Survey on oral hygiene measures for intubated patients in Swiss intensive care units

Five to ten percent of all hospitalized patients are treated in intensive care units. The risk of nosocomial infections is inherent in the latter, especially in cases of intubation. In this context, impaired oral hygiene may play a pivotal role. Therefore, the purpose of this survey among representative Swiss intensive care units was to assess the standards and measures taken in this patient collective with reduced oral hygiene. To this end, a questionnaire was sent to 25 institutions which represented all A- and University hospitals in Switzerland as well as all accredited intensive care units in the canton of Zurich according to the register of the Swiss Society of Intensive Medicine. Intensive care units from pediatric departments were excluded. Twenty-one questionnaires were received and evaluated (84%). Only one quarter of all respondents reported having protocols available for preventing ventilation-associated pneumonia (VAP). Systemic antibiotic regimens were never performed. Ninety percent reported cleaning the patients' teeth mechanically with a toothbrush. Sixty-seven percent used chlorhexidine as a disinfectant (81% in liquid form). Seventy-five percent of the responding hospitals performed routine oral cleaning procedures three times a day (90% immediately after intubation). In summary, oral prophylaxis was neither standardized nor consistently implemented in the evaluated Swiss intensive care units of the responding hospitals. Only a small proportion had protocols available for preventing VAP, which is in accordance with similar surveys conducted in the US and Europe. Additional and improved measures have to be determined to confirm or optimize prophylactic oral strategies and to create standards and guidelines for this at-risk patient collective.