Oral Care ProtocolsNumerous studies

Oral Care Protocols

Numerous studies created new assessment and oral hygiene protocols to reduce the incidence of VAP.11,21,23,25,32,33,40-43 In other studies, existing oral care protocols were adapted to reduce high levels of VAP. The clinicians in the study changed documentation, assessments, and methods of oral care.25,32,44-46 Several studies observed current protocols to understand the practices surrounding oral health in Malaysia, the United States, and England.33,47,48 Having a protocol in place was reported to increase the quality of oral hygiene and decrease VAP rates. However, many studies did not outline the content of their oral hygiene protocols.11,21,23,32,42,43,45,46,49-55


In several studies, a multidisciplinary protocol was created that prescribed the frequency and method of oral care to reduce the incidence of VAP.42,49,56 To increase compliance, Cutler and Davis49 implemented a 24-hour oral care kit instituted at the bedside, with ongoing assessment and training of oral care practices provided; they found that without oral care protocols, oral care was undertaken infrequently, and important steps were omitted.49


A national survey by Kearns et al51 researched current oral care practices in 24 Scottish ICUs. Eighty-eight percent of the ICUs undertook oral care assessments, but only 29% had current oral care protocols, indicating a lack of protocol-based oral care.51 Similarly, Soh et al47 undertook a survey of Malaysian hospitals to determine the oral care practices within Malaysian ICUs and the nurses' attitudes toward oral hygiene. Although nurses had a positive attitude toward oral care, there was little consensus on oral hygiene practices, and the nurses did not adhere to evidence-based practice because they did not use toothbrushes.