Despite the availability of protocols and clinical practice guidelines for preventing VAP through good oral hygiene, nurses’ knowledge and use of evidence-based oral care practices remain variable, but improve with experience and specialization. Lemon glycerin swabs, which inhibit salivary production, causing dry mouth and promoting the growth of bacteria and plaque, are still used as a method of oral care. Another common but unsafe custom is the use of tap water to brush the teeth or rinse the mouth of critically ill patients. This practice is harmful because tap water contains bacteria, which can cause infection in people with depressed immune function. In some cases,hydrogen peroxide is used, but it is not recommended
for critically ill patientsbecause if not sufficiently diluted or used too often, it can irritate sensitive gums.