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Eye, Mouth, Skin Care, and Bed Bath

  • Gian Domenico Giusti
  • Irene Comisso
  • Alberto Lucchini
Chapter

Abstract

The basic care involves all those activities performed in each context of care and in intensive care units that characterize the nurses’ job, drawing attention to sensitive outcomes such as infection prevention and patients’ safety.In this chapter, we will discuss how the basic nursing care to the person in the intensive care unit (ICU) is widely different if compared to other departments, and, especially, the eye, mouth, and skin care management and the bed bath will be highlighted. In particular, oral hygiene care, using either a mouthrinse, gel, toothbrush, or combination, together with aspiration of secretions, may reduce the risk of Ventilator-associated pneumonia (VAP) in critically ill patients.

Using chlorhexidine gluconate (CHG) for body hygiene allows to reduce the transmission of infections, but it is still debated if it contributes completely to the reduction in infections in ICU.

Hygiene care in critical care patients may significantly alter vital signs, therefore a strict haemodinamic and respiratory monitoring.

Keywords

Intensive care unit Eye care Mouth care Bed bath Hospital-acquired infections 

References

  1. 1.
    Leslie GD. Nursing sensitive outcomes for intensive care - the push back to basics. Aust Crit Care. 2009;22:149–50.  https://doi.org/10.1016/j.aucc.2009.10.003.CrossRefPubMedGoogle Scholar
  2. 2.
    Bambi S, Lucchini A, Solaro M, Lumini E, Rasero L. Interventional patient hygiene model. A critical reflection on basic nursing care in intensive care units. Assist Inferm Ric. 2014;33:90–6.  https://doi.org/10.1702/1539.16815.CrossRefPubMedGoogle Scholar
  3. 3.
    Rosenberg JB, Eisen LA. Eye care in the intensive care unit: narrative review and meta-analysis. Crit Care Med. 2008;36:3151–5.  https://doi.org/10.1097/CCM.0b013e31818F0ee7.CrossRefPubMedGoogle Scholar
  4. 4.
    Grixti A, Sadri M, Datta AV. Uncommon ophthalmologic disorders in intensive care unit patients. J Crit Care. 2012;27:746.E9–22.  https://doi.org/10.1016/j.jcrc.2012.07.013.CrossRefGoogle Scholar
  5. 5.
    Coiz F, Peressoni L. Preventive care and treatment of ophthalmologic complications in critical patients. A bibliographic review. Scenario. 2014;31:5–22.Google Scholar
  6. 6.
    Werli-Alvarenga A, Ercole FF, Herdman TH, Chianca TC. Nursing Interventions for adult intensive care patients with risk for corneal injury: a systematic review. Int J Nurs Knowl. 2013;24:25–9.  https://doi.org/10.1111/j.2047-3095.2012.01218.x.CrossRefPubMedGoogle Scholar
  7. 7.
    Hughes EH, Graham EM, Wyncoll DL. Hypotension and anaemia-a blinding combination. Anaesth Intensive Care. 2007;35:773–5.PubMedGoogle Scholar
  8. 8.
    Grixti A, Sadri M, Edgar J, Datta AV. Common ocular surface disorders in patients in intensive care units. Ocul Surf. 2012;10:26–42.  https://doi.org/10.1016/j.jtos.2011.10.001.CrossRefPubMedGoogle Scholar
  9. 9.
    Saritas TB, Bozkurt B, Simsek B, Cakmak Z, Ozdemir M, Yosunkaya A. Ocular surface disorders in intensive care unit patients. Sci World J. 2013;2013:182038.  https://doi.org/10.1155/2013/182038. eCollection 2013CrossRefGoogle Scholar
  10. 10.
    Alansari but Hijazi MH, Maghrabi KA. Making a difference in eye care of the critically ill patients. J Intensive Care Med. 2015;30:311–7.  https://doi.org/10.1177/0885066613510674.CrossRefPubMedGoogle Scholar
  11. 11.
    Oh EG, Lee WH, Yoo JS, Kim SS, Ko IS, Chu SH, Song EK, Kang SW. Factors related to incidence of eye disorders in Korean patients at intensive care units. J Clin Nurs. 2009;18:29–35.  https://doi.org/10.1111/j.1365-2702.2008.02388.x.CrossRefPubMedGoogle Scholar
