Oral Care: Good for One, Good for All

 

A few months ago, I opened the topic of oral care for the NICU baby. We know that it has long been established as our standard of care for our ELBW and VLBW infants. It was fun to bring a fresh idea to the table to present oral care as immune therapy and spark new life to this “old” topic.  And thanks to you, the readers of this blog, it was a great discussion among many in the NICU.

As I read through some of the comments on that particular blog and on other NICU sites, I began to realize a commonality among us all. We, as clinicians, have created wonderful protocols and practice around oral care using colostrum in our small babies.

We are diligent to do it in the first 72 hours and while a patient is intubated, or on NCPAP. However, while reading through these pages of information, I realized that there are few protocols that call for oral care beyond the initial few days and weeks of life, or that recommend continuation of this beyond the life of the colostrum. And so I began to wonder, shouldn’t we be doing oral care on everyone?

After thinking through some of this, I scoured the research. Unfortunately, there isn’t much that focuses on oral care beyond the premature infant. However, there are some intriguing things to discuss. And then, you can make your own judgment.

If you use your favorite search engine to identify information related to oral care in the hospital, you are greeted with a laundry list of reputable articles that discuss the importance of oral care in the adult population – far beyond the ICU, and far beyond ventilated patients. As I took it a step further and used a medical library search engine, I found countless journal articles that supported the internet search.  Many led to the conclusion that oral care in adult patients decreased their risk of hospital acquired infections.

I then went on to think about how our NICU babies are at such a high risk for nosocomial infection given their environment, their gestational age, and a developing immune system. As a bedside nurse, I want to always do what I can to help each baby overcome the circumstances they are in.

We have already discussed the immune therapy of breast milk and colostrum, and so I ask the question, why wouldn’t we use this for all our babies?

My one obstacle was what to use if there is no breast milk. Thankfully, there is a great pilot trial completed by Stephanescu, et al that evaluated the effectiveness of Biotene^® and sterile water.1  Their conclusion was that Biotene and sterile water were both acceptable for oral care, and for decreasing ventilator associated pneumonia (VAP), although the Biotene group had lower infections. These results suggest that these may be secondary options for completing oral care in all our patients in the NICU.

I leave you to decide what is best by closing with my experience during a recent visit to a children’s hospital. I was in discussion with a nursing educator who happened to share with me that their NICU had transitioned to oral care for everyone in the previous year. As she was sharing, she mentioned that their VAP rates were zero, and then mentioned that this practice crossed unit lines into their Cardiac ICU, where they also achieved a zero VAP rate.

So my final question to you: If swabbing a baby’s mouth with a little bit of colostrum, breast milk, sterile water, or a commercial gel seems to help decrease their risk for a hospital acquired infection, shouldn’t we do it on all our patients? Let us know your thoughts in the comments section below!

Reference:

1. Stephanescu, B., Hetu, C.,Slaughter, J., et al (2013). A Pilot Study of Biotene OralBalance^®Gel for Oral Care in Mechanically Ventilated Preterm Neonates.  Contemporary Clinical Trials. (35)33-39.