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American Journal of Critical Care. 2007;16: 552-562
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CE Article

Systematic Literature Review of Oral Hygiene Practices for Intensive Care Patients Receiving Mechanical Ventilation

By Angela M. Berry, RN, BAppSc, MHthSc, Patricia M. Davidson, RN, BA, MEd, PhD, Janet Masters, RN, BHSc (Nur), MN and Kaye Rolls, RN, BAS. Angela M. Berry is a clinical nurse consultant in intensive care services at Westmead Hospital and a doctoral candidate in nursing at the University of Western Sydney, Australia. Patricia M. Davidson is professor of cardiovascular and chronic care in the School of Nursing and Midwifery, Curtin University of Technology, Australia. Janet Masters is a clinical nurse educator in the high-dependency unit at Mt Druitt Hospital in Western Sydney, Australia. Kaye Rolls is a clinical nurse consultant in the NSWHealth Intensive Care Coordination and Monitoring Unit and a master of nursing candidate at the University of Sydney, Australia.

Corresponding author: Angela Berry, Intensive Care Unit, Westmead Hospital, Darcy Rd, Westmead NSW 2145, Australia (e-mail: angela_berry{at}wsahs.nsw.gov.au).

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.

Notice to CE enrollees:A closed-book, multiple-choice examination following this article tests your understanding of the following objectives:
  1. Describe important strategies to decrease ventilator-associated pneumonia.
  2. Compare different studies that examine various oral hygiene methods.
  3. Analyze the results of different studies of oral hygiene practices.
To read this article and take the CE test online, visit www.ajcconline.org and click "CE Articles in This Issue." No CE test fee for AACN members.






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