Abstract
To perform a systematic review of the literature on the control of oral biofilms and the incidence of nosocomial pneumonia, in addition to assessing and classifying studies as to the grade of recommendation and level of evidence. The review was based on PubMed, LILACS, and Scopus databases, from January 1st, 2000 until December 31st, 2012. Studies evaluating oral hygiene care related to nosocomial infections in patients hospitalized in intensive care units were selected according to the inclusion criteria. Full published articles available in English, Spanish, or Portuguese, which approached chemical or mechanical oral hygiene techniques in preventing pneumonia, interventions performed, and their results were included. After analysis, the articles were classified according to level of evidence and grade of recommendation according to the criteria of the Oxford Centre for Evidence-Based Medicine. A total of 297 abstracts were found, 14 of which were full articles that met our criteria. Most articles included a study group with chlorhexidine users and a control group with placebo users for oral hygiene in the prevention of pneumonia. All articles were classified as B in the level of evidence, and 12 articles were classified as 2B and two articles as 2C in grade of recommendation. It was observed that the control of oral biofilm reduces the incidence of nosocomial pneumonia, but the fact that most articles had an intermediate grade of recommendation makes clear the need to conduct randomized controlled trials with minimal bias to establish future guidelines for oral hygiene in intensive care units.
Highlights
IntroductionThe mouth of Intensive Care Units (ICU) patients can serve as an important reservoir for respiratory pathogens associated with hospital-acquired pneumonia
Nosocomial infections are among the main causes of mortality in seriously ill patients at Intensive Care Units (ICU), and the most frequent infections are urinary, surgical wounds, and pneumonias.(1)The risk of developing nosocomial pneumonia (NP) increases with the use of mechanical ventilation (MV), and besides prolonging, on average, the length of hospital stay for 5 to 9 days, it rises hospital costs.(2)The mouth of ICU patients can serve as an important reservoir for respiratory pathogens associated with hospital-acquired pneumonia
The need to use one of these methods was made evident when studies demonstrated that 48 hours after admission to the ICU, all the patients presented with oropharyngeal colonization by Gram-negative bacilli, which are frequent etiological agents of nosocomial pneumonia – the biofilm is considered an important pool of respiratory pathogens.(2,6-8)
Summary
The mouth of ICU patients can serve as an important reservoir for respiratory pathogens associated with hospital-acquired pneumonia. These data suggest a new view, in which specific procedures for the control of these oral cavity pathogens should be considered in the prevention of NP.(3). The need to use one of these methods was made evident when studies demonstrated that 48 hours after admission to the ICU, all the patients presented with oropharyngeal colonization by Gram-negative bacilli, which are frequent etiological agents of nosocomial pneumonia – the biofilm is considered an important pool of respiratory pathogens.(2,6-8)
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