Translating evidence into nursing practice: oral hygiene for care dependent adults


  • Conflict of interest: We declare that we have no conflict of interests.

  • Source of funding: None.

  • Ethical approval: This study has obtained the ethical approval from the National Healthcare Group Domain Specific Review Boards, Singapore.

Miss Ee Yuee Chan, 11 Jalan Tan Tock Seng, Singapore 308433. Email:


Background  Oral hygiene is necessary to maintain the health and well-being of hospitalised patients. However, studies indicated that nurses lacked the evidence-based knowledge to deliver proper care. A prior survey conducted on nurses working in the intensive care and high dependency units in our institution revealed that oral care practices varied and highlighted the need for an oral care protocol. These triggered us to embark on an evidence-based project on oral care to improve patients' oral health during their hospitalisation.

Aim  We aimed to translate the best available evidence to improve our oral care practices.

Methods  We followed the Iowa Model of Evidence-based Practice. Having identified a problem, we formed a team. We searched for best available evidence on oral care management and appraised them using the Scottish Intercollegiate Guidelines Network checklists. We developed an evidence-based oral care protocol and outlined key changes necessary to improve patients' oral care during hospitalisation. We chose the medical intensive care unit and a neurology ward to pilot the changes. The changes included introducing an oral assessment guide to assess patients' oral condition and intervening appropriately according to their risk levels, recommending 0.2% chlorhexidine solution as the main oral cleaning solution, and standardising oral care documentation. We compared the pre- and post-audits to assess improvement in the nurses' knowledge and compliance to the protocol. Auditors also physically inspected the oral health of functionally dependent patients under the charge of the audited nurses.

Results  The team involved 25 patients and 25 nurses in each pre- and post-audits. The median pre- and post-scores were 60% and 100%, respectively. The results revealed that the project led to improvements in nurses' oral care knowledge and practices, especially in nurses taking appropriate interventions as recommended, and in correctly using oral care products to clean patients' mouths. Auditors reported improvement in patients' oral care during their physical assessments of patients' oral cavities. This finding was supported by feedback from other healthcare providers.

Conclusions  This evidence-based project heightened nurses' awareness and knowledge on oral care, and led to nurses providing practices based on best available evidence. These have translated to improvements in patients' oral health.