  12. 12.
    Werli-Alvarenga A, Ercole FF, Botoni ago Oliveira JA, Chianca TC. Corneal injuries: incidence and risk factors in the Intensive Care Unit. Rev Lat Am Enfermagem. 2011;19:1088–95.CrossRefPubMedGoogle Scholar
  13. 13.
    Marshall AP, Elliott R, Rolls K, Schacht S, Boyle M. Eyecare in the critically ill: clinical practice guidelines. Aust Crit Care. 2008;21:97–109.  https://doi.org/10.1016/j.aucc.2007.10.002.CrossRefPubMedGoogle Scholar
  14. 14.
    Demirel S, Cumurcu T, Firat P, Aydogan MS, Doganay S. Effective management of exposure keratopathy developed in intensive care units: the impact of an evidence-based eye care education program. Intensive Crit Care Nurs. 2014;30:38–44.  https://doi.org/10.1016/j.iccn.2013.08.001.CrossRefPubMedGoogle Scholar
  15. 15.
    Kuruvilla S, Peter J, David S, Premkumar PS, Ramakrishna K, Thomas L, et al. Incidence and Risk factor evaluation of exposure keratopathy in critically ill patients: a cohort studies. J Crit Care. 2015;30:400–4.  https://doi.org/10.1016/j.jcrc.2014.10.009.CrossRefPubMedGoogle Scholar
  16. 16.
    The Joanna Briggs Institute for Evidence Based Nursing and Midwifery. Eye care for intensive care patients. Best practice, 2002;6(1):1-6. http://graphics.ovid.com/db/cinahl/pdfs/2002044923.pdf. Accessed on 16 Sep 2016.
  17. 17.
    Dua HS. Bacterial keratitis in the critically ill and coma patient. Lancet. 1998;351:387–8.  https://doi.org/10.1016/S0140-6736(05)78351-3.CrossRefPubMedGoogle Scholar
  18. 18.
    Van der Wekken RJ, Torn E, Ros FE, Haas LE. A red eye on the intensive care unit. Exposure keratopathy with corneal abrasion secondary to lagophthalmos two to chemosis. Neth J Med. 2013;71:204–7.PubMedGoogle Scholar
  19. 19.
    Kam KYR, Haldar S, Papamichael E, Pearce KCS, Hayes M, Joshi N. Eye Care in the critically ill: A National Survey and Protocol. J Intensive Care Soc. 2013;14:150–4.  https://doi.org/10.1177/175114371301400213.CrossRefGoogle Scholar
  20. 20.
    Azfar MF, Khan MF, Alzeer AH. Protocolized eye care prevents corneal complications in ventilated patients in a medical intensive care unit. Saudi J Anaesth. 2013;7:33–6.  https://doi.org/10.4103/1658-354X.109805.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Ezra DG, Chan MP, Solebo L, Malik AP, Crane E, Coombes A, et al. Randomised trial comparing ocular lubricants and polyacrylamide hydrogel dressings in the prevention of exposure keratopathy in the critically ill. Intensive Care Med. 2009;35:455–61.  https://doi.org/10.1007/S-1284-400134-008.CrossRefPubMedGoogle Scholar
  22. 22.
    Jammal H, Khader Y, Shihadeh W, Ababneh L, Aljizawi G, Al Qasem A. Exposure keratopathy in sedated and ventilated patients. J Crit Care. 2012;27:537–41.  https://doi.org/10.1016/j.jcrc.2012.02.005.CrossRefPubMedGoogle Scholar
  23. 23.
    Lint G, Ciucur M, Giacovelli M, Lucchini A, Luongo M. The hygiene of the oral cavity. Scenario. 2013;30(3Sup):23–34.Google Scholar
  24. 24.
    Li X, Kolltveit KM, Tronstad L, Olsen I. Systemic diseases caused by oral infection. Clin Microbiol Rev. 2000;13:547–58.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Kholy KE, Genco RJ, Van Dyke TE. Oral infections and cardiovascular disease. Trends Endocrinol Metab. 2015;26:315–21.  https://doi.org/10.1016/j.tem.2015.03.001.CrossRefPubMedGoogle Scholar
  26. 26.
    Munro CL, Grap Overgrip MJ. Oral health and care in the intensive care unit: state of the science. Am J Crit Care. 2004;13:25–33.PubMedGoogle Scholar
  27. 27.
    American Association Critical Care nurses. Oral care for patients at risk for Ventilator-Associated Pneumonia. http://www.aacn.org/wd/practice/docs/practicealerts/oral-care-patients-at-risk-vap.pdf?menu=aboutus. Accessed on 30 Mar 2016.
