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During the fall of 1999, an article appeared in the American Journal of Critical Care highlighting the importance of oral care. Using this article as a catalyst, the intensive care unit (ICU) clinical practice council conducted a detailed literature search. The findings of this search were compared with current practice, and opportunities for improvement were identified.
Studies have documented that patients in medical ICUs have poorer oral hygiene than non-hospitalised patients. This lack of oral hygiene contributes to the development of oral colonisation. Additionally, oral bacteria aspirated into the lung may result in aspiration pneumonia. Specifically, potential pathogens for ventilator associated pneumonia (VAP) are noted to be present in oral secretions in 67% of patients orally intubated for ⩾24 hours. Also, after 24 hours, most suction equipment is colonised with many of the same pathogens cultured from secretions.
Pneumonia is the second most common hospital associated infection and the leading cause of nosocomial death. Healthcare associated pneumonia increases a patient’s length of stay in the ICU by 6.1 days and hospitalisation by 10.5 days. This increase in length of stay and need for empiric antimicrobial treatment significantly impacts costs. The primary cause of healthcare associated pneumonia is mechanical …