Improving oral care in patients receiving mechanical ventilation.
BACKGROUND
Comprehensive oral care is an evidence-based prevention strategy to reduce the risk of ventilator-associated pneumonia in patients receiving mechanical ventilation. Until recently, no comprehensive guidelines or standards existed to define necessary tasks, methods, and frequency of oral care to provide patients with optimal results.


OBJECTIVE
To observe current practice of, define best practice for, and measure compliance with standardized comprehensive oral care.


METHODS
This observational study was part of a larger research study performed at 5 acute care hospitals. Time blocks of 4 hours were randomized over 8 intensive care units and the 7 days of the week. Baseline data were collected before implementation of multifaceted education on an oral-cleansing protocol; interventional data were collected afterward.


RESULTS
Oral care practices were observed for 253 patients. During the baseline period, oral cleansing was primarily via suction swabs. Toothbrushing and moisturizing of the oral tissues were not observed. Only 32% of the patients had suctioning to manage oral secretions. During the interventional period, 33% of patients had their teeth brushed, 65% had swab cleansing, and 63% had a moisturizer applied to the oral mucosal tissues. A total of 61% had management of oral secretions; 38% had oropharyngeal suctioning via a special catheter.


CONCLUSIONS
Implementation of an evidence-based oral cleansing protocol improved the care of patients receiving mechanical ventilation. Multifaceted education and implementation strategies motivated staff to increase oral care practices.
Cutler
Constance J
CJ
Clinical Excellence Department, Advocate Health Care, Oak Brook, IL, USA.
Davis
Nancy
N
D003422:Critical Care / Q000379:methods*; D006801:Humans; D007318:Inservice Training; D007362:Intensive Care Units; D015588:Observer Variation; D009910:Oral Hygiene / Q000193:education / Q000379:methods / Q000592:standards*; D011014:Pneumonia / Q000209:etiology / Q000517:prevention & control*; D011785:Quality Assurance, Health Care; D012121:Respiration, Artificial / Q000009:adverse effects*