Prevention of Ventilator-Associated Pneumonia: Role of Oral Care Protocol

Ventilator-associated pneumonia (VAP) is one of the most common infections in intubated patient receiving mechanical ventilation in intensive care unit (ICU). A study was done to compare the incidence of VAP in critically ill patients receiving oral care with and without manual teeth brushing and the application of moisturizers to the mouth besides routine oral chlorhexidine care. We conducted a prospective randomized control study, comprised of 220 ICU patients between 18 and 65 years of age, and of either sex. The patients were divided into two groups of 110 each. Care for one group (Study group) consisted of chlorhexidine wash, tooth brushing, and moisturizing gel over gums, buccal mucosa, and lips. The other group of patient was treated with chlorhexidine wash only. The oral assessment was done at 4, 6, 8, and 12 hours using the Beck Oral Assessment Scale (BOAS). Pneumonia was assessed based on abnormal chest x-rays, fever, chest auscultation, endotracheal culture report, and the incidence of VAP, and mortality was observed. Abnormal chest x-rays, positive auscultatory findings, fevers, and positive culture reports were significantly reduced in study group compared to these measurements in control group. The incidences of VAP and mortality were also significantly lower in study group compared with the incidences in control group. It was concluded that Conventional method of oral care with chlorhexidine could be replaced with adding teeth brushing and application of moisturizing lotion with routine oral care. It has additional advantage in the prevention of VAP in mechanically ventilated patient with significant decrease in length of ICU stay and mortality.