Brushing the teeth 4 times a day rather than twice per day reduces the amount of bacterial colonisation in the upper respiratory tract of ventilated patients in ITU

INTERVENTION: Twenty patients will be randomised to one of two groups. Twenty envelopes will contain ten labels for each group. Either control or enhanced. These will be shuffled into a random order, then labelled 1 to 20. As each patient is admitted, their group will be decided by sequential envelopes containing the randomised group name. Envelope one will be used first, then envelope two and so forth. The control group patients will receive the ITC standard oral hygiene. That is, teeth brushed twice per day, in the morning and evening with a small toothbrush and toothpaste. The toothbrush and toothpaste will be identical for each patient. Oropharyngeal suction will be performed by nursing staff as required using a Yankaur suction device. Foam swabs wet with water will be used in between times for comfort. The enhanced care group will receive the standard oral care as described, but will have their teeth brushed four times per day at 6 hourly intervals. Oropharyngeal suction will be provided as required as will wet foam swabs for comfort. If untoward bleeding of the gums occurs in participants, they may be withdrawn from the trial. Each patient will have an oral/dental swab taken on admission. The sterile swab will be wiped around all facets of the teeth and gums that are accessible. The participant will also have a sputum specimen taken. This will be aspirated from the endotracheal tube using a closed system suction device and specimen trap. The participant will be preoxygenated before the procedure to prevent instability of their condition. The procedure will only be carried out at a time when aspiration of sputum from the chest is already indicated as part of the normal treatment. Both these procedures will be carried out by registered physiotherapists who will be blinded to the treatment group of the participant. Specimens will be anonymised as each patient will be allocated a number at the beginning of the study. The specimens will be sent to the microbiology dept. for an CONDITION: Oral Health: Ventilator associated pneumonia ; Oral Health ; Complications of procedures, not elsewhere classified PRIMARY OUTCOME: Levels of bacterial colonisation in the upper respiratory tract over the ten day period measured as numbers of colony forming units. Comparison between the control and enhanced care group. SECONDARY OUTCOME: Not provided at time of registration INCLUSION CRITERIA: Eligible patients are to be enrolled between 12/05 and 03/06 from Epsom and St Helier Hospital ITUs. The study will be a prospective blind randomised controlled trial. Approval from the Research Ethics Committee and Research and Development are being sought. Patients admitted to the ITU for mechanical ventilation will be invited to join the study as long as they fulfill the following criteria: all adult patients, male and female aged 18 to 95 with written consent. This may be obtained from the participant or from a legal representative or next of kin. Participants must have been intubated within the hospital. However, if intubated in another hospital they may be included as long as they arrive in the ITU within 12 hours of intubation. Participants must not be endentulous or have a tracheostomy tube. Patients with both medical and surgical diagnosis will be included but their condition must suggest an expected admission period of more that 8 days.