Enhanced Moisture-Focused, Nurse-Led Oral Care Improves Oral Health and Suppresses Bacterial Overgrowth in Mechanically Ventilated ICU Patients: A Quasi-Experimental Study.

The study was quasi-experimental without randomisation or blinding, so the observed benefits could be due to other differences between the two time periods rather than the intervention itself. Oral health outcomes were only measured up to ICU Day 3, so long-term effects on oral function or swallowing recovery were not directly assessed. The sample size was small for rare events like ventilator-associated pneumonia, so the zero incidence in the intervention group may not be generalisable. The study was conducted in Japan where chlorhexidine use is restricted, so the applicability of this specific chlorhexidine-free protocol to settings where chlorhexidine is standard care is uncertain.

The authors declare no conflicts of interest. The work was supported by the Japan Science and Technology Agency.

Do not assume this protocol causes the reduction in dysphagia or shorter ICU stays. As a non-randomised study with a contemporaneous control group, unmeasured differences between the patient cohorts in February-April versus May-July could explain the outcomes.