Oral Care for Patients at Risk for Oral Care for Patients at Risk for Ventilator-Associated PneumoniaVentilator-Associated Pneumonia

Issued April 2010Issued April 2010

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Expected Practice

Develop and implement a comprehensive oral hygiene program for patients at high risk for ventilator-associated pneumonia (VAP).

Brush at least twice a day Oral chlorhexidine gluconate (0.12%) rinse twice a day

for adult cardiac surgery patients Routine use of oral chlorhexidine gluconate (0.12%) in

other populations is not recommended

Scope and Impact of the Problem

Hospital-acquired infection is a significant concern.

VAP contributes to mortality.

Oral hygiene is an important intervention.

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Supporting Evidence

Colonization of the oropharynx contributes to VAP

Growth of pathogenic bacteria in dental plaque provides a breeding ground for microorganisms that produce VAP.

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Supporting Evidence

Microorganisms in the mouth translocate and colonize the lung.

Dental plaque can be removed by brushing. The American Dental Association

recommends that healthy people brush teeth twice daily to remove plaque.

Use of an oral care protocol reduces oral inflammation and improves oral health.

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Chlorhexidine EvidenceOral rinse reduced

respiratory infections in cardiac surgery patients

Reduced nosocomial pneumonia in patients intubated >24 hours.

In a more varied ICU population, no difference was observed in VAP, mortality, or length of stay.

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Chlorhexidine Evidence

A 2005 meta-analysis found no significant reduction in the incidence of hospital-acquired pneumonia or mortality rate.

The CDC guidelines recommend use only during the perioperative period for adult cardiac surgery patients; routine use is not recommended.

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Supporting Evidence

To date, no data from large, controlled clinical trials of oral care interventions in critical care patients other than chlorhexidine studies have been published.

Clinical reports of infection rate changes before and after implementation of oral care protocols have been noted.

Actions for Nursing Practice

Ensure that your unit has written practice documents describing the oral care procedure.

Document frequency of oral care.

Include the oral care procedure as part of unit orientation.

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Need More Information or Help?

Practice Alerts are online at www.aacn.org.

For additional information / assistance go to the Practice Resource Network at www.aacn.org

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