for students

1. JOURNAL PRESENTATION

2. PROBLEM STATEMENT
A comparative study to assess the
effectiveness of povidone iodine
mouthwash versus chlorhexidine
mouthwash on radiation or
chemotherapy induced Oral
mucositis among cancer patients.

3. ABOUT JOURNAL
I have taken this topic from TNNMC journal of
medical surgical nursing.
It is a peer reviewed journal of TNNMCMedical
surgical nursing has been launched to publish
the most recent findings of scientific research
in the field of medical surgical nursing care in
acute and chronic situation with evidence
based nursing.

4. ABOUT AUTHOR
Josni T chacko, Lecturer
TKM College of Nursing, Kerala
University of Health sciences.

5. ABSTRACT
The aim of study is to assess the
effectiveness of povidone iodine
mouthwash versus chlorhexidine
mouthwash on radiation or
chemotherapy induced oral
mucositis among cancer patients.

6. •A quasi experimental two group pre
test and post test was adopted.The
study was conducted in caritas
hospital, Kottayam.

7. •The objective of the study were to
assess the radiation or
chemotherapy induced oral
mucostis in cancer patients.Assess
the effectiveness of povidone
iodine mouthwash on radiation or
chemotherapy induced oral
mucositis in cancer patients.

8. •Assess the effectiveness of
chlorhexidine mouthwash on radiation
or chemotherapy induced oral
mucositis. Compare the effectivenes of
povidone iodine and chlorhexidine
mouthwash on radiation or
chemotherapy induced oral mucositis in
cancer patients

9. • Purposive sampling technique was
adopted to select the desired
samples. The samples obtained were
46(each group 23 patients with oral
mucositis). The data were collected
by means of interview , medical
record and observation checklist.

10. •Subjects were assessed with the
grade of oral mucositis before and
after povidone iodine mouthwash
and chlorhexidine mouthwash.
Patients were alloted for treatment
either povidone iodine or
chlorhexidine mouthwash
alternatively.

11. •Patients were instructed to rinse
their mouth with 10ml of
mouthwash and swish it for 2 min
in mouth and expectorate
it.Treatment was given twice a day
daily post assessment were done
every 3rd day.This was continued
tI'll the discharge.

12. . In both povidone iodine group and
chlorhexidine group maximum of
18th day and minimum of 9th day
assessment was done. Paired t value
shows the effect of povidone iodine
mouthwash ( t=8.7) and
chlorhexidine mouthwash (t=4.73)on
radiation or chemotherapy induced
oral mucositis.

13. It was statistically signficant
independent t value (t=4.78) shows
povidone iodine mouthwash is more
effective than chlorhexidine
mouthwash on radiation or
chemotherapy induced oral
mucositis.
Healing of oral mucositis was faster
in povidone iodine than
chlorhexidine group.

14. INTRODUCTION
•Cancer is one of the most significant
health problems in the world as a
major cause of morbidity and
mortality. Oral mucositis remain a
major source of illness despite the
use of variety of agents to prevent
them.

15. •Oral mucositis is defined as
inflammation and ulceration of the
mouth mucosa and pseudo
membrane formation
•Incidence vary from patient to
patient and treatment to treatment.

16. •Various agents are used to reduce
severity of oral mucositis .
Chlorhexidine gluconate is an
antimicrobial agent control
infection.
•However nurses face significant
challenges in managing oral
mucositis since the assessment and
management is inconsistent and
treatment largely ineffective.

17. •Need of the study is to educate
people regarding various agent that
are beneficial to reduce severity of
oral mucositis among cancer
patients.

18. OBJECTIVES
* To assess the radiation or
chemotherapy induced oral
mucositis in cancer patients
* To assess the efectiveness of
povidone iodine mouthwash on
radiation or chemotherapy induced
oral mucositis in cancer patients

19. •To assess the effectiveness of
chlorhexidine mouthwash on
radiation or chemotherapy induced
oral mucositis in cancer patients.
•To compare the effectiveness of
povidone iodine &chlorhexidine
mouthwash on radiation or
chemotherapy induced oral
mucositis in cancer patients

20. HYPOTHESES
H1 : There is a significant difference
between pretest and protest grade
of radiation or chemotherapy
induced oral mucositis in agroup
using povidone iodine mouthwash.

21. •H2 : There is a significant difference
between pretest and posttest of
radiation or chemotherapy induced
oral mucositis in a group using
chlorhexidine mouthwash.

22. •H3 : There is a significant
difference between grade of
radiation or chemotherapy induced
oral mucositis in group using
povidone iodine mouthwash and
chlorhexidine mouthwash.

23. METHODOLOGY
Research Design : Quantitative
research approach
Design : quasi experimental 2 group
pretest post test design.

24. •Variables
•Dependent variable : oral mucositis
•Independent variable : povidone
iodine mouthwash and
chlorhexidine mouthwash

25. •Population: patients who were
admitted in radiation therapy
ward, chemotherapy ward and
special rooms of caritas hospital
and had oral mucositis.
•Setting of the Study : caritas
hospital, Kottayam

26. Sampling
•Sampling Technique : Purposive
sampling technique
•Sample size : 46 samples were
selected for this study ,each group
consists of 23 patients

27. Criteria for selection of samples
•Inclusion criteria
•Patient with oral mucositis developed
after radiation or chemotherapy.
•Patient those who are willing to
participate in study.

