10. The Current Status of Perioperative Oral Healthcare in Showa University Northern Yokohama Hospital

Ventilator-associated pneumonia(VAP), defined as hospital-acquired pneumonia occurring within 48 h after the initiation of mechanical ventilation in intubated patients, can be life threatening. The development of VAP may lead to prolonged duration of mechanical ventilation, longer intensive care unit(ICU)stay, and increased healthcare cost. Oropharyngeal bacterial colonization contributes to the pathogenesis of VAP. Oral care interventions that prevent the accumulation of dental plaque and stimulate local oral immunity would be expected to attenuate the etiologic factors of VAP. We report the current status of perioperative oral healthcare in Showa University Northern Yokohama Hospital(SUNYH). The interventions involving tooth brushing and swabbing with benzalkonium chloride solution are routinely conducted by ICU nurses three times daily for intubated or tracheostomized patients. A dental hygienist is dispatched once a week to SUNYH from Showa University Dental Hospital as advisory staff. Recently, dental anesthesiologists under training in SUNYH began to provide interventions in the operating room for surgical patients scheduled to receive postoperative mechanical ventilation for a definite period of time in the ICU. Immediately after the induction of general anesthesia, a dental anesthesiologist provided thorough tooth cleaning for the specified patients using a sonic scaler and an electric toothbrush in combination with an antibacterial-agent supply and suction system. An anesthetized and paralyzed condition facilitates providing this sort of expert technique known as “professional mechanical tooth cleaning.” Further investigation is needed to establish a feasible prophylactic against postoperative VAP through oral healthcare, especially for patients undergoing major surgery at SUNYH.