Registered Nurses' Association of Ontario

Clients at Risk of Aspiration

  • Aspiration is defined as the inhalation of oropharyngeal or gastric contents into the larynx and lower respiratory tract, while aspiration pneumonia is a result of the inhalation of oropharyngeal secretions that are colonized by pathogenic bacteria.
  • Clients at an increased risk of aspiration:
    • Those clients experiencing dysphagia (difficulty swallowing, including stroke related dysphagia);
    • Being bedridden in a prone position; reduced respiratory status (intubated on a ventilator);
    • Prolonged bolus holding;
    • Poor head/trunk control;
    • Dependence for feeding;
    • Poor oral hygiene;
    • High levels of tooth decay;
    • Dependence for oral care;
    • Past history of aspiration and inability to manage their own secretions (i.e. excessive drooling).
  • Risk factors associated with oropharyngeal colonization include:
    • Acidosis
    • Age
    • Alcohol abuse
    • Decreased level of consciousness
    • Chronic Obstructive Pulmonary Disease (COPD)
    • Dental status
    • Dependence for oral care
    • Diabetes mellitus
    • Endotracheal intubation
    • Malnutrition
    • Medications
    • Nasogastric (NG) tube and Percutaneous Endoscopically-guided Gastrostomy (PEG) tube feeding
    • Severity of illness
    • Smoking
    • Stroke/dysphagia
    • Xerostomia
Clinical Management
Oral Health: Nursing Assessment and Intervention
Point of Care Resources