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The Effects of Oral Care Protocol on the Incidence of Ventilation-Associated Pneumonia in Selected Intensive Care Units in Jordan

Alja’afreh, Mahmoud A., PhD, RN; Mosleh, Sultan M., PhD, RN; Habashneh, Sakhaa S., MSN, RN

Dimensions of Critical Care Nursing: January/February 2019 - Volume 38 - Issue 1 - p 5–12
doi: 10.1097/DCC.0000000000000334

Purpose This study aims to evaluate the effects of oral care protocol on the incidence of ventilator-associated pneumonia (VAP) at selected intensive care units (ICUs) in Jordan using clinical pulmonary infection score.

Methods A quasi-experimental design was used, and 1 large teaching hospital from the Jordanian capital, along with 2 hospitals from the southern region, was selected. A total of 218 patients participated, among which VAP risk in 2 independent groups was evaluated through the Clinical Pulmonary Infection Score sheet.

Results The VAP incidence rate was significantly lower in the intervention group (n = 102) as compared with control group (n = 116) (21.6 vs 35.3, respectively; P = .018); in addition, ICU stay and intubation period were significantly shorter among the intervention group. A higher risk of VAP was independently predicted by previous lung diseases (odds ratio [OR], 1.441; 95% confidence interval [CI], 1.185-1.88), open suctioning system (OR, 2.536; 95% CI, 1.261-5.101), and duration of intubation (OR, 1.770; 95% CI, 0.845-2.220). The oral care protocol has effectively improved ventilated patients’ oral health, which has statistically reduced the incidence of VAP. It occurred more frequently among patients who have lung disease and those who were intubated for more than 7 days and have an open suctioning system.

Conclusion Health care teams should ensure that effective care protocol is implemented among patients.

Mahmoud Ali Alja’afreh, RN, PhD, is an assistant professor, vice dean, and head of the Adult Health Nursing Department, Faculty of Nursing, Mutah University, Mutah, Karak, Jordan. His research interest is focused on four major areas: (1) studying of patient and family satisfaction in acute and critical care settings; (2) use of local resources to develop student center knowledge about disaster education; (3) development of patient safety guidelines for pressure ulcers patients, mechanically ventilated patients, and critical care practices issues; and (4) reshaping and enforcement of structures, processes, and outcomes of risk assessment, and management of pressure ulcers patients and critical care/cancer patients.

Sultan Mosleh, RN, PhD, is an associate professor and a former head of the Adult Health Nursing Department, Faculty of Nursing, Mutah University, Jordan. His research interest is focused on four major areas: (1) critical care environment issues for patients and staff; (2) palliative care and end-of-life care of cancer patients; (3) clinical cardiac patients’ rehabilitation; and (4) patient and nursing education.

Sakhaa S. Habashneh, RN, MsN, is a lecturer at the Department of Adult Health Nursing, Faculty of Nursing, University of Mutah, Mutah, Karak, Jordan. Her research interest is focused on four major areas: (1) clinical critical nursing issues; (2) knowledge and compliances of critical care units’ staff; and (3) patient and nursing education.

This study received fund from scientific research committee / Mutah University/ Jordan (Grant No. 77/14/120).

The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Address correspondence and reprint requests to: Mahmoud Alja’afreh, PhD, RN, Department of Adult Health Nursing, Faculty of Nursing, Mutah University, PO Box (7), Mutah_Karak, Jordan 61710 (

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