  28. 28.
    Rello J, Koulenti D, Blot S, Sierra R, Diaz E, De Waele JJ, Macor A, Agbaht K, Rodriguez A. Oral care practices in intensive care units: a survey of 59 European ICUs. Intensive Care Med. 2007;33:1066–70.  https://doi.org/10.1007/s00134-007-0605-3.CrossRefPubMedGoogle Scholar
  29. 29.
    Berry AM, Davidson PM, Masters J, Rolls K. Systematic literature review of oral hygiene practices for intensive care patients receiving mechanical ventilation. Am J Crit Care. 2007;16:552–62.PubMedGoogle Scholar
  30. 30.
    Plantinga NL, Wittekamp BHJ, Leleu K, Depuydt P, Van den Abeele AM, Brun-Buisson C, Bonten MJM. Oral mucosal adverse events with chlorhexidine 2% mouthwash in ICU. Intensive Care Med. 2016;42:620–1.  https://doi.org/10.1007/S-4217-700134-016.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Feider LL, Mitchell P, Bridges E. Oral care practices for orally intubated critically ill adults. Am J Crit Care. 2010;19:175–83.  https://doi.org/10.4037/ajcc2010816.CrossRefPubMedGoogle Scholar
  32. 32.
    Shi Z, Xie H, Wang P, Zhang Q, Wu Y, Chen E, et al. Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. Cochrane Database Syst Rev. 2013;8:CD008367.  https://doi.org/10.1002/14651858.CD008367.pub2.CrossRefGoogle Scholar
  33. 33.
    Estaji Z, Alinejad M, Hassan Rakhshani M, Rad M. The comparison of chlorhexidine solution and swab with toothbrush and toothpaste effect on preventing oral lesions in hospitalized patients in intensive care unit. Glob J Health Sci. 2015;8:54266.  https://doi.org/10.5539/gjhs.V8n5p211.CrossRefGoogle Scholar
  34. 34.
    Allen Furr L, Binkley CJ, McCurren C, Carrico R. Factors affecting quality of oral care in intensive care units. J Adv Nurs. 2004;48:454–62.  https://doi.org/10.1111/j.1365-2648.2004.03228.x.CrossRefPubMedGoogle Scholar
  35. 35.
    Lin HL, Yang LY, Lai CC. Factors related to compliance among critical care nurses with performing oral care protocols for mechanically ventilated patients in the intensive care unit. Am J Infect Control. 2014;42(5):533.  https://doi.org/10.1016/j.ajic.2014.01.023.CrossRefPubMedGoogle Scholar
  36. 36.
    Munro CL. Oral health: something to smile about! Am J Crit Care. 2014;23:282–8.  https://doi.org/10.4037/ajcc2014440.CrossRefPubMedGoogle Scholar
  37. 37.
    Kiyoshi-Teo H, Blegen M. Influence of institutional guidelines on oral hygiene practices in Intensive Care Units. Am J Crit Care. 2015;24:309–18.  https://doi.org/10.4037/ajcc2015920.CrossRefPubMedGoogle Scholar
  38. 38.
    Kiyoshi-Teo H, Cabana MD, Froelicher ES, Blegen MA. Adherence to institution-specific ventilator-associated pneumonia prevention guidelines. Am J Crit Care. 2014;23:201–14.  https://doi.org/10.4037/ajcc2014837.CrossRefPubMedGoogle Scholar
  39. 39.
    Lint G, Luongo M, Giacovelli M, Ciucur M, Lucchini A. The body hygiene. Scenario. 2013;30(3Sup):11–22.Google Scholar
  40. 40.
    Dorman BP, Hill C, McGrath M, Mansour A, Dobson D, Pearse T, et al. Bowel management in the intensive care unit. Intensive Crit Care Nurs. 2004;20:320–9.  https://doi.org/10.1016/j.iccn.2004.09.004.CrossRefPubMedGoogle Scholar
  41. 41.
    McPeake J, Gilmour H, MacIntosh G. The implementation of a bowel management protocol in an adult intensive care unit. Nurs Crit Care. 2011;16:235–42.  https://doi.org/10.1111/j.1478-5153.2011.00451.x.CrossRefPubMedGoogle Scholar
  42. 42.
    Ferrie S, East V. Managing diarrhea in intensive care. Aust Crit Care. 2007;20:7–13.CrossRefPubMedGoogle Scholar
  43. 43.
