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This study sought to determine the strategies, methods and frequency of oral care provided for mechanically ventilated patients in Malaysian intensive care units. The study also described nurses' attitudes to providing oral care and their knowledge of the mode of transmission of ventilator-associated pneumonia.Oral care is an important nursing intervention in the intensive care unit to reduce dental plaque. Dental plaque provides a repository for respiratory pathogens contributing to ventilator-associated pneumonia in the critically ill.Cross-sectional study.This study used both survey and observational methods. The observational study was conducted by a nurse, trained in the study protocol. The observation period a selected shift over three weeks in 2007.Intensive care unit nurses (n = 284) participated in the survey. Respondents had a positive attitude towards providing oral care. On a 10-point Likert scale, aspiration of contaminated secretions from the oropharynx was identified by nurses as the highest risk factor for ventilator-associated pneumonia (mean response 6·8, SD 2·0). The majority of nurses used cotton and forceps for oral care. Toothbrushes were not used in any of the study sites.Although nurses had a positive attitude to oral hygiene, this study found no intensive care units incorporated a soft toothbrush in oral care protocols which is recommended in best practice guidelines. A review of strategies to implement evidence-based practice in the intensive care unit is warranted.This study has identified a failure to adhere with evidence-based practice. Implementing and evaluating protocols for oral hygiene in the intensive care unit has the potential to improve patient outcomes.