Critical care nurses are mindful of the need for oral care in patients receiving mechanical ventilation. The Centers for Disease Control and Prevention (CDC) recommend comprehensive oral hygiene programs (potentially including antiseptic agents) for patients at risk for nosocomial pneumonia.11 The Centers for Medicare and Medicaid Services (CMS) have recently identified 10 “never-event” diagnoses with hospital reimbursement implications. CMS has indicated that it will create a code to identify ventilator-associated pneumonia (VAP) as a future preventable hospital-acquired condition.22 Nosocomial pneumonia has been correlated with dental plaque and oropharynx colonization in patients receiving mechanical ventilation.33,1010 

Oropharyngeal flora and microbes undergo changes within 48 hours of admission to the intensive care unit (ICU).1111 Endotracheal tubes most likely serve as conduits for colonization because these same microorganisms can be traced to respiratory infections. Subglottal...

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