Do institutional oral hygiene recommendations influence bedside practices?

Purpose:
The goal of the study was to explore how institutional oral hygiene recommendations or guidelines influence critical care nurses' oral hygiene practices with focus on ventilator-associated pneumonia prevention (VAP).

Background/Significance:
VAP is still a common nosocomial infection in critical care units despite continuous prevention efforts. Maintaining oral hygiene is one of the key components of VAP prevention. Institutional recommendations or guidelines are used by administrators to implement evidence-based practices. However, evidence suggests that there are gaps between evidence-based recommendations and bedside practices.

Methods:
Paper surveys were distributed via the research team to all critical care nurses at eight Northern California hospitals. Within a VAP prevention survey, 21 questions addressed oral hygiene practices (frequencies, methods used, and guideline adherence) and practice perceptions (awareness, priority levels, attitudes, and time availability). ANOVA was used to explore the relationship between implementation method of institutional recommendations and adherence to oral hygiene recommendations and practice perceptions. Spearman's correlations were used to examine adherence to oral hygiene recommendation and adherence factors.

Results:
Surveys were completed by 576 ICU nurses (44.6% response rate). Institutional oral hygiene recommendations were implemented as either a nursing policy (four hospitals), standard order set (two hospitals), or information bulletin (two hospitals). For oral assessment and oral swabs practice frequencies, just having the recommendations were associated with more frequent oral cavity assessment and use of oral swabs (p≤.01). Adherence, awareness, and level of priority were lowest in hospitals with a nursing policy (p≤.020-.032). Spearman's correlations were most robust for time availability (r = .409). Moderate correlations existed between adherence and practice perceptions (r =.253-.269).

Conclusions and Implications for Practice:
Institutional recommendations are valuable to guide bedside practices. Implementation methods of the institutional recommendations should be carefully considered and utilized to encourage more favorable attitudes and behaviors.