Table 1.

Oral care bundle

Comprehensive oral care Q12 hours	Equipment	Procedure
1. Oral assessment	•Flashlight •Tongue depressor •Gloves •Face shield	•Explain procedure to patient •Gently open mouth or use mouth prop •Inquire about mouth/throat pain (0–10 NRS) •Use CPOT tool to evaluate pain in non-verbal pt. •Treat pain prior to proceeding
2. Tooth brushing	•Yankauer •12 or 14 French flexible catheter •Small soft-bristle or suction toothbrush •Sponge swabs •Sterile water •Gloves •Face shield	•Explain procedure to patient •Perform hand hygiene •Elevate HOB 30–45 degrees as tolerated •Use oral prop to open mouth as needed •Oral suction with Yankauer or sterile flexible catheter to remove secretions that may migrate down airway •Moisten toothbrush with sterile water •Connect suction toothbrush to continuous suction if applicable •Brush accessible teeth and gums for 2 full minutes or 30 s per quadrant; brush in one continuous line LUQ > RUQ > RLQ > LLQ •Gently brush tongue
3. Mouth and lip moisturizer	•Swabs •Mouth moisturizer/saliva replacement or sterile water •Gloves •Face shield	•Explain procedure to patient •Use oral prop to open mouth as needed •Use 1–3 swabs to apply moisturizer to oral mucosa, tongue, and lips
4. Deep oral suctioning	•Yankauer or flexible catheter •Gloves •Face shield	•Explain procedure to patient •Use oral prop to open mouth as needed •Deep oropharyngeal suction (above the cuff) to remove pooled secretions
Maintenance oral care Q4 hours and PRN	Equipment	Procedure
Mouth and lip moisturizer	•As above	•As above
Oral secretion removal	•As above	•As above

CPOT Critical-Care Pain Observational Tool, HOB head of bed, PRN pro re nata or “as needed”