28. •Exclusion Criteria
•Patient with hyperthyroidism
•Patient having allergy to iodine or
povidone iodine.

29. DATA COLLECTION TOOL
A structured assessment tool was
prepared which consist of selection
tool, demographic and baseline data
and oral mucositis assessment tool.

30. •Selection of tool
•It consist of one question to find out
oral mucositis was developed only
after radiation or chemotherapy.

31. •Demographic and baseline
data
•it consists of age,sex,educational
status, marital status, medical
diagnosis,stage of cancer,drug
intake or any surgical intervention

32. •Observation checklist
•Observation check list was
formulated based on oral mucositis
assessment tool

33. Data Collection Procedure
•A written permission was obtained
from administration of caritas
hospital, Kottayam. Samples who
met inclusion and exclusion criteria
were selected by using Purposive
sampling technique for the study.
An informed consent was obtained.

34. •After selecting the sample , baseline
data was collected through interview
method and from medical record and
grade of oral mucositis were assessed
by using observation check list. After
initial assessment 1 patient was treated
with povidone iodine mouthwash and
next patient with chlorhexidine
mouthwash.

35. •Treatment was given twice a day
daily and post assessment were done
every third day. Treatment was done
daily and post assessment were done
every 3rd day .In both povidone
iodine group and chlorhexidine group
maximum of 18th day and minimum
of 9th day assessment were done.

36. DATA ANALYSIS
•The frequency table formulated for
baseline information like
age,educational status,diagnosis,drug
intake, treatment ,characteristics of
treatment. Paired 't' test and 'z' test was
adopted to assess significant difference
between both mouthwash.

37. Result And Discussion
Section A : Demographic
characteristics
1) Age and Sex : Age of patient
ranged from 35 -75years .In
povidone iodine group the minimum
age was 47 years and maximum age
was 75 years.

38. •In chlorhexidine group minimum
age was 38 years and maximum age
was 74 years.In povidone iodine
group number of males were 13
and females were 10.In
chlorhexidine group number of
males were 12 and females were
11.

39. •Medical Diagnosis : This showed that
patients with oral cavity cancer
undergoing chemotherapy or radiation
therapy had more chance of developing
oral mucositis.
•Stages of cancer: most of the patient
were on stage 2.

40. •Types of treatment : 14 patient in
povidone iodine and 13 patient in
chlorhexidine group were in
radiation therapy alone, 6 patient in
povidone iodine group and 4
patient in chlorhexidine group were
in chemotherapy alone

41. •3 patient in povidone iodine group
and 6 patient in chlorhexidine group
under went combination of both
radiation and chemotherapy.

42. •Section B
•Effectiveness of povidone iodine
& chlorhexidine mouthwash on
chemotherapy or radiation
therapy induced oral mucositis

43. Comparison of pre and Post
assessment of oralmucositis grade
through paired 't' test analysis in
povidone iodine group.

44. The calculated value of 't' is 8.7 ,which is
more than tabulated value at p<0.5 level
.There is significant difference in pre and
post assessment of oral mucositis grade in
povidone iodine group. Povidone iodine
mouthwash was effective in radiation or
chemotherapy induced oral mucositis.

45. •Comparison of pre and post
assessment of oralmucositis grade
through paired 't' test of analysis in
chlorhexidine group

46. •Calculated 't' value is 4.73 ,which is more
than the tabulated value of p<0.05 level
.This shows that there is significant
difference in pre and post assessment of
oralmucositis grade in chlorhexidine
group. Chlorhexidine mouthwash was
effective on radiation or chemotherapy
induced oral mucositis.

47. •Section C : Compare the
effectiveness of povidone iodine
and chlorhexidine mouthwash on
chemotherapy and radiation
therapy induced oral mucositis

48. •The calculated value is 4.78, which
is more than the tabulated value of
p<0.05 level.This shows there is a
significant difference of oral
mucositis grade in povidone iodine
and chlorhexidine group.

49. •Hence the above finding showed
that povidone iodine mouthwash is
better than chlorhexidine
mouthwash on radiation or
chemotherapy induced oral
mucositis.

50. CONCLUSION
•The result showed that both
povidone iodine and chlorhexidine
mouthwash has effect in radiation
or chemotherapy induced oral
mucositis.But healing was faster in
povidone iodine group than
chlorhexidine group.

51. RECOMMENDATIONS
•It can be done in large sample size

52. REFERENCES
1 Josini T Chacko, Lecturer(2021)
,TNNMC journal of Medical and
Surgical Nursing 9(1);15-20
2 Radhika B (2008), Cancer and
surveillance , journal of medical
oncology,16(4) ;22-23

53. 3 Suman A(2004),chemotherapy
induced oral and radiation therapy
induced oral mucositis complicating
the treatment of cancer.journal of
neoplasia 423-431.