title: A review of oral preventative strategies to reduce ventilator-associated pneumonia.
abstract: OBJECTIVE
  This article evaluates the evidence for and efficacy of the use of mechanical hygiene and chlorhexidine in the prevention of ventilator-associated pneumonia (VAP).
  
  
  METHODS
  
  
  
  METHODS
  primary research articles; randomized controlled trials; systematic reviews.
  
  
  METHODS
  quasi-experimental trials; opinion articles. Search Engines: PubMed; CINAHL; and EBSCO.
  
  
  BACKGROUND
  VAP is the commonest infection found in critically ill patients who are mechanically ventilated. It is associated with increased mortality, increased length of stay in intensive care and increased costs.
  
  
  CONCLUSIONS
  VAP is a health care-associated infection consistent with the presence of an endotracheal tube and mechanical ventilation for greater than 48 h. Efforts aimed at reducing infection rates include oral decontamination and mechanical hygiene to control the bacteria responsible, since there is an association between changes in bacteria found in the oropharynx and its development. Tooth brushing and the use of an oral antiseptic such as chlorhexidine gluconate are increasingly recommended in ventilator care bundles.
  
  
  CONCLUSIONS
  While there have been a number of studies conducted evaluating the efficacy of both approaches, there is limited evidence to support their use. The frequency of oral decontamination and mechanical hygiene interventions have not been established and chlorhexidine 2% seems to be more effective compared to weaker concentrations, but data is mainly confined to patients following cardiothoracic surgery.
authors.affiliation: School of Nursing and Midwifery University College Cork Cork Ireland. t.andrews@ucc.ie
authors.forename: Tom
authors.initials: T
authors.lastname: Andrews
authors.forename: Colin
authors.initials: C
authors.lastname: Steen
mesh_terms: D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D002710:Chlorhexidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control*; D014099:Toothbrushing
chemical_list: D000891:Anti-Infective Agents, Local; C010882:chlorhexidine gluconate; D002710:Chlorhexidine