The oral health of critically ill children: an observational cohort study

Authors

  • Amanda Ullman,

    1. Authors: Amanda Ullman, BN, Grad. Cert. PICU, Masters of App. Sci. (Research), Clinical Nurse Researcher, School of Nursing, Queensland University of Technology, Paediatric Intensive Care Unit, Royal Children’s Hospital; Debbie Long, BN, Masters of Nursing (Crit Care), PhD Candidate, CNC Clinical Improvement, Paediatric Intensive Care Unit, Royal Children’s Hospital, Herston; Peter Lewis, PhD, RM, Cert. CC MN Ed, Senior Lecturer, School of Nursing, Queensland University of Technology, Kelvin Grove, Qld, Australia
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  • Debbie Long,

    1. Authors: Amanda Ullman, BN, Grad. Cert. PICU, Masters of App. Sci. (Research), Clinical Nurse Researcher, School of Nursing, Queensland University of Technology, Paediatric Intensive Care Unit, Royal Children’s Hospital; Debbie Long, BN, Masters of Nursing (Crit Care), PhD Candidate, CNC Clinical Improvement, Paediatric Intensive Care Unit, Royal Children’s Hospital, Herston; Peter Lewis, PhD, RM, Cert. CC MN Ed, Senior Lecturer, School of Nursing, Queensland University of Technology, Kelvin Grove, Qld, Australia
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  • Peter Lewis

    1. Authors: Amanda Ullman, BN, Grad. Cert. PICU, Masters of App. Sci. (Research), Clinical Nurse Researcher, School of Nursing, Queensland University of Technology, Paediatric Intensive Care Unit, Royal Children’s Hospital; Debbie Long, BN, Masters of Nursing (Crit Care), PhD Candidate, CNC Clinical Improvement, Paediatric Intensive Care Unit, Royal Children’s Hospital, Herston; Peter Lewis, PhD, RM, Cert. CC MN Ed, Senior Lecturer, School of Nursing, Queensland University of Technology, Kelvin Grove, Qld, Australia
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Amanda Ullman, Clinical Nurse Researcher, School of Nursing, Queensland University of Technology, Paediatric Intensive Care Unit, Royal Children’s Hospital, Herston, Qld 4029, Australia. Telephone: +6 17 3636 8700.
E-mail:amanda_ullman@health.qld.gov.au

Abstract

Aims and objectives.  This study will describe the oral health status of critically ill children over time spent in the paediatric intensive care unit, examine influences on the development of poor oral health and explore the relationship between dysfunctional oral health and healthcare-associated infections.

Background.  The treatment modalities used to support children experiencing critical illness and the progression of critical illness may result in dysfunction in the oral cavity. In adults, oral health has been shown to worsen during critical illness as well as influence systemic health.

Design.  A prospective observational cohort design was used.

Method.  The study was undertaken at a single tertiary-referral Paediatric Intensive Care Unit. Oral health status was measured using the Oral Assessment Scale and culturing oropharyngeal flora. Information was also collected surrounding the use of supportive therapies, clinical characteristics of the children and the occurrence of healthcare-associated infections.

Results.  Of the 46 participants, 63% (n = 32) had oral dysfunction and 41% (n = 19) demonstrated pathogenic oropharyngeal colonisation during their critical illness. The potential systemic pathogens isolated from the oropharynx and included Candida sp., Staphylococcus aureus, Haemophilus influenzae, Enterococcus sp. and Pseudomonas aeruginosa. The severity of critical illness had a significant positive relationship (p < 0·05) with pathogenic and absent colonisation of the oropharynx. Sixty-three percent of healthcare-associated infections involved the preceding or simultaneous colonisation of the oropharynx by the causative pathogen.

Conclusions.  This study suggests paediatric oral health to be frequently dysfunctional and the oropharynx to repeatedly harbour potential systemic pathogens during childhood critical illness.

Relevance to clinical practice.  Given the frequency of poor oral health during childhood critical illness in this study and the subsequent potential systemic consequences, evidence based oral hygiene practices should be developed and validated to guide clinicians when nursing critically ill children.

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