Impact of oral hygiene involving toothbrushing versus chlorhexidine in the prevention of ventilator-associated pneumonia: a randomized study

BMC Infectious Diseases

Research Article

José Gildo de Moura Monteiro¹  Marta Amorim Leandro²  Aracele Cavalcanti³  Ana Paula da Costa Henriques⁴  Heloísa Ramos Lacerda⁵  Aurora Karla de Lacerda Vidal⁶  Ricardo de Alencar Ximenes⁷  Ulisses Montarroyos⁸  Márcia Oliveira⁹  Mirella Coutinho^1,10  Bárbara Gomes^1,10  Claudia Ângela Vilela^1,10  Pollyanna Dutra Sobral^1,10  Michele Godoy^1,10  Claudia Fernanda de Lacerda Vidal^1,11 

[1] Cardiac Intensive Care Unit, Pronto-Socorro Cardiológico de Pernambuco, Universidade de Pernambuco, Recife, Pernambuco, Brazil;Committee on Infection Control of Hospital das Clinicas, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil;Committee on Infection Control, Pronto-Socorro Cardiológico de Pernambuco, Universidade de Pernambuco, Recife, Pernambuco, Brazil;Committee on Infection Control, Real Hospital Português de Beneficência em Pernambuco, Recife, Pernambuco, Brazil;Department of Infectious and Parasitic Diseases, Faculty of Medical Sciences, Tropical Medicine Health Sciences Center, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil;Department of Pathology, Institute of Biological Sciences, Universidade de Pernambuco, Hospital de Câncer de Pernambuco, Real Hospital Português de Beneficência em Pernambuco, Recife, Pernambuco, Brazil;Faculty of Medical Sciences, Tropical Medicine Health Sciences Center, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil;Institute of Biological Sciences, Universidade de Pernambuco, Recife, Pernambuco, Brazil;Intensive Care Unit, Hospital Agamenon Magalhães, Secretaria de Saúde de Pernambuco, Recife, Pernambuco, Brazil;Intensive Care Unit, Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil;Tropical Medicine Health Sciences Center, Committee on Infection Control of Hospital das Clinicas, Universidade Federal de Pernambuco, Av. Professor Moraes Rego, 1235 Hospital das Clínicas - Cidade Universitária, 50670-901, Recife, Pernambuco, Brazil;

关键词: Pneumonia;    Mechanical ventilator;    Oral hygiene;    Toothbrushing;    Chlorhexidine;    Intensive care;   

DOI  :  10.1186/s12879-017-2188-0

 received in 2015-08-03, accepted in 2017-01-05,  发布年份 2017

来源: Springer

【 摘 要 】

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).

【 授权许可】

CC BY   
© The Author(s). 2017