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- Volume 27, Issue 2, 2011
Southern African Journal of Critical Care - Volume 27, Issue 2, 2011
Volume 27, Issue 2, 2011
Author Rencia GillespieSource: Southern African Journal of Critical Care 27, pp 34 –36 (2011)More Less
The Critical Care Nursing Forum was formally established as a substructure of the Critical Care Society of Southern Africa (CCSSA) at a Council meeting chaired by Professor Andrew Argent in June 2007. This was to address a need expressed by South African critical care nurses (CCNs) for a credible and legitimate body of CCNs in southern Africa that would address CCN matters in a constructive way.
Author Nicki FoucheSource: Southern African Journal of Critical Care 27, pp 38 –40 (2011)More Less
The theory of stewardship incorporates concepts of environmental and theological notions of practical reasoning. Within the nursing literature, stewardship has emerged as a topic of nurse leadership; however, there is a need to clarify the origins and meaning of the term.
Source: Southern African Journal of Critical Care 27, pp 42 –46 (2011)More Less
Background. Recent research has highlighted the importance of oral care in the prevention of ventilator-associated pneumonia. Although oral care is a fundamental aspect of nursing care, it is often given lower priority than other nursing interventions in intensive care units (ICUs).
Objectives. The aim of this study was to describe current oral care interventions for ventilated patients in South African ICUs. The objectives of the study were to determine the knowledge, attitudes and beliefs, and training of ICU nurses who render oral care; the type and frequency of oral care delivered to ventilated patients; hospital support and supplies available; and the availability of oral care protocols in the ICU.
Methods. A quantitative, prospective, cross-sectional research design was used. Approval to conduct the study was obtained from the Human Research Ethics Committee, University of the Witwatersrand. The study population consisted of nurses working in ICUs who provide oral care to ventilated patients.
Results. Almost all the nurses perceived oral care to be a high priority. Nurses were generally aware of the most likely mechanism of acquiring pneumonia. The type and frequency of oral care varied widely. Most nurses stated that they had adequate time and supplies to provide oral care. The majority of nurses had had some formal training in oral care, but would appreciate an opportunity to improve their knowledge and skills.
Conclusions. There is a variety of oral care practices for ventilated patients. The introduction of evidence-based oral care guidelines into units that do not currently have these guidelines may further enhance best practice and ensure that patient outcomes are not compromised unnecessarily.
Oral chlorhexidine in the prevention of ventilator-associated pneumonia in critically ill adults in the ICU : a systematic reviewSource: Southern African Journal of Critical Care 27, pp 48 –56 (2011)More Less
Purpose. The aim of this review was to evaluate the evidence on the effectiveness of oral chlorhexidine in the prevention of ventilator-associated pneumonia (VAP) in critically ill adult mechanically ventilated patients in intensive care units (ICUs).
Methodology. An extensive literature search of studies published in English was undertaken between June 2010 and June 2011. Electronic databases searched were the Cochrane Central Register of Controlled Trials (CENTRAL), the Cumulative Index of Nursing and Allied Health (CINAHL) and MEDLINE. Reference lists of articles, textbooks and conference summaries were examined and hand searching was performed. Literature searches were done using the following
Medical Subject Headings (MeSH) terms: ventilator-associated pneumonia, VAP, chlorhexidine, hospital-acquired pneumonia, nosocomial infections, mechanically ventilated patients, intensive care, mouthwash, mouth care, oral care, oral hygiene and dental care.
Selection criteria. Two reviewers selected the studies independently. Eight randomised controlled trials investigating the efficacy of oral chlorhexidine versus power tooth brushing, Listerine, placebos, bicarbonate isotonic serum rinse and normal saline in the prevention of VAP in adult mechanically ventilated, critically ill patients in ICUs met the inclusion criteria.
Data collection and analysis. All relevant data were entered into Review Manager (version 5.1) for analyses. The effect measure of choice was the risk ratio (RR) with 95% confidence intervals (CIs) for dichotomous data using the random effects (Mantel-Haenszel) model (p-value 0.05). Heterogeneity was assessed using the Cochrane Q statistic and I2.
Results. Eight randomised controlled trials met the inclusion criteria for this review. There was a 36% higher chance of VAP in the control group compared with the chlorexidine group (RR 0.64, 95% CI 0.44 - 0.91). The variation between the included studies was very small (χ2=0.24).
Conclusion. Treatment with chlorhexidine decreased the risk of VAP by 36%. The use of 2% chlorhexidine may be most effective in reducing the incidence of VAP. There was no evidence of an effect of chlorhexidine on mortality.