Pneumonia occurring during mechanical ventilation (ventilator associated pneumonia) is the most common infection acquired by patients in intensive care. Reported rates range from 9% to 67% and 4.4 to 15.7 cases per 1000 ventilator days.1 In this week's BMJ, a systematic review by Chan and colleagues2 assesses the effect of oral decontamination with antiseptics on ventilator associated pneumonia and mortality in mechanically ventilated adults.

Ventilator associated pneumonia prolongs lengths of stay in intensive care and hospital, and it increases costs of care and possibly increases mortality.3 4 The prevention of this infection is therefore a high priority for infection control in intensive care.5

Preventive procedures deal with three broad areas: prevention of cross transmission; upper digestive tract colonisation and the risk of inhalation; and maintenance and care of the artificial and natural airways.5 6 7 Because the oropharynx and upper intestinal tract are the major sources of organisms causing pneumonia in intensive care, they would appear …