The importance of oral hygiene for patients on mechanical ventilation

Mechanical ventilation is often a requirement for patients in hospital intensive care units (ICUs). This may be because of a critical condition impairing their ability to breathe unassisted, or due to a requirement for these patients to be under sedation. Mechanical ventilation may be necessary in patients following trauma, recent surgery, brain injury, respiratory failure or after recreational drug usage.

As a consequence of the current COVID-19 pandemic, discussion of the use of ventilators has been prevalent in both local and global media (BBC News, 2020). Infection with COVID-19 may lead to respiratory complications and, in severe cases, patients may need to rely on mechanical ventilation to assist with breathing.

This article describes the consequences of poor oral health, the importance of oral hygiene for ventilated patients and the latest recommended approaches to oral hygiene care in ventilated patients for ICU nurses.

The aim of providing good oral care is to decrease the microflora load present in a patient's oral cavity. Poor oral health has been linked to increased levels of hospital-acquired pneumonia (HAP), the leading type of hospital-acquired infection (Mehndiratta et al, 2016). Pneumonia is an inflammatory condition of the lung, usually caused by a bacterial infection. It primarily affects the alveoli, which can become filled with pus and fluid (pulmonary oedema). This limits oxygen intake and makes it painful for the individual to breathe (Leach, 2010; World Health Organization, 2019). Although there are several routes to lower airway colonisation, the primary mechanism by which microorganisms enter the lungs is through aspiration of contaminated oropharyngeal secretions (including dental plaque) (El-Rabbany et al, 2015). Patients lying supine in a hospital bed and older patients with decreased levels of consciousness are more likely to aspirate oral secretions (Mehndiratta et al, 2016). Poor oral health is also strongly associated with poor nutritional intake and malnutrition, which in turn can affect a patient's recovery. This can lead to longer hospital stays and, consequently, higher care costs (Gil-Montoya et al, 2008; El-Rabbany et al, 2015; Health Education England, 2016).