pneumonia (VAP) continues to complicate the hospital stay of patients receiving
mechanical ventilation. It is the second most common nosocomial infection in
the intensive care unit (ICU) and the most common for those mechanically ventilated.
Bacteria responsible for VAP accumulate and colonize on the oral mucosa as well
as the dental biofilm of intubated patients. However, oral care is often
insufficient in the ICU; many nurses are unaware of appropriate biofilm removal
techniques and/or do not have the required armamentarium to perform oral care.
As oral care is critical to patient’s dental hygiene and overall health status,
it seems logical to utilize the expertise of multiple professions to ensure
optimal oral care is being provided.
University (VCU) School of Dentistry senior level dental
hygiene and VCU nursing students were paired in four ICUs at VCU Health in an
interprofessional learning experience to share skills and knowledge between the
respective professions. The dental hygiene students provided oral care for
intubated patients in the nursing student’s care; nursing students were able to
witness their techniques and ask questions for their learning purposes. Dental
hygiene students provided oral screenings to assess for mouth ulcerations,
tooth brushing, tongue brushing/scraping, application of antiseptic cleanser
and lip care. Nursing students were able to contribute by providing proper
patient positioning and use of in-line suctioning needed. Dental hygiene
students were able to observe and learn from the nursing students assessing
patient comfort and sedation during the oral care. The interprofessional
experience provided opportunity for dental hygiene and nursing students to gain
appreciation and understanding of the roles they have in patient care and the
importance of a collaborative approach in improving patient outcomes. Dental
hygiene and nursing students expressed their enthusiasm for knowledge gained,
as well as the importance and desire for further collaboration.
In a hospital setting,
multiple professions use their expertise bedside to improve patient outcomes,
however, oral health care professionals are not utilized. Dental hygienists are
uniquely positioned to improve patient outcomes and reduce the incidence of
ventilator associated pneumonia by providing bedside oral care for patients and
oral health education to family care providers.
Before being paired with
nursing students in the ICU, dental hygiene students had the opportunity to
review oral care techniques for intubated patients in the nursing school
simulation lab with faculty. Faculty would like the addition of joint classroom
teaching sessions which highlight the importance effective oral care and its
relationship to systemic health for the students so that students could then
work together to provide in-services for nurses on units regarding effective
mouth care and benefits of such in order to reduce the incidence of ventilator
associated pneumonia and provide education pertaining to oral/systemic link of
good oral health. By continuing to promote interprofessional education, dental
hygiene and nursing students will learn the role of each discipline and
importance of continued collaboration.
Courtesy of Tammy Swecker
M.Ed., BSDH, Dental Hygiene Clinical Coordinator, Virginia Commonwealth
University School of Dentistry
Published on Dec. 11, 2019