Authors (including presenting author) :
Fong SYVL(1)(5), Chu SF(2)(5), Leung KH(2)(5), Wong YSF(3)(5), Yip PN(4)(5), Ling WM(2)(5), Chan SY(2)(5)
Affiliation :
(1)Department of Paediatrics and Adolescent Medicine, Pamela Youde Nethersole Eastern Hospital, (2)Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, (3)Department of Medicine and Rehabilitation, Tung Wah Eastern Hospital, (4)Infection control Team, Pamela Youde Nethersole Eastern Hospital, (5)Evidence-based Practice Workshop Group 4, Hong Kong East Cluster
Introduction :
Glycerin Swabsticks (GS) has been used in mouth care for years in local hospitals. However, negative effects were witnessed from which concerns of its application are arisen.
Objectives :
Reviewing the effectiveness of GS for oral care among hospitalized patients and making recommendations to our senior nursing management.
Methodology :
Johns Hopkins Nursing Evidence-Based Practice Model was adopted. Evidence was searched independently by members through 6 databases [Cochrane, PubMed, CINAHL, Ovid (Medicine), Nursing Reference Center Plus, EKG 1-click-search] and hand-searching. All evidence involving GS published in English and Chinese was included whilst excluding non-human studies. Time frame was set from the inception of each database till March 2018.
Result & Outcome :
Eleven papers (Evidence level: II-B for two, III-A for one, IV-B for four, V-B for four; Origin: ten from Western countries and one from Asia) were extracted for evidence synthesis after appraisal. No positive effect was reported. Yet, risks of enamel erosion and mouth dryness were revealed. Acidity of GS is the crucial factor for the former. Oral moisturizers with pH value below 6.33, attributed by citric acid existence, could cause structural tooth damage. For the latter, glycerin concentration over 30% would induce mouth dryness. Unfortunately, one of the GS brands used in our hospital yields pH 2.6 with glycerin proportion as high as 50%. Although the highest level of evidence collected was derived from two quasi-experiments, we do not recommend GS for mouth care of which the opinion is also shared by several overseas guidelines from prestige institutions. It is because GS induces the aforesaid risks whilst there is safer alternative such as the dry sponge swab stick. Both pH value and glycerin concentration should be considered in introducing new oral-care products. Our results were reported to senior nursing management both in hospital and cluster level for decision-making. With the guidance of a well-developed evidence-based-practice model, nurses are capable of reviewing clinical practice critically to safeguard the quality and safety of patient care.
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