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Oral care interventions in critical care: frequency and documentation.

BACKGROUND
No data have been collected to describe the products, methods, and frequency of oral care needed to reduce dental plaque, oral colonization, and ventilator-associated pneumonia in critically ill patients.


OBJECTIVES
To describe the frequency of use of oral care interventions reported by nurses in several intensive care units in a large southeastern medical center.


METHODS
Staff members completed a written survey describing their oral care practices, and oral care interventions were recorded from the unit's flow sheet for the previous 24 hours for all patients at 5 randomly selected times during 1 month.


RESULTS
Most respondents (75%) reported providing oral care 2 or 3 times daily for nonintubated patients, and 72% reported providing care 5 times daily or more for intubated patients. However, oral care was documented on the unit's flow sheet a mean of 1.2 times per patient. Reported use of toothpaste and a toothbrush was significantly greater in nonintubated patients (P < .001), and use of a sponge toothette was significantly greater in intubated patients (P < .001). Nurses' mean rating of oral care priority was 53.9 on a 100-point scale.


CONCLUSIONS
Despite evidence that they are ineffective for plaque removal, sponge toothettes remain the primary tool for oral care, especially in intubated patients in intensive care units. Nurses report frequent oral care interventions, but few are documented. Education and focus on good oral care strategies are required; nursing research to delineate the best procedure for all patients in intensive care units is needed.