Basic Nursing 1st Edition by Judith Wilkinson, Leslie Treas

Exercise 31

American Association of Critical-Care Nurses (AACN). (2007). AACN practice alert. Oral care in the critically ill. Retrieved December 18, 2008, from http://classic.aacn.org/ AACNIpracticeAlertnsf/Files/OC/$filelOrark.20Care%20in %20the%20Critically%20111%20.pdf
This evidence report reviewed 14 references and graded the evidence for the conclusions they drew. They used a scale of I to VI, with Level VI being the strongest support and Level I being the weakest (manufacturer's recommendations only).The following are two AACN recommendations for oral care in the critically ill:
Use oral chlorhexidine gluconate (0.12%) rinse twice a day for adult patients undergoing cardiac surgery; not routinely for all patients. (Level V)
Brush teeth, gums, and tongue at least twice a day. (Level II)
Sona, C., Zack, J., Schalbm, M., et al. (2008, Nov. 17).The impact of a simple, low-cost oral care protocol on ventilator-associated pneumonia rates in a surgical intensive care unit. Journal of Intensive Care Medicine. Abstract retrieved December 22, 2008, from http:llwww.ncbi.nlm.nih.govl pubmed/19017665 Researchers examined the effects of an oral care protocol on VAP rates on ventilator patients in a surgical intensive care unit. The protocol included brushing the teeth twice daily with a fluoride toothpaste and brush and applying chlorhexidine gluconate (0.12%) twice daily. They concluded that the oral care protocol led to a significantly decreased risk of acquiring VAP in surgical intensive care patients. Watando, A., Ebi hara, S., Ebihara, T., et al. (2004). Daily oral care and cough reflex sensitivity in elderly nursing home patients. Chest, 126(4), 1066-1070.
These researchers explored the effects of intensive oral care on improvement of cough reflex sensitivity in elderly nursing home residents. Caregivers cleaned the subjects' teeth after every meal for I month; a control group of patients cleaned their own teeth after every meal. No special paste or solution was used. The intervention significantly improved cough reflex sensitivity in the intervention group. Therefore, researchers concluded that intensive oral care may reduce the incidence of pneumonia by improving cough reflex sensitivity in elderly nursing home residents.
Which of the two studies above provide additional support for that guideline? Explain your thinking.