A nonexperimental, longitudinal, descriptive design was used. The study was approved by the Virginia Commonwealth University Office of Research Subjects Protection and was carried out in accordance with the ethical standards set forth in the Helsinki Declaration of 1975. Subjects were recruited from the medical respiratory ICU at Virginia Commonwealth University Health Systems in Richmond, Va. This 12-bed unit has about 1000 admissions each year; approximately 50% of the patients admitted require mechanical ventilation.
All patients admitted to the unit were reviewed for potential enrollment in the study. Patients receiving mechanical ventilation were enrolled within 24 hours of intubation. Because reintubation increases the risk for VAP,19,20 patients who already had had endotracheal intubation during the current hospital admission were excluded. Data were obtained during a period of up to 7 days or until extubation. Because clinical evidence of VAP occurs after 48 hours of intubation, data on VAP and oral health were collected on days 1 (baseline), 4, and 7.