Train Caregivers In Oral Care After Discharge
Mechanically ventilated patients are at a particularly high risk of pneumonia even after discharge. Yet oral care protocols have been shown to make a positive difference in ventilator-associated pneumonia (VAP) risk. Teaching your patients’ caregivers how to perform proper oral care after discharge is paramount to the successful outcome and continuity of care for your patients.
Not only will proper oral care after discharge improve patient comfort but any reduction in VAP rate can significantly lower treatment costs.
Home oral care procedures address:
- Oropharyngeal colonization
- Oral secretions that migrate to the subglottal area
- Dental plaque 
Along with assessing a caregivers’ commitment to caring for the ventilated patient and ensuring the home is set up for safe home administration of care, there are many steps to ensure that the caregiver understands how to perform the proper oral care protocols including suctioning secretions, reconnecting the ventilator if disconnected and information about the overall plan of oral care. [ 2]
Steps to Care for Patients Oral Care after Discharge
Physicians and critical care clinicians should ensure the caregiver has instructions for oral care and has received all information needed on when and how to perform oral care after discharge.
Suggested Steps for Oral Care
- Wash hands with warm water and antiseptic soap and apply fresh gloves. 
- Assess oral cavity every eight hours looking for bleeding, inflammation, ulcers, odor, yeast, plaque and overproduction of saliva. 
- Set up suction equipment and oral care kits. 
- Position the patient’s head to the side.
- Suction mouth prior to oral care. 
- Brush teeth for two minutes using suction toothbrush, a small amount of water and alcohol-free antiseptic oral rinse.
- Brush gently using circular or short horizontal strokes. 
- Brush the tongue softly. 
- Use a suction swab to clean the teeth and tongue if brushing causes bleeding. 
- Use a swab placed perpendicular to the gum line to clean along the gums using gentle pressure for two minutes. 
- Turn swab clockwise to remove any mucous and debris.
- Suction secretions 
- Apply a mouth moisturizer inside mouth every two to four hours.[1,3]
- Apply lip balm to moisturize lips every two to four hours. 
- Maintain endotracheal tube pressure and change position of the tube and the patient’s head after cleaning procedure. 
- Discard all swabs and brushes used. 
- Remove gloves and discard. 
- Document oral care. 
The 24-Hour Oral Care Kits can help caregivers address patients’ oral care. Clinicians may find the kit easy to use with individually packaged oral care products to help caregivers select the right tools, and a color-coded order of use guide.
Preventing ventilator-associated infections is key to maintaining patient health, reduced costs, fewer complications and positive outcomes after discharge. Caregivers who have been thoroughly trained in these proper oral care procedures by physicians, clinicians or critical care nurses will have the best chance of preventing serious complications.
 Lloyd, R. Oral Care of the Mechanically Ventilated Patient: You can make a Difference in Five Minutes. [cited at the State of Illinois Critical Care Conference]. March, 2002. Found https://sageproducts.com/wp-content/uploads/20303C_Oral_care_of_the_mechanically_ventilated_patient_you_can_make_a_difference_in_five_minutes_poster.pdf
 Ackley, B. Nursing Diagnosis Handbook: An Evidence Guide to Planning. 2014. Page 822. Found https://books.google.com/books?id=DtvRkCbiJ9QC&pg=PA844&lpg=PA844&dq=teaching+caregivers+%2B+oral+care+procedures+for+discharged+ventilated+patients&source=bl&ots=7OfqKVDSdE&sig=gGGkB4ueYlB39NGaIde9WWmmBdk&hl=en&sa=X&ved=0ahUKEwjV09veodHbAhUB7awKHQGKDeM4ChDoAQgzMAE#v=onepage&q=teaching%20caregivers%20%2B%20oral%20care%20procedures%20for%20discharged%20ventilated%20patients&f=false
 Booker, S. Mouth Care to Reduce Ventilator Associated Pneumonia. American Journal of Nursing. [cited Oct. 2013] Found https://www.nursingcenter.com/cearticle?an=00000446-201310000-00022&Journal_ID=54030&Issue_ID=1606223