Oral care and nosocomial pneumonia: a systematic review

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.

Oral Health and Care at Intensive Care Units

“…Dentistry in Intensive Care Units stands out due to the important role it plays in the comprehensive care provided to critically ill patients [24,25,[30][31][32].…”

“…Other factors also predispose ICU patients to develop pneumonia, namely: the use of endotracheal tube, the deficient cleaning performed by the nursing team, as well as the complexity of the oral biofilm found on the patients' teeth and tongue and, mainly, in the ICU equipment [12,14,18,31,33].…”

“…The orotracheal intubation poses the risk of developing such type of infection, since the tube has direct access to the lower respiratory tract and allows microorganisms found in the mouth to have mechanical access to the lungs [12,13,15,21,31,32,[36][37][38].…”

“…When it comes to ICU environments, there is high correlation between pneumonia and oral health, which is a disturbing element, since nosocomial pneumonia -an extremely debilitating infection diagnosed 48 h after the patient's admission to the hospital -is the second leading cause of death among hospital-acquired infections (20-50% of the affected patients die) [15,18,31,32,47].…”

“…It is expected that the clinical experience and the dentistry orientation focused on promoting health and quality of life to critically ill patients may work as possible training or future guides to hospital environment assistance, mainly in Intensive Care Units [13,15,17,19,20,24,26,29,30,31,35,36,42].…”