The mouth care protocol was developed in collaboration with the respiratory therapy department. The old protocol consisted of mouth care every 4 hours with toothettes. With the new protocol, mouth care was done every 2 hours or 12 times in 24 hours. The decision to increase mouth care to
every 2 hours was based on the studies of oral health and the development of VAP.12 The mouth-care
protocol was accomplished by alternating responsibility for mouth care between respiratory therapists and
nurses. Each patient’s teeth were brushed at 8 AM and 8 PM with chlorhexidine, and the mouth was cleansed with tooth sponges 10 times per day. Respiratory therapists and nurses discussed this protocol at length and decided that they would share in implementing the protocol to conserve resources. Documentation in the medical record of completion of the protocol was used for the audit.