Main Article Content

กนกพรรณ งามมุข
ดร.ศศิมา กุสุมา ณ อยุธยา
ดร.วันเพ็ญ ภิญโญภาสกุล


The critically ill patients must use endotracheal tube to prolong their life, so the natural defense mechanism would be disturbed. Moreover, the microorganisms were accumulated in the oral cavity. If oral care is not efficient enough, it will result in severe gingivitis and oral lesions which leading to the cause of death.

The objective of this study was to develop oral care practice guideline in critically ill patients to prevent ventilator-associated pneumonia by analyzing and synthesizing knowledge on oral care’s evidence-based practices. Related literatures were searched by using the PICO framework and through evidence-based practice documents published between 2002 to 2012 which acquired 15 research papers altogether. According to the findings, the priority to promote best outcomes of oral care is the standardized oral cleaning process including assessing oral cavity, using appropriate equipment and cleansing agents and applying methods of effective oral hygienic care for each individual. To enhance clinical outcomes of oral care, policy support is important. The policy requires the Board of Directors of the multidisciplinary team to help support and initiate preparation of personnel to make them understand the guidelines for oral care. All team members must operate in the same directions and towards the same goal. This would lead to better outcomes and sustainability. There should be a dissemination of knowledge from these evidence-based practices to health care organizations, and further research on oral care in critically ill patients in a different setting.


Download data is not yet available.

Article Details

How to Cite
งามมุข ก., กุสุมา ณ อยุธยา ด., & ภิญโญภาสกุล ด. (2018). ORAL CARE PRACTICE GUIDELINE IN CRITICALLY ILL PATIENTS TO PREVENT VENTILATOR-ASSOCIATED PNEUMONIA. Vajira Nursing Journal, 18(2), 1–11. Retrieved from https://he02.tci-thaijo.org/index.php/vnj/article/view/139178
research article


คณะกรรมการการป้องกันและควบคุมการติดเชื้อในโรงพยาบาล. (2553).รายงานการเฝ้าระวังอัตราการติดเชื้อในโรงพยาบาลปี พ.ศ.2553. กลุ่มการพยาบาลคณะแพทยศาสตร์วชิรพยาบาล มหาวิทยาลัยกรุงเทพมหานคร.
American Thoracic Society. (2005). Guidelines for management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. American Journal of Respiratory and Critical care Medicine, 171, 388-416.
Ames, N. J., Sulima, P., Yates, J. M., McCullagh, L., Gollins, S. L., Soeken, K., et al. (2011). Effects of systematic oral care in critically ill patients: A multicenter study. American Journal of Critical Care, 20(5), 2-10.
Beraldo, C. C., & Andrade, D. (2008). Oral hygiene with chlorhexidine in preventing pneumonia associated with mechanical ventilation. Journal Brasileiro de Pneumologia , 34(9), 707-714.
Berry, A. M., Davidson, P. M., Master, J., Rolls, K., & Ollerton, R. (2011). Effects of three approaches to standardized oral hygiene to reduce bacterial colonization and ventilator associated pneumonia in mechanically ventilated patients: A randomised control trial. Internatinal Journal of Nursing Studies, 48, 618-688.
Centers for Disease Control and Prevention. (2009). Ventilator-associated pneumonia (VAP) Event. Retrieved November 11, 2010, from www.cdc.gov/nhsn/PDFs/pscManual/ 6pscVAPcurrent.pdf
Cutler, C. P., & Davis, N. (2005). Improving oral care in patients receiving mechanical ventilation. American Journal of Critical Care, 14(5), 389-394.
DiCenso, A., Hutchison, B., Grimshaw, J., Edwards, N., & Guyatt, G. (2005). Health services interventions. In A. DiCenso, G. Guyatt & D. Ciliska (Eds.), Evidence-based nursing a guide to clinical practice (pp. 265-297). St. Louis, MO: Elsevier Mosby.
Fields, L. B. (2008). Oral Care intervention to reduce incidence of ventilator-associated pneumonia in neurologic intensive care unit. Journal of Neuroscience Nursing. 40(5). 291-298.
Grace, J. T. (2009). Essential skills for evidence-based practice: Strength of evidence. Journal of Nursing Science, 27(2), 8-13.
Hsu, S., Liao, C., Li, C., & Chiou, A. (2010). The effects of different oral care protocols on mucosal change in orally intubated patients from an intensive care unit. Journal of Clinical Nursing, 40, 1044-1053.
Hutchins, K., Karrens, G., Erwin, J., & Sullivan, L. K. (2009). Ventilator-associated pneumonia and oral care: A successful quality improvement project. American Journal of Infection Control, 37, 590-597.
Labeau, S. O., Van de Vyver, K., Brusselaers, N., Vogelaers, D., & Blot, S.I. (2011). Prevention of ventilator-associated pneumonia with oral antiseptics: A systematic review and meta-analysis. The Lancet Infectious Diseases, 11(11): 845-854.
Melnyk, B. M., & Fineout-Overtholt, E. (2002). Key steps in implementing evidence-based practice: Asking compelling, searchable questions and searching for the best evidence. Pediatric Nursing, 28(3), 161-165.
Mori, H., Hirasawa, H., Oda, S., Shiga, H., Matsuda, K., & Nakamura, M. (2006). Oral Care Reduce Incidence of Ventilator-Associated Pneumonia in ICU population. Intensive Care Medicine, 32,230-236.
Prendergast, V., Jakobsson, U., Renvert, S., & Hallberg, I. R. (2012). Effect of a standard versus comprehensive oral care protocol among intubated neuroscience ICU patients: Results of a randomized controlled trial. Journal of Neuroscience Nursing, 44(3), 134-146.
Roberts, N., & Moule, P. (2011). Chlorhexidine and tooth-brushing as prevention strategies in reducing ventilator-associated pneumonia rates. British Association of Critical Care Nurses. 16(6), 295-302.
Ross, A., & Crumpler, J. (2007). The impact of an evidence – based practice education program on the role of oral care in the prevention of ventilator-associated pneumonia. Intensive and Critical Care Nursing, 5, 1-5.
Rujipong, P., Lekutai, S., Pinyopasakul, W., & Rungruanghiranya, S. (2009). The effect of using an oral care clinical nursing practice guideline on oral hygiene status and ventilator-associated pneumonia in intubated patients. Journal of Nursing Science, 27(3),57-64.
Scannapieco, F. A. (2006). Pneumonia in nonambulatory patients: The role bacteria and oral hygiene. Journal of the American Dental Association, 137, 215-255.
Stonecypher, K. (2010). Ventilator-associated pneumonia: The Importance of oral care in intubated adults. Critical Care Nursing Quarterly, 33, 339-347.
Yao, Y. L., Chang, K. C., Maa, H. S., Wang, C., & Chen, C. C. (2011). Brushing Teeth With Purified Water to Reduce Ventilator-Associated Pneumonia. Journal of Nursing Research, 19(4), 289-296.