The impact of oral health and 0.2% chlorhexidine oral gel on the prevalence of nosocomial infections in surgical intensive-care patients: a randomized placebo-controlled study

Abstract

Among surgical ICU patients, poor oral health had a significant positive correlation with bacterial colonization and the evolution of nosocomial infections. Oral decontamination with chlorhexidine significantly decreased oropharyngeal colonization, the incidence of nosocomial infections, length of ICU stay, and mortality in these patients.

Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia

“…In three of the included studies, participants were children (Jacomo 2011; Kusahara 2012a; Sebastian 2012); in one study, participants were neonates (Stefanescu 2013); and in the remaining studies, only adults participated. In six studies, participants were either medical or surgical patients (Berry 2013;Meinberg 2012;Mo 2016;; in another five studies, participants were described as trauma patients (Grap 2011;Prendergast 2012;Scannapieco 2009;Seguin 2006;Seguin 2014); six studies recruited surgical patients only (Chen 2008;DeRiso 1996;Jacomo 2011;Kusahara 2012a;Yao 2011;Zhao 2012); nine studies recruited medical patients only (Cabov 2010;Fields 2008;Fourrier 2000;Fourrier 2005;Ozcaka 2012;Sebastian 2012;Stefanescu 2013;Tang 2013;Tantipong 2008); and in the remaining 12 studies, it was not clearly stated whether participants were medical, surgical, or trauma cases. Nine of the included studies (Fields 2008;Fourrier 2000;Grap 2011;Lorente 2012;Ozcaka 2012;Pobo 2009;Prendergast 2012;Roca Biosca 2011) specifically excluded edentulous participants, and the remaining studies did not report whether or not participants were dentate.…”

“…VAP was fully reported by 34 of the included studies (Bellissimo-Rodrigues 2009;Berry 2013;Bopp 2006;Cabov 2010;Caruso 2009;Chen 2008;DeRiso 1996;Feng 2012;Fourrier 2005;Grap 2011;Hu 2009;Jacomo 2011;Kusahara 2012a;Long 2012;Lorente 2012;Meinberg 2012;Mo 2016;Ozcaka 2012;Pobo 2009;Prendergast 2012;Scannapieco 2009;Sebastian 2012;Seguin 2006;Seguin 2014;Stefanescu 2013;Tang 2013;Tantipong 2008;Xu 2007;Xu 2008;Yao 2011;Zhao 2012). One study reported only that there was no difference in VAP between the two arms of the study (Roca Biosca 2011).…”

“…Twenty-four studies reported the outcome of mortality, either as ICU mortality or 30-day mortality (Bellissimo-Rodrigues 2009;Cabov 2010;Caruso 2009;Fourrier 2000;Fourrier 2005;Jacomo 2011;Kusahara 2012a;Long 2012;Lorente 2012;Meinberg 2012;Mo 2016;Ozcaka 2012;Pobo 2009;Prendergast 2012;Scannapieco 2009;Sebastian 2012;Seguin 2006;Seguin 2014;Stefanescu 2013;Tang 2013;Tantipong 2008;Yao 2011). Where ICU mortality was reported, we used these data; where ICU mortality was not reported, we used 30-day mortality.…”

“…1. Chlorhexidine versus placebo/usual care, with or without toothbrushing (19 studies: Bellissimo-Rodrigues 2009;Bopp 2006;Cabov 2010;Chen 2008;DeRiso 1996;Fourrier 2000;Fourrier 2005;Grap 2011;Jacomo 2011;Kusahara 2012a;Meinberg 2012;Ozcaka 2012;Scannapieco 2009;Sebastian 2012;Tantipong 2008) 2. Toothbrushing versus no toothbrushing (in addition to usual care) (eight studies : Bopp 2006;Fields 2008;Lorente 2012;Long 2012;Pobo 2009;Roca Biosca 2011;Yao 2011) 3.…”

“…Other solutions (15 studies) i) Saline (Caruso 2009;Hu 2009;Mo 2016;Seguin 2006;Tang 2013;Xu 2007;Xu 2008) ii) Bicarbonate Berry 2013) iii) Povidone iodine (Feng 2012;Seguin 2006;Seguin 2014) iv) Triclosan (Zhao 2012) v) Furacilin (Feng 2012) vi) Listerine (Berry 2013) vii) Biotene OralBalance (Stefanescu 2013) There was some variation between the studies in the number of episodes of OHC per day, with most of the studies (79%) delivering two to four episodes of care daily. Thirteen studies Bopp 2006;DeRiso 1996;Fields 2008;Hu 2009;Jacomo 2011;Kusahara 2012a;Prendergast 2012;Scannapieco 2009;Xu 2007;Xu 2008;Yao 2011) delivered two episodes of OHC a day, nine studies (Bellissimo-Rodrigues 2009;Cabov 2010;Fourrier 2000;Fourrier 2005;Long 2012;Lorente 2012;Pobo 2009;Sebastian 2012) had three episodes a day, and eight studies (Chen 2008;Feng 2012;Meinberg 2012;Mo 2016;Ozcaka 2012;Tantipong 2008;Zhao 2012) had four episodes a day. One study delivered OHC every two hours (Berry 2013), another only once (Grap 2011), and in the remaining three studies it is unclear (Caruso 2009;Roca Biosca 2011;Tang 2013).…”