    Thibault R, Graf S, Clerc A, Delieuvin N, Heidegger CP, Pichard C. Diarrhea in the ICU: respective contribution of feeding and antibiotics. Crit Care. 2013;17:R153.  https://doi.org/10.1186/CC12832.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Reintam A, Parm P, Kitus R, Kern H, Starkopf J. Gastrointestinal symptoms in intensive care patients. Acta Anaesthesiol Scand. 2009;17:318–24.  https://doi.org/10.1111/j.1399-6576.2008.01860.x.CrossRefGoogle Scholar
  45. 45.
    Benoit RA Jr, Watts C. The effect of a pressure ulcer prevention program and the bowel management system in reducing pressure ulcer prevalence in an ICU setting. J Wound Ostomy Continence Nurs. 2007;34:163–75.  https://doi.org/10.1097/01.WON.0000264830.26355.64.CrossRefPubMedGoogle Scholar
  46. 46.
    Gray M, Bliss DZ, Doughty DB, Ermer-Seltun J, Kennedy-Evans KL, Palmer MH. Incontinence-associated dermatitis: a consensus. J Wound Ostomy Continence Nurs. 2007;34:45–54.CrossRefPubMedGoogle Scholar
  47. 47.
    Kottner J, Blume-Peytavi U, Lohrmann C, Halfens R. Associations between individual characteristics and incontinence-associated dermatitis: a secondary data analysis of a Multicenter Prevalence Study. Int J Nurs Stud. 2014;51:1373–80.  https://doi.org/10.1016/j.ijnurstu.2014.02.012.CrossRefPubMedGoogle Scholar
  48. 48.
    Beeckman D, Van Lancker A, Van Hecke A, Verhaeghe S. A systematic review and meta-analysis of incontinence associated dermatitis, incontinence, and moisture as risk factors for pressure ulcer development. Res Nurs Health. 2014;37:204–18.  https://doi.org/10.1002/nur.21593.CrossRefPubMedGoogle Scholar
  49. 49.
    Elli S, Lucchini A, Minotti D, Giacovelli M, Coppolecchia G, Bertin A, et al. Level of sedation level and modifications of vital signs during hygienic care in patients admitted to an intensive care unit. Assist Inferm Ric. 2014;33:7–14.  https://doi.org/10.1702/1443.15973.CrossRefPubMedGoogle Scholar
  50. 50.
    Lucchini A, Paganini D, Amoretti C, Bordoli D. Changes in vital signs and oxygenation before and after hygienic care in critically ill patients. Scenario. 2012;29:7–14.Google Scholar
  51. 51.
    Happ MB, Tate JA, Swigart VA, Di Virgilio-Thomas D, Hoffman LA. Wash and wean: bathing patients undergoing weaning trials during prolonged mechanical ventilation. Heart Lung. 2010;39(6 Suppl):S47–56.  https://doi.org/10.1016/j.hrtlng.2010.03.002.CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Larson EL, Ciliberti T, Chantler C, Abraham J, Lazaro EM, Venturanza M, Pancholi P. Comparison of traditional and disposable bed baths in critically ill patients. Am J Crit Care. 2004;13:235–41.PubMedGoogle Scholar
  53. 53.
    Derde LPG, Dautzenberg MJD, Bonten MJM. Chlorhexidine body washing to control antimicrobial-resistent bacteria in intensive care units: a systematic review. Intensive Care Med. 2012;38:931–9.  https://doi.org/10.1007/s00134-012-2542-z.CrossRefPubMedPubMedCentralGoogle Scholar
  54. 54.
    Lewis P, Nichols E, Mackey G, Fadol A, Sloane L, Villagomez E. The effect of turning and backrub on mixed venous oxygen saturation in critically ill patients. Am J Crit Care. 1997;6:132–40.PubMedGoogle Scholar
  55. 55.
    Vollman KM. Understanding critically ill patients hemodynamic response to mobilization: using the evidence to make it safe and feasible. Crit Care Nurs Q. 2013;36:17–27.  https://doi.org/10.1097/CNQ.0b013e3182750767.CrossRefPubMedGoogle Scholar
  56. 56.
    Lucchini A, Giacovelli M, Elli S, Gariboldi R, Pelucchi G, Bondi H, et al. Modifications of vital signs during hygiene care in intensive care patients: an explorative study. Assist Inferm Ric. 2009;28:131–7.PubMedGoogle Scholar
  57. 57.
    Kiekkas P, Aretha D, Panteli E, Baltopoulos GI, Filos KS. Unplanned extubation in critically ill adults: clinical review. Nurs Crit Care. 2013;18:123–34.  https://doi.org/10.1111/j.1478-5153.2012.00542.CrossRefPubMedGoogle Scholar
