Discussion of the primary research requirement

Several types of research have been conducted on Oral Microbial Flora. Pedreira, Kusahara, Carvalho, Nunez and Peterlini (1) delved into colonization in Children undergoing Mechanical Ventilation. Munro, Grap, Jones, McClish and Sesslar (2) tackles Tooth brushing and Preventing Ventilator-Associated Pneumonia in Critically Ill Adults. Preza, Olsen, Aas, Willumsen, Grinde and Paster (2) study Bacteria Profiles of Root Caries in Elderly Patients.

Pedreira’s (1) objective was to compare the microbial profile in the oral pharynx path, the length of ventilation and the duration of stay in the intensive care unit by children subjected to ventilation process that have history of drug or non-drug oral care. The method used involved randomized control study conducted in a PICU in Sao Paulo, Brazil. The patients or their guardians were given highlights on aims, methods and limitations to be encountered. Of the 146 patients during the 9 months of the study 38 percent took part in the study. Criteria for eligibility were thoroughly interrogated. Children who were in the PICU less than 48 hours were also not allowed to take part in the study. There was random assignment of the children to the two groups of the study. In the experimental group, oral care included the use of an oral gel containing chlorbexidine digluconate 0.12 percent as an active ingredient. The control group was subjected to the same oral care except for unavailability of the antiseptic agent. Gel was given code according to codes to conceal identities. The pharmacist was the custodian of the information pertaining to the identity of the gel types. PICU nurses were trained in oral care by a dentist. Evaluation of child oral status was done. The selection of oral care equipment was done bearing in mind the child’s age. During the training, a description of the required outcome was covered with care taken to avoid interference with the oral and labial mucosa. Children were put in lateral position to avert the possibility of pulmonary aspiration of the secretions. A toothbrush with gel was used to clean the teeth in quadrants. The teeth were cleaned, ventral surface of the tongue was brushed in a posterior-anterior manner. Oral mucosa was rubbed by swab dipped in gel. A total of 56 children took part in the study, with 52 percent being control group and 48 percent in the experimental group. The two groups had similar demographic features, medical conditions, and diseases, drug and nutrient requirements. There was no significant difference in intubation characteristics between the control and experimental groups. The two groups had no disparity in the Nine Equivalents of Nursing Manpower Use Score, oral cavity clinical conditions according to the DMFT index, the health status of the oral mucosa, length of mechanical ventilation or length of PICU stay. After two days of admission, there was notable decrease in microbial invasion in children in the experimental group compared to those in control group that increased. In both, the groups’ Streptococcus viridans was detected in high numbers. Coagulase-negative Staph and Moraxella were notably present after thorough isolation exercise. Gram-negative bacteria were overly predominant. P. aureginosa and A. baumanii were higher in control group than the experimental group and that of K. pneumonia and Enterobacter spp higher in experimental group. Sample totaling 26 had pathogenic bacteria among which some antibiotic-resistant like the K. pneumonia which is resistant to beta-lactamase, methicillin-resistant S. aureus. The buccal cavity can be the origin of the spread of pathogenic organisms to other organs such as lungs. Nosocomial infections are caused by microbes colonizing oral-pharynx path. Inhalation of air containing bacteria, make the microbes spread from different locations of the body. The movement of bacteria takes place in the gastrointestinal tract. Therefore, reduction of bacteria in the oral pharyngeal tract can have effect on oral colonization and the prevalence of respiratory hospital-acquired infections. The difference in colonization by pathogenic bacteria was insignificant between control and experimental entities. There was no difference in microbial activity in the oral cavity by the oral flora between the two groups. E. coli, K. pneumonia, and other species of Acinetobacter were very prevalent. Gram-negative bacteria cause the highest number of infections in adults in ICU. Children in experimental group had more Enterobacter species accounting for 75 percent, E. coli- 100 percent and K. pneumonia-71 percent than in children in control group. Future studies should capture the effects of oral care on development of VAP in infants.

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