Systematic Literature Review of Oral Hygiene Practices for Intensive Care Patients Receiving Mechanical Ventilation

Abstract

Background Oropharyngeal colonization with pathogenic organisms contributes to the development of ventilator-associated pneumonia in intensive care units. Although considered basic and potentially nonessential nursing care, oral hygiene has been proposed as a key intervention for reducing ventilator-associated pneumonia. Nevertheless, evidence from randomized controlled trials that could inform best practice is limited. Objective To appraise the peer-reviewed literature to determine the best available evidence for providing oral care to intensive care patients receiving mechanical ventilation and to document a research agenda for this important activity in optimizing patients’ outcomes. Methods Articles published from 1985 to 2006 in English and indexed in the CINAHL, MEDLINE, Joanna Briggs Institute, Cochrane Library, EMBASE, and DARE databases were searched by using the key terms oral hygiene, oral hygiene practices, oral care, mouth care, mouth hygiene, intubated, mechanically ventilated, intensive care, and critical care. Reference lists of retrieved journal articles were searched for publications missed during the primary search. Finally, the Google search engine was used to do a comprehensive search of the World Wide Web to ensure completeness of the search. The search strategy was verified by a health librarian. Results The search yielded 55 articles: 11 prospective controlled trials, 20 observational studies, and 24 descriptive reports. Methodological issues and the heterogeneity of samples precluded meta-analysis. Conclusions Despite the importance of providing oral hygiene to intensive care patients receiving mechanical ventilation, high-level evidence from rigorous randomized controlled trials or high-quality systematic reviews that could inform clinical practice is scarce.

Pilot Study of an Oral Care Protocol on PostStroke Survivors

“…A growing body of nursing literature has addressed the association between oral care and the prevention of ventilator‐associated pneumonia (VAP) in the intensive care unit (ICU) (Ames et al., ; Berry, Davidson, Masters & Rolls, ; Munro & Grap, ; Parsons, Lee, Strickert & Trumpp, ; Prendergast, Jakobsson, Renvert & Hallberg, ). Rigorous oral care protocols are now the standard of care in ICU patients because they have been shown to reduce the risk of infection especially VAP.…”

“…Duration of hospitalization has been shown to be a risk factor for MRSA, and longer stays in acute care rehabilitation settings increase risk (Minary‐Dohen, Bailly, Bertrand & Talon, ). There is substantial evidence to support the benefits of aggressive oral care programs in decreasing oral bacteria colonization in elderly patients and critically ill patients (Ames et al, ; Abe, Ishihara, Adachi & Okuda, ; Berry et al., ; Mori et al., ; Munro & Grap, ; Yoneyama et al., ). To date, only one study has examined the impact of oral care programs on oral opportunist pathogens in the acute rehabilitation setting.…”

Chlorhexidine and tooth-brushing as prevention strategies in reducing ventilator-associated pneumonia rates

“…Fourrier et al (2000) also used sodium bicarbonate as a placebo, which dissolves mucus and loosens oral debris (Carl et al , 1999). This decreases the study's validity and may have influenced the results (Berry et al , 2007). Fourrier et al (2000) highlighted that the standard of oral care accepted in ICU is insufficient to control plaque formation and oral infections by nosocomial pathogens.…”

“…They used a CHX mixture containing 95% ethanol and 5% peppermint oil. Essential oils remain untested in ICU patients and the antiseptic properties of alcohol (Berry et al , 2007) may have had an additional therapeutic effect, potentially affecting the results. This could have a great impact on the results by further decreasing the infection rate and therefore decreasing the validity of the study.…”

“…Hydrogen peroxide has been untested in ICU patients for many years. Berry et al (2007) questioned its safety and cited studies that found significant abnormalities when treating patients with it. The use of hydrogen peroxide has not been subjected to rigorous randomized controlled trials and therefore cannot be recommended for use in the critically ill (Berryand Davidson2006).…”