1. Field of the Disclosure
The present disclosure relates generally to disinfecting mouth guards to prevent ventilator associated pneumonia (VAP).
2. Related Art
Ventilator Associated Pneumonia (VAP) is one of the major categories of Healthcare Acquired Infections (HAI) in hospitals today. It is the second most common HAI, and the most common HAI in the ICU. 86% of nosocomial pneumonias are associated with mechanical ventilation. Koenig, Steven M. et al, “Ventilator-Associated Pneumonia: Diagnosis, treatment, and prevention,” Clinical Microbiology Review, October 2006, 19(4): 637-657. Between 8 and 28% of patients receiving mechanical ventilation are affected by VAP. Mortality for VAP ranges from 24-50% and can reach 76% in some specific settings or when lung infection is caused by high risk pathogens. Chastre J, et al. “Ventilator-associated Pneumonia,” American Journal of Respiratory and Critical Care Medicine, Apr. 1, 2002, 165(7): 867-903. In the United States alone, between 250,000 and 300,000 cases of VAP occur per year. Koenig, Steven M. et al, “Ventilator-Associated Pneumonia: Diagnosis, treatment, and prevention,” Clinical Microbiology Review, October 2006, 19(4): 637-657. VAP occurs more often in the first few days after intubation. VAP has been associated with increased intensive care unit costs and increased intensive care unit length of stays, which can be from 4-13 days. Additionally, incremental costs associated with VAP have been estimated as being between $5,000-$20,000 per diagnosis. Koenig, Steven M. et al, “Ventilator-Associated Pneumonia: Diagnosis, treatment, and prevention,” Clinical Microbiology Review, October 2006, 19(4): 637-657.
Recent studies have shown a significant improvement in patient outcome when a threefold approach is taken for those patients on ventilators. This threefold approach includes, keeping the patient elevated at a 30-45 degree angle, challenging the patient daily to determine if they still need breathing support, and daily oral hygiene. The oral hygiene is typically provided by nurses by performing an oral scrub with sponge tipped oral swabs that are soaked in a 0.12% chlorhexidine gluconate solution every 6-8 hours.
The present disclosure relates to a disinfecting mouth guard for VAP prevention. The mouth guard includes first and second side walls, first and second curved walls, and a central wall having a top and a bottom surface. The first and second curved walls are connected to the first and second sidewalls. The side walls and the curved walls define a periphery of the mouth guard. The central wall extends between the first and second sidewalls, and the first and second curved walls. The mouth guard includes top and bottom channels for receiving a patient's upper and lower teeth, respectively. First and second protrusions extend from the top surface of the central wall, and a first tube channel is formed between the first and second protrusions. A second tube channel is formed in the central wall and is connected with the first tube channel. An opening is formed in the curved walls and is in communication with the second tube channel. The first and second channels, and the opening receive an intubation tube.
In another embodiment, the mouth guard comprises a body shaped to cover at least a portion of a patient's mouth and an antimicrobial substance. The antimicrobial substance prevents infections associated with ventilation of a patient.
In still another embodiment, the mouth guard comprises a strip, a means for adhering the strip to a patient's mouth, and an antimicrobial substance suitable for preventing infections associated with ventilation of a patient. The strip includes the antimicrobial substance. The means for adhering the strip can be an adhesive.
The present disclosure further relates to a method of preventing ventilator associated pneumonia. The method comprises providing a mouth guard having an antimicrobial substance. The mouth guard is positioned in a patient's mouth, and an intubation tube is inserted into the patient's mouth. The antimicrobial substance disinfects at least a portion of the patient's mouth to prevent infection.
The foregoing features of the disclosure will be apparent from the following Detailed Description, taken in connection with the accompanying drawings, in which:
The present disclosure relates to a disinfecting mouth guard for VAP prevention, as discussed in detail below in connection with
A top channel 16 for receiving the patient's upper teeth extends about the inner face of the first and second curved walls 12a, 12b, and the first and second side walls 14a, 14b, and is further defined by first and second protrusions 17a, 17b. The top channel 16 is generally horseshoe shaped. The first and second protrusions 17a, 17b extend from the top surface 15a of the central wall 15 and define a first tube channel 18 therebetween, for receiving an intubation tube. The first tube channel 18 extends into the central wall 15 such that there is depth between the top surface 15a and the bottom of the first tube channel 18. The first tube channel 18 extends from the proximal end of the mouth guard 10 toward the distal end, where it connects with a second tube channel 20. The second tube channel 20 is formed in the central wall 15 as a recess extending into the top surface 15a. The tube first channel 18 and the second tube channel 20 can have the same depth. The second tube channel 20 extends to the distal end of the mouth guard 10 where it connects with an opening 22. The opening 22 is positioned at the distal end of the mouth guard 10, and extends through the first and second curved walls 12a, 12b. Accordingly, the first tube channel 18, the second tube channel 20, and the opening 22 provide a pathway connecting the proximal end of the mouth guard 10 with the distal end of the mouth guard 10.
The arrangement of the first tube channel 18, the second tube channel 20, and the opening 22 allows a tube 30 (shown in
The mouth guard 10 need not be horseshoe in shape, but could have various shapes and sizes. For example, some instances may require only a portion of a patient's mouth and/or teeth to be disinfected. In such instances, the mouth guard 10 can be shaped to match only the portion of the patient's mouth and/or teeth which requires disinfecting. This can be, for example, the top set of teeth, the bottom set of teeth, the incisors, the cuspids and/or bicuspids, the molars, or any combination thereof. Similarly, the mouth guard 10 can be sized to cover the gum line. The mouth guard 10 could also be provided as two portions, i.e., upper and lower portions. Such an arrangement would allow the upper and lower mouth portions to move independent of one another.
