Systematic literature review of oral hygiene practices for intensive care patients receiving mechanical ventilation

Background: Oropharyngeal colonization with pathogenic organisms is noted to be a contributing factor to the development of ventilator associated pneumonia in the Intensive Care Unit (ICU). Oral hygiene, although considered by some clinicians to be basic and potentially non-essential nursing care, has been proposed as a key intervention for reducing ventilator-associated pneumonia (VAP). Yet in spite of this recommendation there is limited randomized controlled trial evidence to inform best practice. Aim: The aim of this review is to appraise the peer reviewed literature to determine the best available evidence for the provision of oral care in ventilated ICU patients and to document a research agenda for this important activity in optimizing patient outcomes. Method: 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 using the key terms ‘oral hygiene’, ‘oral hygiene practices’, ‘oral care’, ‘mouth care’, ‘mouth hygiene’, ‘intubated’, ‘mechanically ventilated’, ‘intensive care’ and ‘critical care’. In addition, reference lists of retrieved journal articles were searched for possible missed papers during the primary search. Finally a comprehensive search of the World Wide Web using the Google search engine was undertaken to ensure completeness of the search process. The search strategy was verified by a health librarian. Results: The search strategy retrieved 57 articles; 12 prospective controlled trials; 21 observational studies and 24 descriptive papers. Methodological issues and the heterogeneity of samples precluded meta-analysis techniques. Conclusions: In spite of the importance of this activity there is a scarcity of high level evidence, such as rigorous randomized controlled trials or high quality systematic reviews, exists to inform clinical practice in the provision of oral hygiene in ventilated intensive care patients