Comparing Oral Care Interventions for the Management of Ventilator-Associated Pneumonia in Adult Patients in...

Ventilator-associated pneumonia (VAP) is a common but preventable complication in mechanically ventilated adults. Nurse-delivered oral care is central to VAP prevention; however, the comparative effectiveness of distinct oral care intervention strategies remains unclear. The aim of this review was to evaluate and compare the effectiveness of multiple oral care approaches- including herbal, natural agents, chlorhexidine (CHX)-based protocols, ozonated water and oral care bundles-in reducing VAP incidence among adult patients in the ICU.

This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Seven databases were searched for studies published between January 2015 and June 2025. Title and abstract screening were independently reviewed by two reviewers, while conflicts were resolved by the third reviewer. After the full-text review, 11 articles that met the inclusion criteria were extracted. Methodological quality was assessed using the Critical Appraisal Skills Program (CASP) tool. Due to the heterogeneity of interventions, findings were synthesised narratively and grouped according to the primary intervention strategy evaluated in each study.

Three dominant themes emerged from the 11 reviewed articles. These were: Alternative mouthwashes compared with CHX for their effects on VAP incidence in the ICU, CHX concentration and timing, and their comparison with VAP control and oral care protocols, as well as mechanical interventions for VAP management. The evaluated interventions included herbal and natural agents (propolis, clove extract and Zataria multiflora), CHX-based protocols, multidisciplinary oral care bundles, and ozonated water. Several herbal and natural agents showed promising reductions in VAP incidence compared with CHX in individual studies. Higher-concentration CHX formulations and structured oral care protocols were generally associated with lower VAP incidence and improved oral health outcomes compared with routine oral care. Ozonated water also demonstrated potential antimicrobial benefits; however, current evidence remains limited by small sample sizes and methodological variability.

Nurse-delivered oral care is an important component of VAP management in mechanically ventilated adult patients in ICU. Current evidence supports the use of structured and standardised oral care protocols within multidisciplinary ICU practice. Herbal agents and ozonated water demonstrate promising findings; however, further high-quality studies are needed before these interventions can be routinely recommended in clinical practice.