Comparative Study of the Effect of Three Oral Care Protocols on Ventilator Associated Pneumonia in Critically Ill Patients: A Clinical  Trial

Somayeh Haghighat, Hossein Mahjobipoor, Samira Ghasemi Gavarti


Background: Oral care plays a significant role in reducing the incidence of Ventilator‑Associated Pneumonia (VAP) in Intensive Care Units (ICUs). The aim of this study was to investigate the effect of three oral care protocols on the incidence of VAP in Mechanically‑Ventilated (MV) patients hospitalized in ICUs.

Materials and Methods: This parallel randomized clinical trial was performed in 2019 on 71 MV adult patients with endotracheal intubation hospitalized in ICUs. The patients were divided into three groups: a 7‑day oral care by using swab (group 1), two‑times‑brushing group (group 2), and four‑times‑brushing group (group 3) by using chlorhexidine. The data related to the incidence of pneumonia were analyzed during several days using Chi‑square and ANOVA tests.

Results: The incidence of pneumonia on the fourth day of the intervention in the first group (35.00%) was significantly higher than that of the two intervention groups (10.00%) (χ2 = 5.86, df = 2, p = 0.03)). The mean score of modified clinical pulmonary infection in the third group was significantly lower seven days after the intervention than before the intervention (p = 0.04) and the fourth day of intervention (p = 0.003). In the first group, this score was significantly higher in the fourth day of the intervention than the seventh day (p = 0.003).

Conclusions: Based on the results, the oral care protocol, including four‑times‑brushing, reduced the risk of VAP more than two times brushing. Therefore, the use of this protocol is recommended to provide a minimum level of oral care and reduce the risk of VAP in MV patients.


Intensive care units, mouth, nursing care, pneumonia, ventilator-associated

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