Oral hygiene is crucial for everyone, including those who are experiencing illness of any kind. Often described as the ‘gateway to the body’, the mouth can support or hinder the body’s recovery, so maintaining oral health is key. As such, mouth care has been recognised as an important part of caring for patients in hospital, particularly at a time when COVID-19 remains a threat to the UK population. Public Health England (PHE) has now released guidance to help healthcare professionals look after this aspect of their patients’ health. The ‘Mouth care for hospitalised patients with confirmed or suspected COVID-19’ document – available online[i] – has been designed for adults and children who are ventilated, non-ventilated or receiving step down or end of life care. The aim is to prevent oral infection, reduce the risk of bacterial pneumonia and maintain some quality of life for those affected.
The guidance advises that basic oral hygiene be continued wherever possible, with patients given the opportunity and encouraged to brush their teeth regularly with a manual toothbrush. Where assistance is required, this should be provided by a healthcare professional, taking frequent breaks to enable the patient to rest and swallow. To combat dry mouth and lips, patients should be advised to sip water or use a hydrating product used on the tongue, inside the cheeks and on the roof of the mouth. Dentures should be removed after meals and overnight, again being cleaned regularly.
Ventilator-associated pneumonia is a common infection in the intensive care unit, which is often caused by poor oral care practises.[ii] The PHE guidance sets out steps designed to minimise the risk of patients developing the infection, though it states clearly that the nurse in charge should be consulted before commencing protocols to ensure that the endotracheal tube cuff is inflated to prevent aspiration. It then suggests moistening the mouth with a chlorhexidine (CHX) mouthwash and using appropriate products to keep the lips moist.
End of life care
As with any end of life care, the dental protocols for those with COVID-19 are about making the patient as comfortable as possible. The advice given for looking after non-ventilated patients should be re-applied, focusing on keeping the mouth and lips moist. The safe transfer of dentures should be considered when necessary as well.
Though conceived specifically for patients with confirmed or suspected COVID-19, this oral health guidance could be applied to many other situations. Dental hygiene is key for all hospitalised patients and this document serves to promote the importance of oral health among the wider healthcare profession and the general population. Perhaps moving forward, a similar approach could be adopted to support the oral health of patients in hospital for prolonged periods of time with varying health conditions.
So, what’s the dental team’s role in all this? For a start, colleagues in hospital may need information and training and on how to supervise or deliver dental hygiene for their patients. Education on brushing techniques and prevention of dry mouth could be provided through written materials or via video conferencing with a local dental professional. Alternatively, a member of the dental team could visit their local hospital to perform the oral hygiene protocols and teach healthcare staff this way.
Aside from techniques, dental professionals can also recommend appropriate products for colleagues in hospital to use with non-ventilated, ventilated and end of life care patients. Understanding which solutions enable a gentle but effective clean of a patient’s mouth is key. For example, J&S Davis provides the comprehensive Curasept ADS range of mouth rinses, containing CHX to minimise the risk of infection, as well as a patented Anti Discolouration System than reduces any potential for staining or taste disturbance often associated with other CHX products.
An opportunity for integrated care
For some dental practices, working with healthcare professionals in hospital environments could present a new opportunity to support the local community and help frontline NHS staff better care for their patients now and in the future. This is also an ideal time to form these connections and prepare the wider health sector to deliver enhanced care to COVID-19 patients, before we potentially see a second spike in cases. It embodies the integrated approach to healthcare that so many have spoken about in recent years and provides an initial pathway to take action for the benefit of the UK population.
Public Health England’s guidance on oral care of COVID-19 patients is a step in the right direction for raising awareness of the importance of dental hygiene. Why not see how you could support colleagues in your local hospital and take an integrated approach to caring for COVID-19 patients.
[i] Public Health England. Mouth care for hospitalised patients with confirmed or suspected COVID-19. 6 August 2020. https://www.gov.uk/government/publications/covid-19-mouth-care-for-patients-with-a-confirmed-or-suspected-case/mouth-care-for-hospitalised-patients-with-confirmed-or-suspected-covid-19 [Accessed August 2020]
[ii] Gupta A, Gupta A, Singh TK, Saxsena A. Role of oral care to prevent VAP in mechanically ventilated Intensive Care Unit patients. Saudi J Anaesth. 2016;10(1):95-97. doi:10.4103/1658-354X.169484