Investigation of Spattering and Intraoral Environment During Oral Care of Patients

Abstract

Given the several opportunities to come in contact with moist biological substances, it is important to observe standard precautions during oral care. However, there have been only few investigations on such precautions. In this study, we surveyed oral care methods and cleaning solution spattering, as well as the necessity for personal protective equipment. A total of 106 oral care procedures, in which 91 nurses performed oral care for 26 unconscious patients with cerebrovascular disease, were analyzed. Adenosine triphosphate (ATP) measurements were used to calculate the relative light unit (RLU) of cleaning solution spatters swabbed from the nurses' wrist, face shield, and apron surfaces before and after oral care. The mean age of patients was 76 years. On oral examination, 13 patients had furred tongue, 14 had oral dryness, and 11 had gingival bleeding. A history of aspiration pneumonia was also noted in 11 patients. Methicillin-resistant Staphylococcus aureus was isolated from the sputum of five patients and Pseudomonas aeruginosa from the sputum of two patients. The mean number of nurses' years of experience was 11.9, and the mean time spent performing oral care was 4 min and 5 s. The mean wrist RLU was 636.2 before oral care, which significantly increased to 836.2 after oral care (p = 0.0003). The same trend was noted for face shields and aprons (p < 0.01). RLU was high when a toothbrush, sponge brush, suction, or bed elevation was used during oral care or when the procedure took ≥5 min. Bleeding was observed 40 times during oral care procedures, suggesting the occurrence of blood-containing droplets. These results re-emphasize the necessity of using personal protective equipment, such as gloves, face shields, and aprons, during oral care.