探討長期照護機構失能住民口腔衛生改善專案

Exploring Oral Hygiene Project for Frail Elders in a Long-Term Care Institution

長期照護機構中的老人常常受限於溝通能力不佳或失能，無法表達口腔方面的需求或自行處理口腔清潔，若加上機構未定時評估住民的口腔衛生情況，往往使得住民的口腔問題每下愈況，牙齦發炎或念珠菌感染者比比皆是，這些都是易導致潛在性感染的來源，也造成住民的生活品質與機構的服務品質下降，因此，長期照護機構失能老人口腔衛生是相當重要的，本文即在瞭解臺灣北部一家大型長期照護機構失能住民的口腔衛生狀況，並改善長期照護機構失能住民的口腔衛生問題。本專案以完全須人協助完成執行口腔衛生清潔住民為主，樣本數共26位，年齡以76～85歲為主(42%)，平均住院年數為3～5年(46%)，隨機分成四組，分別使用四種不同的口腔清潔溶液，並用口腔棉棒執行特殊口腔護理，但是第三組另行使用小支軟毛牙刷和牙線棒：1.主要使用Chlorhexidine(CHX)之口腔清潔溶液。2.使用紅茶溶液。3.使用溫水溶液。4.使用茶油溶液，並於執行前第一週、及執行後第一週、第四週監測執行情形。結果顯示，機構內住民舌苔改善幅度為9.8% (77.8%降至68%)，口臭減輕15.9%(51.9%降至36%)；使用CHX溶液的住民，在執行後第四週的口腔評估分數與執行前比較有達統計顯著意義(p< .05)，因此，建議長期照護機構失能住民亦可選擇使用CHX溶液來增加口腔清潔護理成效。

Often elderly people in long-term care institutions are unable to clearly communicate their oral hygiene needs or unable to perform their own oral hygiene. If no one in the institution assesses the residents' oral hygiene needs, oral problems and infections may occur, such as gingival swelling, inflamed wheals, or candidiasis. Therefore, oral hygiene for the elderly in the long-term care institution is important. The purpose of this project was to understand the current oral hygiene conditions of frail elders in a long-term care institution in northern Taiwan and to determine the best oral hygiene method. Twenty-six (26) elderly patients who needed total oral hygiene care were recruited into this project. The oldest patients were 76~85 years (42%). The average length of stay was 3~5 years (46%). Subjects were randomly assigned to four groups based on oral care methods. Group 1 used Chlorhexidine (CHX) solutions with oral swabs. Group 2 used red tea with oral swabs. Group 3 used warm water with a soft toothbrush and a toothpick. Group 4 used oil tea with oral swabs. Evaluation was done in 3 time frames: one week before intervention and one week and four weeks after intervention. Results showed a decrease in tongue coating of 9.8% (from 77.8% to 66.8%) and a decrease in halitosis of 15.9% (from 51.9% to 36.0%). The group using CHX solutions was significantly more effective than other groups (p<.05). Therefore, findings suggest that nurses use CHX solutions to increase the effectiveness of oral hygiene for elderly patients in long-term facilities.