Alternatively, the mouth guard 10 can have different shapes as necessitated by the patient. For example, instead of a taper, the mouth guard 10 can have a more complicated shape that conforms to the patient's mouth, or to specific portions thereof. Accordingly, the mouth guard 10 can be shaped so that it disinfects the necessary areas of a patient's mouth.
Further, the mouth guard 10 can be made of a sponge material, which can be any suitable sponge or sponge-like material including polyurethane, silicone, polyethylene, cotton, cellulose, regenerated cellulose, gauze, polyester, polyvinyl alcohol, non-woven materials, polypropylene, porous plastic, bonded fiber, latex, polyolefins, nylon, cellulosics, acetates, etc. Additionally, the mouth guard 10, can be pre-saturated with an anti-microbial, such as chlorhexidine gluconate, chlorhexidine acetate, cetylpyridinium chloride, hydrogen peroxide, ethanol, triclosan, sodium bicarbonate, menthol, thymol, methyl salicylate, and eucalyptol. The mouth guard 10 can also be embedded with other anti-microbial materials such as silver, chlorhexidine gluconate, chlorhexidine acetate, etc. In addition, antibiotics, such as rifampin or minocycline, could also be incorporated into the mouth guard 10 to provide an anti-bacterial effect. The mouth guard 10 is shaped to be placed in the oral cavity around the mouth, teeth, and/or gums, but still allow proper placement and positioning of the intubation tube 30. The mouth guard 10 can fill the entire oral cavity, or can be sized to fill only a portion of the oral cavity, e.g., to only cover certain teeth or a portion of the gums. That is, the mouth guard 10 can be strategically designed to only cover certain areas that are prone to infection.
Alternatively, the mouth guard 10 could be made of a soft polymer or rubber formulation that is embedded with an antimicrobial, such as those described above. This may avoid risks of aspiration or fluid dripping down into a patient's airway. Moreover, the mouth guard 10 could be made of a gel-like material that can be mold-able to the shape of a patient's mouth. This could provide more direct contact between the mouth guard 10 and the interior structure of the patient's mouth for improved anti-microbial performance. The gel materials can be any material that is capable of being molded, but resilient to deformation over time. Such gel materials could include hardening gels, soft polymers, or rubber materials.
The disinfectant contained within the mouthpiece could incorporate a residual effect that could provide continued anti-microbial properties over time even after the mouth guard 10 is removed. Examples of such disinfectants include chlorhexidine gluconate and chlorhexidine acetate. Further, the mouth guard 10 can be saturated with enough disinfectant solution so that it remains wetted throughout for the duration of use, but does not dispense enough solution upon application to induce respiratory issues with the patient.
The mouth guard 10 can be sterilized prior to use by patient. For example, the mouth guard 10 can be sterilized by various methods, including utilizing gamma radiation, ethylene oxide sterilization, moist heat, and other means.
The mouth guard 10 could be provided to a customer in a package, such as a foil laminate structure or other material suitable for preventing the mouth guard 10 from drying out in storage. Additionally, the mouth guard 10 can include an applicator for placing the sponge into a patient's mouth.
The mouth guard 10 could also perform other functions, such as oral lubrication to avoid drymouth, a common ailment suffered by those on ventilators.
Other features could be provided. For example, the mouth guard 10 could include a hinge along its length to facilitate fitting within the oral cavity of a patient. Additionally, the mouth guard 10 could include a suction port incorporated therein. The suction port could provide means for removal of any dispensed disinfectant solution, or other oral fluids that are desired to be removed from the oral cavity. Still further, the mouth guard 10 could be provided with flavoring, including mint, cinnamon, spearmint, menthol, artificial sweeteners, fruit or other desirable flavors that may please the patient, partially sedate the patient, and/or provide for patient comfort.
The mouth guard 10 could incorporate a re-use prevention feature. For example, a color changing additive could be incorporated into the base material of the mouth guard 10. The color changing additive could change color over a desired time period that would equate to an allowable use period for the product, after which its anti-microbial effects may lessen.
Prior to using the mouth guard 10, a nurse or other person could initially provide an oral scrub to a patient using a traditional foam swab tip or a traditional toothbrush available on the market today. This can remove loose plaque, food, or mouth debris from the teeth and gums. Upon completion of the oral scrub, the oral disinfecting mouth guard 10 can be placed into the patient's mouth and around the intubation tube 30 to act as further microbial barrier to any organisms that remain in the mouth, on the teeth, or even in the plaque on the teeth. The mouth guard 10 will also prevent any airborne bacteria from entering the mouth and further reducing the risk of infection.
Having thus described the disclosure in detail, it is to be understood that the foregoing description is not intended to limit the spirit or scope thereof. Accordingly, although the present disclosure has been described with reference to particular embodiments thereof, it is understood by one of ordinary skill in the art, upon a reading and understanding of the foregoing disclosure, that numerous variations and alterations to the disclosed embodiments will fall within the spirit and scope of the present disclosure and of the appended claims.
The present application claims the priority of U.S. Provisional Application Ser. No. 61/683,658 filed Aug. 15, 2012, the disclosure of which is expressly incorporated herein by reference in its entirety.
Number | Date | Country | |
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61683658 | Aug 2012 | US |