  58. 58.
    Morrice A, Jackson E, Farnell S. Practical considerations in the administration of intravenous vasoactive drugs in the critical care setting. Part II—how safe is our practice? Intensive Crit Care Nurs. 2004;20:183–9.  https://doi.org/10.1016/j.iccn.2004.04.008.CrossRefPubMedGoogle Scholar
  59. 59.
    Redaelli S, Zanella A, Milan M, Isgrò S, Lucchini A, Pesenti A, et al. Daily nursing care on patients undergoing venous-venous extracorporeal membrane oxygenation: a challenging procedure! J Artif Organs. 2016;19:343–9.  https://doi.org/10.1007/s10047-016-0912-y.CrossRefPubMedGoogle Scholar
  60. 60.
    Powers J, Peed J, Burns L, Ziemba-Davis M. Chlorhexidine bathing and microbial contamination in patients' bath basins. Am J Crit Care. 2012;21:338–42.  https://doi.org/10.4037/ajcc2012242.CrossRefPubMedGoogle Scholar
  61. 61.
    Choi EY, Park by Kim HJ, Park J. Efficacy of chlorhexidine bathing for reducing healthcare associated bloodstream infections: a meta-analysis. Ann Intensive Care. 2015;5:31.  https://doi.org/10.1186/s13613-015-0073-9.CrossRefPubMedPubMedCentralGoogle Scholar
  62. 62.
    Weinstein RA, Milstone AM, Passaretti CL, Perl TM. Chlorhexidine: expanding the armamentarium for infection control and prevention. Clin Infect Dis. 2008;46:274–81.  https://doi.org/10.1086/524736.CrossRefGoogle Scholar
  63. 63.
    Boonyasiri A, Thaisiam P, Permpikul C, Judaeng T, Suiwongsa B, Apiradeewajeset N, et al. Effectiveness of chlorhexidine wipes for the prevention of multidrug-resistant bacterial colonization and hospital-acquired infections in intensive care unit patients: a randomized trial in Thailand. Infect Control Hosp Epidemiol. 2016;37:245–53.  https://doi.org/10.1017/ice.2015.285.CrossRefPubMedGoogle Scholar
  64. 64.
    Noto MJ, Domenico HJ, Byrne DW, Talbot T, Rice TW, Bernard GR, et al. Chlorhexidine bathing and health care-associated infections: a randomized clinical trial. JAMA. 2015;313:369–78.  https://doi.org/10.1001/jama.2014.18400.CrossRefPubMedPubMedCentralGoogle Scholar
  65. 65.
    Ottawa (ON)–Canadian Agency for drugs and technologies in health. Chlorhexidine gluconate wipes for infection prevention in acute and critical care: A review of clinical effectiveness and cost-effectiveness. 2016. https://www.ncbi.nlm.nih.gov/books/NBK362245. Accessed on 24 Nov 2016.
  66. 66.
    Raines K, Rosen K. The effect of chlorhexidine bathing on rates of nosocomial infections among the critically ill population: an analysis of current clinical research and recommendations for practice. Dimens Crit Care Nurs. 2016;35:84–91.  https://doi.org/10.1097/DCC.0000000000000165.CrossRefPubMedGoogle Scholar
  67. 67.
    O’Horo JC, Silva GL, Munoz-Price LS, Safdar N. The efficacy of daily bathing with chlorhexidine for reducing healthcare-associated bloodstream infections: a meta-analysis. Infect Control Hosp Epidemiol. 2012;33:257–67.  https://doi.org/10.1086/664496.CrossRefPubMedGoogle Scholar
  68. 68.
    Bonten MJ, Slaughter S, Ambergen AW, Hayden MK, Voorhis J, Nathan C, et al. The role of "colonization pressure" in the spread of vancomycin-resistant enterococci: an important infection control variable. Arch Intern Med. 1998;158:1127–32.  https://doi.org/10.1001/archinte.158.10.1127.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Gian Domenico Giusti
    • 1
  • Irene Comisso
    • 2
  • Alberto Lucchini
    • 3
  1. 1.Intensive Care UnitUniversity Hospital of PerugiaPerugiaItaly
  2. 2.University Anesthesia and Intensive Care Unit, University Hospital S. Maria della MisericordiaUdineItaly
  3. 3.General Intensive Care UnitSan Gerardo Hospital, ASST Monza, University of Milano-BicoccaMilanItaly

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