Abstract
BackgroundNosocomial pneumonia has correlated to dental plaque and to oropharynx colonization in patients receiving mechanical ventilation. The interruption of this process, by preventing colonization of pathogenic bacteria, represents a potential procedure for the prevention of ventilator-associated pneumonia (VAP).MethodsThe study design was a prospective, randomized trial to verify if oral hygiene through toothbrushing plus chlorhexidine in gel at 0.12% reduces the incidence of ventilatior-associated pneumonia, the duration of mechanical ventilation, the length of hospital stay and the mortality rate in ICUs, when compared to oral hygiene only with chlorhexidine, solution of 0.12%, without toothbrushing, in adult individuals under mechanical ventilation, hospitalized in Clinical/Surgical and Cardiology Intensive Care Units (ICU). The study protocol was approved by the Ethical Committee of Research of the Health Sciences Center of the Federal University of Pernambuco – Certificate of Ethical Committee Approval (CAAE) 04300012500005208. Because it was a randomized trial, the research used CONSORT 2010 checklist criteria.ResultsSeven hundred sixteen patients were admitted into the ICU; 219 fulfilled the criteria for inclusion and 213 patients were included; 108 were randomized to control group and 105 to intervention group. Toothbrushing plus 0.12% chlorhexidine gel demonstrated a lower incidence of VAP throughout the follow up period, although the difference was not statistically significant (p = 0.084). There was a significant reduction of the mean time of mechanical ventilation in the toothbrushing group (p = 0.018). Regarding the length of hospital stay in the ICU and mortality rates, the difference was not statistically significant (p = 0.064).ConclusionsThe results obtained showed that, among patients undergoing toothbrushing there was a significant reduction in duration of mechanical ventilation, and a tendency to reduce the incidence of VAP and length of ICU stay, although without statistical significance.Trial registrationRetrospectively registered in the Brazilian Clinical Trials Registry (Registro Brasileiro de Ensaios Clínicos) - RBR-4TWH4M (4 September 2016).
Highlights
Nosocomial pneumonia has correlated to dental plaque and to oropharynx colonization in patients receiving mechanical ventilation
Considering that the microbiota of the oral cavity plays an important role in the development process of ventilator-associated pneumonia (VAP), some studies have indicated that the topical application of chlorhexidine, initiated before intubation, reduces nosocomial infections in patients submitted to elective cardiac surgery [7, 8]
Among the main causes of exclusion of patients admitted in Intensive Care Unit (ICU) are suspected pneumonia admission, patients without teeth, tracheostomy, extubated withing 12 h wich resulted in failure to apply the oral hygiene protocol, missing randomization withing 24 h of admission. noninvasive ventilation
Summary
Nosocomial pneumonia has correlated to dental plaque and to oropharynx colonization in patients receiving mechanical ventilation The interruption of this process, by preventing colonization of pathogenic bacteria, represents a potential procedure for the prevention of ventilator-associated pneumonia (VAP). The endotracheal tube works as a conductor of the microorganisms of the oropharynx to the lower respiratory tract, and these are frequently identified as etiological agents of the nosocomial pneumonia [3,4,5]. The interruption of this process, by preventing colonization of pathogenic bacteria, represents a potential procedure for the prevention of VAP [6]. Mechanical cleansing, through toothbrushing may be the most effective method of removing all pathogens from the plaque, including anaerobes and multiresistant bacteria such as methicilline-resistant Staphylococcus aureus, (MRSA) or Pseudomonas [10]
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