Barriers and facilitators to oral hygiene for critically ill patients at a regional referral hospital in Uganda: A qualitative study

Abstract

Introduction: Critically ill patients may not take care of activities of daily living like oral care. Due to the complexity of care and need for close monitoring for critically ill patients, they are commonly admitted to high dependence units (HDU) or Intensive Care Unit (ICU) where oral health is expected to be provided by the bed side nurses. In Low and Middle-Income countries (LMIC) where there are low staffing levels, patient family (caregivers) are expected to help with some of the nursing procedures like oral care. We aimed to explore the barriers and facilitators to quality oral hygiene by caregivers for critically ill patients at a rural regional referral hospital in southwestern Uganda. Methods: We conducted in-depth qualitative interviews with 9 purposively selected adult caregivers for patients who were critically ill admitted at emergency ward and intensive care units of Mbarara Regional Referral Hospital. Data was analyzed by thematic analysis. Results: Themes identified were divided into barriers and facilitators. Barriers included lack of knowledge about oral hygiene for critically ill patients, lack of support from the nursing staff, directional training/teaching for oral hygiene, critically ill state of the patient, fear/discomfort, and limited resources for oral hygiene, the facilitators included training/teaching, availability of resources, patients’ previous quality of oral care, and family support. Conclusion: Training/teaching patient family and provision of supplies for oral care may facilitate quality oral care for critically ill patients in resource limited settings like Uganda.