table also shows that the demographic variables age and GCS had shown statistically signi icant association with respiratory rate and PaO 2 score at p<0.01 level and it further shows that the demographic variable is known to cause of illness had shown statistically signi icant association with BUN Value of the mechanical ventilator patients at p<0.05 level. The other demographic variables had not shown statistically signi icant association with any of the pneumonic checklist variables in the experimental group.

CONCLUSIONS
The present study assessed the effect of oral care on bacterial colonization and ventilated associated pneumonia among ventilated patients. The results revealed that oral care provided to ventilated patients in the experimental group was proved to be effective, and there was a signi icant difference is the level of pneumonia among ventilated patients between the groups.