The role of oral care in reducing hospital-acquired infections and improving the health of critically ill patients: A narrative review
Oral hygiene plays a vital role in maintaining the overall health of hospitalized patients, particularly those in intensive care units (ICUs). Neglecting oral care can lead to serious complications such as ventilator-associated pneumonia (VAP), systemic infections, and prolonged hospital stays. Due to their critical condition and ventilator dependency, ICU patients are often unable to perform oral hygiene themselves, placing the responsibility on nursing staff. However, evidence indicates that oral care is not consistently or systematically administered in hospital settings. Contributing factors include a lack of training, the absence of standardized protocols, insufficient equipment, and a lack of a supportive organizational culture. Findings revealed that combining tooth brushing with chlorhexidine application significantly reduces the incidence of VAP, lowers mortality rates, and shortens ICU length of stay. Additionally, a considerable gap in nurses’ knowledge and practice regarding oral care was identified, directly impacting the quality of care. Continuous education and protocol standardization were highlighted as key solutions to address these challenges. The reviewed studies demonstrated a diversity of oral care methods, with herbal mouthwashes, such as those containing clove, and aerosolized antibiotics being introduced as promising innovative interventions. Nonetheless, some studies reported conflicting results regarding the effectiveness of tooth brushing alone, underscoring the need for further research. Ultimately, this review emphasizes the importance of thorough oral care, nurse training, adherence to standardized protocols, and the integration of innovative interventions to enhance care quality and reduce complications and healthcare costs related to hospital-acquired infections. Ensuring access to necessary resources and fostering a supportive organizational culture are crucial factors in implementing these practices effectively.
If you are interested in the dental hygiene of especially ICU and specifically those on a ventilator please visit the CDC Oral health toolkit website.
Here are additional links with more specific toolkits:
1. Beck's Oral Assessment tool
3. Best Practice Toolkit for Nursing Staff Caring for Ventilated Patients
4. Hospital-Acquired Pneumonia Prevention by Engaging Nurses