Intensive Care Med (2007) 33:2228 DOI 10.1007/s00134-007-0873-y CORRESPONDENCE Jordi Rello Stijn Blot Alejandro Rodríguez Oral care practices in critical care unit Received: 14 August 2007 Accepted: 14 August 2007 Published online: 5 October 2007 © Springer-Verlag 2007 An author’s reply to this comment is available at: http://dx.doi.org/ 10.1007/s00134-007-0874-x. Sir: I appreciate the comments by Wise and Cole with regard to our ar- ticle [1] evaluating oral care practices in intensive care units. The question of whether better cleaning of the oral cavity may help to reduce nosoco- mial infections is indeed intriguing; however, this is expert opinion. It re- mains unclear whether small brushes, normal brushes, or electrical brushes are equivalent. A randomized clinical trial is ongoing in our department to clarify this issue. Their observations also reinforce the variability of practices in differ- ent ICUs, explained in part by the different cultures of critical care in different European countries, which is well reflected in the participants at the European Society of Intensive Care Medicine (ESICM) congress. We believe this to be an opportunity to develop a consensus document to be implemented as an European guideline. The multidisciplinary approach used for the development of care bundles on hospital-acquired pneumonia developed by a panel of experts [2] is a good model to follow. Indeed, oral care is part of the recom- mended care bundles for prevention of ventilator-associated pneumonia (VAP), and is recommended by this panel. Once confirmed, however, additional efforts will be necessary to get these recommendations imple- mented, as recently demonstrated in a study which evaluated the know- ledge of ICU nurses about guidelines for the prevention of VAP [3]. Pre- vious reports also pointed out that simply publishing guidelines is in- sufficient to achieve a high rate of compliance [4, 5]. We believe that here. as well, the ESICM can play a pivotal role. References 1. Rello J, Koulenti D, Blot S, Sierra R, Diaz E, De Waele JJ, Macor A, Agbaht K, Rodriguez A (2007) Oral care practices in intensive care units: a survey of 59 European ICUs. Intensive Care Med 33:1066–1070 2. Masterton R, Craven D, Rello J, Struelens M, Frimodt-Moller N, Chastre J, Ortqvist A, Cornaglia G, Lode H, Giamarellou H, Bonten MJ, Eraksoy H, Davey P (2007) Hospital- acquired pneumonia guidelines in Europe: a review of their status and future development. J Antimicrob Chemother 60:206–213 3. Blot S, Labeau S, Vandijck D, Van Aken P, Claes B (2007) Evidence- based guidelines for the prevention of ventilator-associated pneumonia: results of a knowledge test among intensive care nurses. Intensive Care Med 33:1463–1467 4. Ricart M, Lorente C, Diaz E, Kollef MH, Rello J (2003) Nurs- ing adherence with evidence- based guidelines for preventing ventilator-associated pneumonia. Crit Care Med 31:2693–2696 5. Rello J, Lorente C, Bodi M, Diaz E, Ricart M, Kollef MH (2002) Why do physicians not follow evidence- based guidelines for preventing ventilator-associated pneumonia? Chest 122:656–661 J. Rello (✉) · A. Rodríguez Joan XXIII University Hospital, Department of Critical Care, Carrer Dr. Mallafré Guasch 4, 43007 Tarragona, Spain e-mail: jordi.rello@urv.cat Tel.: +34-977-295818 Fax: +34-977-295878 J. Rello · A. Rodríguez CIBERes Enfermedades Respiratorias (06/06/0036), Carretera de Soller, Km 12, 07110 Bunyola, Mallorca, Spain J. Rello Rovira & Virgili University, Carrer del Escorxador s/n, 43007 Tarragona, Spain S. Blot Ghent University Hospital, Critical Care Department, De Pintelaan 185, 9000 Ghent, Belgium