Enhanced Moisture-Focused, Nurse-Led Oral Care Improves Oral Health and Suppresses Bacterial Overgrowth in Mechanically Ventilated ICU Patients: A Quasi-Experimental Study.

BACKGROUND

In Japan, no standardised, evidence-based oral care protocol independent of chlorhexidine (CHX) exists, despite its importance in preventing ventilator-associated pneumonia (VAP) and post-extubation dysphagia (PED) among mechanically ventilated patients.

AIM: To develop and evaluate a nurse-led, assessment-based oral care protocol that excludes CHX and adjusts moisturising frequency according to each patient's oral health status, aiming to prevent VAP and PED in mechanically ventilated patients.

STUDY

DESIGN

This quasi-experimental study was conducted between February and July 2025 in the emergency intensive care unit (ICU) of a university hospital. Adults (≥ 18 years) requiring intubation were assigned to either a control (n = 50; standard care) or an intervention (n = 50; oral care protocol) group. The protocol combined tooth brushing with Oral Health Assessment Tool (OHAT)-guided moisturising; intensified care was provided when any OHAT item scored 2. Primary outcomes were OHAT scores, oral moisture, and bacterial counts over 3 days. Secondary outcomes included duration of ventilation, ICU stay and incidence of VAP, PED and ICU mortality. Statistical analyses included the Mann-Whitney U test, Fisher's exact test, logistic regression and Kaplan-Meier analysis.

RESULTS

Compared with the controls, the intervention group showed significantly better oral health on Day 3 (mean OHAT 1.88 vs. 5.20; oral moisture 20.4 vs. 6.6; bacterial counts 36.3 vs. 83.0; all p < 0.001). Ventilator duration and ICU stay were shorter in the intervention group (5.0 vs. 9.5 days, p < 0.001; 8.0 vs. 11.0 days, p = 0.006). PED incidence markedly reduced (4% vs. 46%; adjusted odds ratio 0.044, 95% confidence interval 0.009-0.209; number needed to treat = 3). Protocol adherence was 97.8%.

CONCLUSIONS

The nurse-led, CHX-free protocol preserved oral health, reduced PED and shortened ventilation and ICU stay, demonstrating feasibility, safety and scalability.

RELEVANCE TO CLINICAL PRACTICE: Systematic oral assessment and moisture-focused care should be integrated into standard oral care protocols for ventilated patients.

TRIAL REGISTRATION: This study was registered with the UMIN Clinical Trials Registry (no. UMIN000056997; registration date 11 February 2025).