The literature reveals that most bacterial nosocomial pneumonias occur by aspiration of bacteria colonizing the oropharynx (Terezakis et al. Concern over laryngeal aspiration is greater in this population, particularly in those individuals with difficulties in oral and pharyngeal secretion management post-stroke (Gordon et al. Stroke patients make up a large proportion of CNS inpatients, and depending on location and severity of cerebral ischaemia, a consequence of stroke can be facial, lingual or pharyngeal weakness, or some combination of these, often making oral care provision even more of a challenge. However, anecdotal reports from staff on our neurology and neurosurgery units indicated that oral care provision varied from patient to patient. Oral care is a basic component of daily patient care within the hospital setting. Policy development, implementation of a valid, reliable and feasible oral health assessment tool and standardized education to all interprofessional groups are all necessary for ensuring evidence-based best practice in oral care. Oral care procedures were not necessarily evidence-based but rather were passed along from one nurse or provider to the next because that is 'the way it has always been done.' Formal education programs devote little, if any, time to oral health theory and practice, and this is reflected in the care provided in acute care settings. Traditionally, oral care has focused on patient comfort, for example, dipping a swab into mouthwash to freshen the patient's oral cavity. Oral care is defined as the care and cleaning of the mouth (teeth, tongue, palate, cheeks and lips), using appropriate products and equipment to promote oral hygiene and maintain patients' health and quality of life (Canadian Dental Association 2013).

This review provides a synopsis of how oral care best practice was implemented in an acute care neurology/neurosurgery setting.

Post-implementation audits indicate increased frequency and quality of oral care. Favourable outcomes to date include improved accessibility of oral health supplies, including regular and suction toothbrushes, toothpaste and bite blocks. A validated, reliable and feasible oral health assessment tool (OHAT) was selected for implementation, and is now completed on every patient within 24 hours of admission to the CNS inpatient unit. Based on the work of the interprofessional Clinical Neurological Sciences (CNS) Continuous Quality Improvement (CQI) Council at London Health Sciences Centre – University Hospital (LHSC-UH), an oral care policy and bedside assessment tool were implemented in line with Stroke Best Practice Recommendations (Heart and Stroke Foundation of Canada 2010). This project used best practice guidelines and evidence in the literature to guide the development of oral care best practice within an acute care inpatient unit. A standardized approach to oral care can change these adverse outcomes. Suboptimal oral care is well documented in the literature and is linked to increased nosocomial pneumonia rates and prolonged hospitalization, negatively affecting patients' quality of life (Terezakis et al.

Swish spit