Oral Hygiene Methodology
There is a significant amount of research that shows statistical correlation between oropharyngeal bacterial colonization and the presence bacteria responsible for ventilator associated pneumonia (VAP). Several interventions have been shown as effective in reducing the incidence of VAP, but many have not gained widespread clinical use in a majority of hospitals. Research does show that the amount of oropharyngeal bacteria present in the mouth and oral cavity has a relationship to the propensity of developing VAP. This is likely due to the lack of appropriate levels of oral hygiene combined with the bacterial colonization of ventilator equipment. We expect that oral and mouth washes regularly administrated that include chlorohexedine will kill bacteria and reduce incidence of VAP infections on ICU patients. The aim of this study will be to survey the efficacy of chlorohexdedine mouth washes in a randomized group of patients who were placed in an ICU ward at X Hospital between (dates).
Support for Methodology -- If VAP is allowed to spread, serious measures are often needed. The issue for most researchers is the cross-contamination with invasive devices in lieu of appropriate use of antibiotics or other substances that prevent the bacteria responsible for VAP (Linvingtston, 2000). Extensive literature reviews showed that physical, positional, and pharmacological interventions may indeed affect the rates and contamination levels of VAP causing bacteria, which also show to place certain patients at a higher risk for gastrointestinal bleeding (Dodek, P., et al., 2004). While it appears that aspiration of gastric secretions contributes to VAP, it also appears that continuous oscillation or at least regularly turning of patients does help decrease the issue which, depending on the cost effectiveness of labor, may be more expensive that adding oral mouthwashes (Collard & Saint, 2005).
Topical use of chlorhexidine resulted in a reduced incidence of VAP in several trials, but had different levels of efficacy depending on the reason for the patient's stay in ICU, with the most benefit going to cardiac surgery patients (Chlebicki & Safdar, 2007). Additional randomized studies showed that patients who received oral decontamination with 2% chlorhexidine or normal saline solution four times per day showed that there was really no significant different in rates of VAP. The saline group did have a small number of increased incidents (12 out of 105 as opposed to 5 out of 102, but saline appears to also be effective in reducing VAP (Tantipong, H., et al., 2008). Still, there are a number of research studies that validate the protocol we will be using to test levels of chlorhexidine on patients using simply one set of variable with solution, one set not (Sharma & Kaur, 2012; Sebastian, M., et al., 2012).
Research Design - A quasi-experimental design will be used to compare two groups of patients, all admitted to an ICU ward and. The study will involve a group in which 11 ICU patients who were fitted with a ventilator were studied and 11 patients not on ventilators. Patients are between 17-72 years old, and exclusion criteria will be patients under 18, those who already have infection pneumonia, and/or patients who have been transferred from another medical facility.
Protection of Patient's Rights - Each patient will be asked to agree to the study, and will be randomly numbered -- V1, V2; R1, R2, etc. Only pertinent demographic information will be collected from the patients, and no personal identification data will be collected or saved. Pre- and post-observational studies included mechanically ventilated patients. Rates of VAP were calculated and analysis done. Only bacterial counts and tests to determine VAP were part of this study; other issues surrounding ventilation and/or other bodily infections based on ICU care were ignored. Permission to conduct the study will be obtained from X University and the Institutional Review Board. In addition, the study will be approved by the hospital's research and ethics committee, as well as the Director of ICU at Y Hospital. An informed consent form will be signed by each patient and/or family member within the study (See Appendix A).
Experimental Methodology- A prospective study will be performed with 22 patients in a trauma ward, 11 on a ventilator, and 11 not on a ventilator. The protocol will be such that each patient will be given a 6oz. cup of a chlorhexidine oral cleansing three times daily, once after breakfast or before 9am; once between 1-2pm, and once between 7pm-8pm. Each patient will be asked to swish the solution for a minimum of 30 seconds if able; if not, medical personnel will artificially use a syringe to spray the mouth, tongue and inner lip area with the solution and allow it to drain into a cloth or pan. Swabs will be taken just prior to the use of the mouthwash. A solution of 2% Chlorhexidine will be used in the rinse. The solution will be alcohol based, but as low a dose as possible to ensure that the chlorhexidine dissolves properly.
For the purposes of this study, the swab results will be limited...
With our progressing knowledge in molecular biology and the increasing understanding of the various signaling pathways there is no question of doubt that in the near future the prognosis for OSCC would be considerably improved. As with any other disease, prevention is better than cure. Avoiding the well-known risk factors, a well-balanced nutritional plan and regular dental health checkups are the most effective means of preventing Oral cancers. Bibliography 1) Michael
suffered from its quasi-experimental approach, as several participants left the study since they left the facility or otherwise were not permitted to participate -- for example, those patients who recovered sufficiently to conduct their own oral care no longer engaged in the experimental protocol and condition. The results were positive and significant, however, the severity of the patients' conditions and the small sample size challenged the researchers, as discussed
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