My surgical ICU lets the patients brush their teeth if they can do by themselves, sometimes the nurses do the brushing and let the patients doing their mouthwash with water. In the intubated patients the routine daily practise are the cleaning with chlorhexidine or special mouthwash of that kind. We always do this once in the morning as a patient care routine.

I work in a residential facility with individuals who have dual diagnosis (MR and other diagnoses, i.e., CP; ASD; Blind; Deaf; Deafblind; Nonverbal, etc.) and I am the chair of the Dysphagia team.

The standard in our facility is to ensure oral hygiene twice daily (morning and night).  I, of course, do not feel that this is adequate; especially for those who have or are at risk for aspiration and aspiration pneumonia.  Our team directs that all individuals who are under the care of the Dysphagia team receive mouth care pre and post-oral consumption with pre-consumption mouth care being defined as "checking mouth for any foreign matter and clearing mouth of all debris as well as providing a sip of a cool fluid to ensure that the mouth is not too dry to consume" and post-consumption mouth care as full hygiene including tooth brushing.

I believe that a lot more needs to be done in the area of oral hygiene--people tend to forget that the mouth is one of the best places to start in decreasing the risk of aspiration pneumonia (as well as allowing a free water protocol to be put in place which I would not feel comfortable beginning until I knew that appropriate mouth care is being provided to all who reside in this facility).

I work as a CNA and soon to be RN in an ICU, a majority of the patients are sedated. The mouthcares are part of the care bundle; ours are done at the 2 hour mark with the Q2 turns. For patients who can do their own cares the patients are offered the materials and encouraged to do mouth cares.

There are some patients that are awake yet intubated who request mouth cares above and beyond the Q2 turns, we try to accommodate these requests as we can, within reason. Because of this last stated reason, I can see how a patient might not be satisfied with their care.

In our ICU, mouth care is done twice daily by staff unless the patient is independent and is nevertheless encouraged to do so. Our hospital provides all required material free of charge. On our ICU flowsheet, a checkbox serves as a reminder, and these checkboxes are linked to our data system for measuiing frequencies and outcomes. If you are interviewing patients post Critical Care stays, keep in mind that patient recall of their stay is notoriously flawed, a topic well studied, and linked to diagnosis, age, length of stay and varies with mean BP, HR, resp rate and O2 sat, but not pCO2 levels observed during the stay in the ICU.

Hi,

in our ICU, oral care is protocolized (chlorhex 1-2%) amidst other VAP bundle prevention care and done 4 times daily by nursing staff even outside participation to multi center observational and interventional studies such as RGNOSIS. Nurses are therefore required to fill out VAP prevention sheets that are a posteriori checked.

We currently use clorhexidin to the mouth care we prefere to use high concentration to prevent Vap four times a day.

Thank you all for your responses, it has been very interesting. 

Our VAP care bundle requires upright positioning, which can exclude acute spinal cord injury patients, who require supine care - how do you manage this problem?

Also our patients complain that Chlorhex causes great discomfort to the tongue and oral mucosa, with a drying effect and taste distortions. I understand that in USA they have stopped routine use of chlorhex and only use it in compromised patients and for short periods of time. A recent systematic review and meta-analysis has suggested higher mortality with chlorhex compared to digestive decontamination.