الفهرس 
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Abstract
SUMMARY
Patients in ICU have specific care needs, demanding the highest standard of professional care. Unfortunately oral health is not always given adequate attention because of the life saving nature of ICU which predisposes critically ill patients to further complications, the oropharynx become more susceptible to further colonization due to inability to attend to their own oral care, or ICU equipment and treatment contribute to reduce salivary secretions or xerostomia (dry mouth). Saliva provides mechanical removal of dental plaque and microorganism. Dental plaque can act as a reservoir for pathogens in patients with poor oral hygiene. This oral colonization precedes pulmonary colonization which may lead to nosocomial pneumonia so, it is important to implement a thorough oral care for intubated patients to keep oral mucosa moist, clean and free from infection.
Some types of equipment used by nurses for oral care not optimal. Cotton swabs, which are commonly used to provide mouth care to patients who cannot provide self care, are ineffective in removing plaque. Toothbrushes are more effective than cotton swabs in removing plaque but are less commonly used in providing mouth care in the ICU.
Therefore, the aim of this study is to compare between tooth brushes and cotton swabs in their ability to removed dental plaque among patients receiving mechanical ventilation. A quasi-experimental design was used to conduct this research. This study was carried out in the general intensive care unit in Assiut University Hospitals. The sample of this study consisted of two groups G1 (interventional group) 30 patients and G2 (control group) 30 patients. The tool was used in this study, it consisted of two parts, part I which include the patient profile, mechanical ventilation parameters, invasive devices, Homodynamic state (vital signs), fluids state, medication and laboratory investigation , part II that included Oral assessment sheet and Criteria for classifying debris (dental plaque).
The main results:
Finding of the revealed that the tooth brush is better than cotton swab to remove dental plaque.
As regard oral assessment guide scores by day of observation. from the admission day to third day, major of both two groups had mild compromise score (7-12 score) with no statistical significant differences between two groups. But, Regarding on the fourth day 73.33% of (G1) had mild compromise score (7-12 score) While, 60.00% of (G2) had compromise score (13-18 score). The percent of oral assessment guide score increase with belonged day until reached on the seventh day 93.33% of (G1) had mild compromise score (7-12 score) While, 80.00% of (G2) had compromise score (13-18 score) with highly statistical significant difference between two groups.
Concerning criteria for classifying debris according to Oral Hygiene Index by day observation. On admission day, major of both groups had score (3) with no statistical significant differences between two groups. On the second and third day 46.67% of (G1) had score (1) While, on the second and third day (40.00% and 53.33%) respectively of (G2) had score (3) with statistical significant differences between two groups. the percent of Oral Hygiene Index score increase with belonged day until reached on the seventh day 93.33% of (G2) had score .While, 46.67% of (G1) had score (1) through six days with highly statistical significant difference between two groups.
Regarding the result of oropharyngeal swab on the seventh day, it was noticed that 46.67% of the interventional group (G1) had growth swab. Distributed as 71.42% patients with klebsialla and 28.57% with staph aureus. While 100% of the control group (G2) had growth swab. Distributed as 60% patients with klebsialla, 33.33% with staph aureus and 6.67%with E.coli with statistical significant differences between two groups.
Based on the current study finding, it was recommended that:
Develop oral health care policies and programs that recognize the components of oral health assessment, oral hygiene care and treatment are integral to quality client care.
Develop oral hygiene care standards that are based on the best available evidence.
Implement continuing education opportunities for nurses and support them to complete oral hygiene education and training.
Development of knowledge of oral assessment, techniques of oral cleansing, recognition of oral pathology.
Emphasize the nurses need to know how to perform mouth care effectively so as to prevent problems developing.
Encourage nurses to participate in oral hygiene research to assist in better understanding the issues related to oral hygiene care provision in various health care settings.
The use of a soft pediatric brush can remove debris and subsequent plaque to assist in decreasing microbial colonization.
Repeat this research on a large sample size