Oral Care and Tooth Brushing for Nosocomial Pneumonia Prevention in Mechanically Ventilated Patients

Abstract

Among preventive measures suggested to reduce the incidence of ventilator associated pneumonia (VAP), regular oral care is included in most of the ventilator care bundles. This nursing care usually includes oral rinses with antiseptic solutions, especially with chlorhexidine at different levels of concentration, tooth brushing, associated with repeated oral aspirations. The rational is based on VAP physiopathology: Most of microorganisms responsible for VAP come from oropharyngeal cavity and dental plaque: Oral care with chlorhexidine or other antiseptic and tooth brushing decrease bacterial colonization at this localization. If randomized trials show positive results in cardiac surgery patients, results are more conflicting in other ICU populations. Meta-analyses confirm these results with a probable but modest preventive effect, mainly in cardiac surgery patients, and they show no additional effect of tooth brushing, nor any impact on mortality, duration of mechanical ventilation or length of stay. Oral care is preeminently a basic hygiene and wellbeing care, and plays a minor role in VAP prevention.