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Background: Effective oral hygiene has been proposed as a key factor in the reduction of dental plaque colonisation and subsequent development of ventilator associated pneumonia (VAP). Listerine(®) oral rinse, while used extensively in dental practice has rarely been tested in mechanically ventilated patients. Sodium bicarbonate as an oral rinse has been more commonly utilised in oral hygiene regimens in intensive care patients., Aim: To test the efficacies of the essential oil mouth rinse, Listerine(®) (Pfizer) and sodium bicarbonate in the reduction of dental plaque colonisation with respiratory pathogens and the subsequent development of VAP., Methods: The study design was a prospective, single blind randomised comparative study of adult patients mechanically ventilated for at least 4 days. Patients were randomised to Listerine(®) (Pfizer) oral rinse twice daily, sodium bicarbonate oral rinse 2/24 or sterile water 2/24 (control group). All groups received tooth brushing 3 times a day. Dental plaque colonisation (primary outcome) and incidence of ventilator associated pneumonia (secondary outcome) were studied., Results: Three hundred and ninety-eight patients were randomised to either the Listerine group (127), sodium bicarbonate group (133) or the control group (138). Baseline characteristics were similar for all groups. There were no significant differences between the control and study groups in colonisation of dental plaque at Day 4 (p=0.243). Ventilator associated pneumonia was diagnosed in 18 patients. The incidence was, Listerine(®) group 4.7%, sodium bicarbonate group 4.5% and control 4.3% [OR, 0.99; 95% CI, 0.31 to 3.16; p=0.92]., Conclusions: Compared to the control group, Listerine(®) or sodium bicarbonate oral rinses were not more effective in the reduction of colonisation of dental plaque or the incidence of VAP. Given the low incidence of VAP, the common factor of a small, soft toothbrush as part of an oral hygiene regimen suggests possible benefit in mechanically ventilated patients., (Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.)

Objectives: Oropharyngeal colonisation has been identified as a factor contributing to ventilator associated pneumonia (VAP) in the Intensive Care Unit (ICU). We sought to develop a clinical practice guideline for providing oral hygiene in the critically ill., Research Methodology: Following a systematic literature review a prospectively derived consensus development conference was convened and sponsored by a clinical governance unit., Results: The consensus development conference generated 12 recommendations for tools and solutions; frequency and duration of cleaning; oral assessment tools and oral hygiene protocols. These recommendations underwent a validation process., Conclusions: In light of sparse high level evidence to inform guidelines, further research is needed inform clinical practice. Oral hygiene is a critical element of nursing care and a standardised approach has the potential to improve clinical outcomes., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Background: Ventilator associated pneumonia remains an important concern in the intensive care unit (ICU). An increasing body of evidence shows that mortality and morbidity can be reduced by implementing a range of preventive strategies, including optimizing oral hygiene., Aim: The aim of this feasibility study was to test two oral hygiene strategies on the effects of microbial colonization of dental plaque with respiratory pathogens (primary outcome) and incidence of ventilator associated pneumonia (secondary outcome)., Methods: A single blind randomised comparative study was conducted in a 20-bed adult intensive care unit in a university hospital. Patients with an expected duration of mechanical ventilation more than 48 h were eligible. Patients were randomised to one of three study regimens (Group A control, second hourly oral rinse with sterile water, Group B sodium bicarbonate mouth wash second hourly, and Group C twice daily irrigations with chlorhexidine 0.2% aqueous oral rinse and second hourly irrigations with sterile water). All study options included cleaning with a toothbrush and non foaming toothpaste., Results: Data from a total of 109 patients were analyzed. Group A 43, Group B 33 and Group C 33 (mean age: 58 ± 17 years, simplified acute physiology score II: 44 ± 14 points). On admission no significant differences were found between groups for all clinical data. While Group B showed a greater trend to reduction in bacterial colonization no significant differences could be demonstrated at Day 4 of admission (p=0.302). The incidence of ventilator associated pneumonia was evenly spread between Groups B and C (5%) while Group A was only 1%., Conclusions: While a number of studies have advocated the use of various mouth rinses in reducing colonization of dental plaque a standardized oral hygiene protocol which includes the use of mechanical cleaning with a toothbrush may be a factor in the reduction of colonization of dental plaque with respiratory pathogens. This feasibility study provides data to inform future adequately powered studies., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

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.

Background: The role of oral hygiene in maintaining the health and well being of patients in the intensive care unit (ICU) is indisputable. This importance is not reflected in the body of research related to ICU practice. While a number of studies have examined oral hygiene practices in oncological patients there is significantly less attention devoted to these practices in the critically ill., Aim: This paper has two discrete yet interrelated aims. Firstly, in relation to current available evidence and based on a sound knowledge of oral physiology, identify barriers to effective oral hygiene and subsequent effectiveness of the most commonly used and recommended methods of providing oral hygiene in the critically ill population. Secondly, informed by the critical review, identify recommendations for practice and future intervention studies., Findings: To date, there is no definitive evidence to determine the most appropriate method of oral hygiene including the use of beneficial mouth rinses. Barriers identified in this review to providing optimal hygiene include: (1) mechanical barriers and equipment issues, (2) perceptions of the importance of mouth care and empathy with patient discomfort by nurses, (3) altered patient sensory perception and discomfort and (4) difficulties in patient communication. In spite of these challenges opportunities for collaborative research and increasing expertise in nurse researchers creates a climate to derive solutions to these factors., Conclusions: It is clearly evident from this review of oral hygiene practices in intensive care that the need for ongoing research is of paramount importance. ICU nurses undeniably require rigorous research studies in order to inform their practice in the provision of oral hygiene for critically ill patients.