Efficacy of toothbrushing procedures performed in intensive care units in reducing the risk of ventilator‐associated pneumonia: A systematic review

Abstract

The aim of this systematic review (SR) was to assess whether toothbrushing‐based oral heath measure (OHM), performed in intensive care units, can reduce the risk of ventilator‐associated pneumonia (VAP). Dental biofilm removal has been considered important to prevent VAP. PUBMED, SCOPUS, WEB OF SCIENCE and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched up to and including December 2018 to identify randomized clinical trials (RCT) on the use of toothbrushing procedures in the prevention of VAP. Search was conducted by two independent reviewers. The risk of bias of each included study was assessed using the Cochrane Collaboration's domain‐based, two‐part tool. Random effects meta‐analyses were conducted thoroughly. Search strategy identified 215 potentially eligible articles, of which 12 RCT were included. All studies evidenced the importance of OHM in mechanically ventilated patients in order to prevent VAP. Seven RCT (58.3%) found some degree of positive association between toothbrushing, alone or associated to oral topical chlorhexidine (CHX), and a potential reduction of mechanical ventilation‐related outcomes and dental biofilm/oral bacteria. However, pooled estimates did not identify an additional decrease of VAP incidence for any of the tested procedures (ie, toothbrushing + CHX versus swab/gauze cleaning + CHX or toothbrushing + CHX versus toothbrushing alone or + placebo). Toothbrushing does not seem to promote a reduction of VAP‐outcomes compared to swab/gauze cleaning, when topic CHX is applied for oral hygiene of patients submitted to mechanical ventilation.

Impact of Healthcare-Associated Infections Connected to Medical Devices—An Update

“…The link between VAP and dental plaque/biofilm has also been intensively studied. It was shown that brushing teeth with 0.12% chlorhexidine is also effective in inhibiting oral biofilms, reducing the incidence of VAP in patients [113]. Hua et al (2016) tested chlorhexidine mouthwash on VAP-associated critically ill patients in the ICU and proved a reduction in VAP from 26% to approximately 18%.…”

Efeito da clorexidina em microrganismos na saliva de doentes internados em unidade de terapia intensiva

“…Previous studies support the suggested mechanism for microbial reduction in shorter time in Medical Clinic patients and non-intubated ICU patients than in intubated ICU patients. First, the literature reports that teeth are an important reservoir for microorganisms (Camargo et al, 2019;Vidal et al, 2017). In this study, the majority of intubated ICU patients had no teeth.…”

“…After 12 hours, the number of microorganisms decreased by 12% and 58% in both groups, respectively. Chlorhexidine is widely used for reducing the number of microorganisms in the oral cavity, and several studies have reported its influence on the prevention of VAP in hospitalized patients (Camargo et al, 2019;Deschepper et al, 2018;Meidani et al, 2018;Rabello et al, 2018;Vidal et al, 2017;Zand et al, 2017). In this context, the time necessary for microbial reduction after oral hygiene with a 0.12% chlorhexidine solution is still unclear, especially in patients with an orotracheal tube.…”

Microbial Etiology and Prevention of Dental Caries: Exploiting Natural Products to Inhibit Cariogenic Biofilms

“…In recent years, many chemical agents have been reported to have effects on the metabolism of bacteria and the adherence of bacterial cells. Some, such as chlorhexidine [14][15][16][17], delmopinol [17,18], and triclosan [19], have shown potent inhibitory activities against the development and maturation of biofilm. It is generally believed that the mechanism of chlorhexidine bactericidal activity is the destruction of the serosa permeability barrier against bacterial cells.…”