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Eye, Mouth, Skin Care, and Bed Bath

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Nursing in Critical Care Setting

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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.

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References

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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. 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.

    Article  PubMed  Google Scholar 

  7. Hughes EH, Graham EM, Wyncoll DL. Hypotension and anaemia-a blinding combination. Anaesth Intensive Care. 2007;35:773–5.

    PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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 2013

    Article  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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. 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.

    Article  PubMed  CAS  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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. Li X, Kolltveit KM, Tronstad L, Olsen I. Systemic diseases caused by oral infection. Clin Microbiol Rev. 2000;13:547–58.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    PubMed  Google Scholar 

  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. 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.

    Article  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  36. Munro CL. Oral health: something to smile about! Am J Crit Care. 2014;23:282–8. https://doi.org/10.4037/ajcc2014440.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  39. Lint G, Luongo M, Giacovelli M, Ciucur M, Lucchini A. The body hygiene. Scenario. 2013;30(3Sup):11–22.

    Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  42. Ferrie S, East V. Managing diarrhea in intensive care. Aust Crit Care. 2007;20:7–13.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  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. 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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Intensive Care Unit, University Hospital of Perugia, Perugia, Italy

    Gian Domenico Giusti

  2. University Anesthesia and Intensive Care Unit, University Hospital S. Maria della Misericordia, Udine, Italy

    Irene Comisso

  3. General Intensive Care Unit, San Gerardo Hospital, ASST Monza, University of Milano-Bicocca, Milan, Italy

    Alberto Lucchini

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Giusti, G.D., Comisso, I., Lucchini, A. (2018). Eye, Mouth, Skin Care, and Bed Bath. In: Nursing in Critical Care Setting. Springer, Cham. https://doi.org/10.1007/978-3-319-50559-6_7

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