Oral Care for Patients at Risk for
Ventilator-Associated Pneumonia
Issued April 2010
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
Oral Care for Patients at Risk for VentilatorAssociated Pneumonia
2
Scope and Impact of the
Problem
Hospital-acquired
infection is a
significant concern.
VAP contributes to
mortality.
Oral hygiene is an
important
intervention.
Oral Care for Patients at Risk for VentilatorAssociated Pneumonia
3
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.
Oral Care for Patients at Risk for VentilatorAssociated Pneumonia
4
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.
Oral Care for Patients at Risk for VentilatorAssociated Pneumonia
5
Chlorhexidine Evidence
 Oral 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.
Oral Care for Patients at Risk for VentilatorAssociated Pneumonia
6
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.
Oral Care for Patients at Risk for VentilatorAssociated Pneumonia
7
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.
Oral Care for Patients at Risk for VentilatorAssociated Pneumonia
8
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.
Oral Care for Patients at Risk for VentilatorAssociated Pneumonia
9
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
Oral Care for Patients at Risk for VentilatorAssociated Pneumonia
10