Evaluation of Effectiveness of Comprehensive Oral Hygiene Management in Mechanical Ventilation Patients in Chinese Intensive Care Unit

Abstract

Objective: To investigate the effect of toothbrushes and oral care solution in oral hygiene management on the prevention of ventilator-associated pneumonia (VAP) and ventilator-associated events (VAE) in the critically ill patients. Methods: The patients were divided into 5 groups according to the time of admission of ICU. Toothbrush and oral care solution were used as intervention for oral care. By comparing halitosis, dental plaque, oral mucosa status, and secretion bacteriological analysis, the changes of oral status were observed and evaluated, and VAE was evaluated and diagnosed according to the corresponding standards. ICU and hospital length of stay, duration of MV were calculated from the medical records. Bacterial count and VAP pathogens of oral secretion were also evaluated. Results: The incidence rate of VAE, duration of MV and ICU stays and mortality rate in each group of neurosurgical and general ICU did not show a significant difference. VAE developed later in the intervention group using 0.1% cetylpyridinium chloride solution. The evaluation of halitosis and dental plaque in general and neurosurgical ICU on the 7th day after intubation were significantly improved compared with those on admission (P < 0.05). However, the bleeding in the patients diagnosed as cerebral hemorrhage increased in the intervention group. The number of S.pneumoniae in oral secretion of each group was different. The bacterial count of intervention groups in general ICU began to decrease on the third day, while that of control group did not decrease significantly or even increased. Conclusions: The oral care incorporating toothbrush brushing was effective to reduce the bacterial count in the oral cavity and eliminate halitosis and dental plaque in mechanically ventilated patients.