Factors affecting quality of oral care in intensive care units.

Aims: This paper presents a study to assess to nurses' attitudes and practices concerning oral care and to determine predictors of the quality of oral care in intensive care units.

Background: The oropharynx of critically ill patients becomes colonized with potential respiratory pathogens; oral care has been shown to reduce oropharyngeal bacteria and ventilator-associated pneumonia.

Methods: In April 2002, a random and national sample of 420 intensive care unit directors was asked to participate in the survey. Of invited directors, 126 (30%) agreed to participate and were sent questionnaires to be completed anonymously by their staff, and 102 institutions returned 556 surveys. This gave a response rate of 83% of those who consented to participate.

Results: The path model shows that nurses' oral care education, having sufficient time to provide care, prioritizing oral care, and not viewing oral care as unpleasant had direct effects on the quality of provided care. Intensive care unit experience, oral care education, and having sufficient time had indirect effects.

Conclusion: Improving the quality of oral care in intensive care units is a multi-layered task. Reinforcing proper oral care in education programmes, de-sensitizing nurses to the often-perceived unpleasantness of cleaning oral cavities, and working with hospital managers to allow sufficient time to attend to oral care are recommended.