From the Research
Oral care for intubated patients should include comprehensive cleaning every 2-4 hours using chlorhexidine gluconate 0.12-0.2% solution, as evidenced by the most recent study in 2021 1. This approach is crucial for preventing ventilator-associated pneumonia (VAP) and ventilator-associated tracheobronchitis (VAT), which are significant concerns in intubated patients. The use of chlorhexidine gluconate has been shown to reduce oral bacterial load and prevent microbial colonization, thereby decreasing the risk of VAP and VAT.
Key Components of Oral Care
- Elevate the head of the bed to 30-45 degrees to prevent aspiration
- Use a soft toothbrush to gently clean the teeth, gums, tongue, and oral mucosa
- Suction to remove secretions
- Apply chlorhexidine using a swab to all oral surfaces, without rinsing afterward
- Moisturize the lips and oral mucosa every 2 hours with water-based moisturizers to prevent drying and cracking
- Regularly check and reposition the endotracheal tube to prevent pressure ulcers and ensure proper securing
Rationale for Chlorhexidine Gluconate
The 2021 study 1 demonstrated that the use of 0.12% chlorhexidine gluconate for oral care significantly reduced the rate of VAP development and decreased oropharyngeal colonization. This is consistent with the broad-spectrum antimicrobial activity of chlorhexidine, which reduces oral bacterial load and prevents microbial colonization.
Importance of Proper Oral Care
Proper oral care is essential for intubated patients, as it not only prevents VAP and VAT but also reduces patient discomfort, prevents oral tissue breakdown, and may shorten mechanical ventilation duration and ICU stays. The evidence from the 2021 study 1 supports the use of chlorhexidine gluconate as a key component of oral care in intubated patients.