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Singh P, Arshad Z, Srivastava VK, Singh GP, Gangwar RS. Efficacy of Oral Care Protocols in the Prevention of Ventilator-Associated Pneumonia in Mechanically Ventilated Patients. Cureus 2022; 14:e23750. [PMID: 35518542 PMCID: PMC9064705 DOI: 10.7759/cureus.23750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 11/05/2022] Open
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Silva PUJ, Paranhos LR, Meneses-Santos D, Blumenberg C, Macedo DR, Cardoso SV. Combination of toothbrushing and chlorhexidine compared with exclusive use of chlorhexidine to reduce the risk of ventilator-associated pneumonia: A systematic review with meta-analysis. Clinics (Sao Paulo) 2021; 76:e2659. [PMID: 34133659 PMCID: PMC8158674 DOI: 10.6061/clinics/2021/e2659] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 04/15/2021] [Indexed: 01/08/2023] Open
Abstract
This study aimed to compare the effectiveness of 0.12% chlorhexidine alone and 0.12% chlorhexidine in combination with toothbrushing to prevent ventilator-associated pneumonia (VAP) in mechanically ventilated patients. The Embase, Latin American and Caribbean Health Science Literature, PubMed, Scientific Electronic Library Online, Scopus, LIVIVO, Web of Science, Cochrane Library, OpenThesis, and Open Access Thesis and Dissertations databases were used. Only randomized controlled trials without restrictions on the year or language of publication were included. Two reviewers assessed the risk of bias using the Joanna Briggs Institute Critical Appraisal Tool. A meta-analysis using a random-effects model estimated the combined relative risk (RR). The Grading of Recommendations, Assessment, Development and Evaluations approach was used to assess the certainty of the evidence. Initially, 2,337 studies were identified, of which 4 were considered in the systematic review and 3 in the meta-analysis (total sample: 796 patients). The studies were published between 2009 and 2017. All eligible studies had a low risk of bias. The meta-analysis revealed that the risk of VAP was 24% lower in patients receiving chlorhexidine combined with toothbrushing than in those receiving chlorhexidine alone (RR: 0.76; 95% confidence interval: 0.55-1.06), with moderate certainty of evidence and without statistical significance. In conclusion, considering the limitations of this study, a standard protocol for the prevention of VAP is not yet recommended. More studies with larger sample sizes are needed to draw strong conclusions. However, considering that toothbrushing is a simple intervention, it should be a common practice in mechanically ventilated patients, especially among patients with coronavirus disease.
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Affiliation(s)
- Pedro Urquiza Jayme Silva
- Programa de Pos-Graduacao em Odontologia, Faculdade de Odontologia, Universidade Federal de Uberlandia, Uberlandia, MG, BR
| | - Luiz Renato Paranhos
- Area de Odontologia Preventiva e Social, Faculdade de Odontologia, Universidade Federal de Uberlandia, Uberlandia, MG, BR
- Corresponding author. E-mail:
| | - Daniela Meneses-Santos
- Programa de Residencia em Cirurgia e Traumatologia Buco-Maxilo-Facial, Faculdade de Medicina, Universidade Federal de Uberlandia, Uberlandia, MG, BR
| | - Cauane Blumenberg
- Programa de Pos-Graduacao em Epidemiologia, Faculdade de Medicina, Universidade Federal de Pelotas, Pelotas, RS, BR
| | | | - Sérgio Vitorino Cardoso
- Area de Patologia, Faculdade de Odontologia, Universidade Federal de Uberlandia, Uberlandia, MG, BR
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Pawlaczyk-Kamieńska T, Śniatała R, Batura-Gabryel H, Borysewicz-Lewicka M, Cofta S. Periodontal Status and Subgingival Biofilms in Cystic Fibrosis Adults. Pol J Microbiol 2019; 68:377-382. [PMID: 31880883 PMCID: PMC7256727 DOI: 10.33073/pjm-2019-040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/22/2019] [Accepted: 07/30/2019] [Indexed: 12/27/2022] Open
Abstract
The aim of this study was to assess the periodontal status of cystic fibrosis (CF) adult patients and to evaluate whether there is a correlation between the bacterial population of the subgingival biofilm and the health status of the periodontal tissues in this group of adults. The study involved 22 cystic fibrosis adult patients. The periodontal condition was assessed using Plaque Index (PLI), Gingival Index (GI), and Probing Pocket Depth (PPD). The gingival sulcus samples were analyzed by the Real-Time PCR assay (RT-PCR). Majority of patients showed moderate or severe bacterial dental plaque accumulation, but none of them had clinical symptoms of periodontal diseases. RT-PCR showed the presence of periopathogens in 50% of patients. Red complex microorganisms were detected in 9.09%, orange complex in 27.27%, and green complex in 31.82% of the samples analyzed. In cystic fibrosis patients colonized by periopathogens, the periodontal markers were significantly higher in comparison to not colonized by periopathogens patients. Despite the widespread presence of bacterial dental deposits in the cystic fibrosis adult patients examined, none of them has clinical symptoms of periodontal disease; however, the presence of periodontal pathogens in subgingival biofilm may represent a possible risk factor of this disease in the future. An unsatisfactory level of oral hygiene in any patient with cystic fibrosis indicates a need to focus on standards of dental care for such patients.
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Affiliation(s)
| | - Renata Śniatała
- Department of Paediatric Dentistry, Poznan University of Medical Sciences , Poznan , Poland
| | - Halina Batura-Gabryel
- Department of Pulmonology, Allergology and Respiratory Oncology, Poznan University of Medical Sciences , Poznan , Poland
| | | | - Szczepan Cofta
- Department of Pulmonology, Allergology and Respiratory Oncology, Poznan University of Medical Sciences , Poznan , Poland
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de Lacerda Vidal CF, Vidal AKDL, Monteiro JGDM, Cavalcanti A, Henriques APT, Oliveira M, Godoy M, Coutinho M, Sobral PD, Vilela CÂ, Gomes B, Leandro MA, Montarroyos U, Ximenes RDA, Lacerda HR. Impact of oral hygiene involving toothbrushing versus chlorhexidine in the prevention of ventilator-associated pneumonia: a randomized study. BMC Infect Dis 2017; 17:112. [PMID: 28143414 PMCID: PMC5286780 DOI: 10.1186/s12879-017-2188-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 01/05/2017] [Indexed: 11/13/2023] Open
Abstract
BACKGROUND Nosocomial 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). METHODS The 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. RESULTS Seven 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). CONCLUSIONS The 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 REGISTRATION Retrospectively registered in the Brazilian Clinical Trials Registry (Registro Brasileiro de Ensaios Clínicos) - RBR-4TWH4M (4 September 2016).
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Affiliation(s)
- Claudia Fernanda de Lacerda Vidal
- 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, Recife, Pernambuco 50670-901 Brazil
| | - Aurora Karla de Lacerda Vidal
- 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
| | - José Gildo de Moura Monteiro
- Cardiac Intensive Care Unit, Pronto-Socorro Cardiológico de Pernambuco, Universidade de Pernambuco, Recife, Pernambuco Brazil
| | - Aracele Cavalcanti
- Committee on Infection Control, Pronto-Socorro Cardiológico de Pernambuco, Universidade de Pernambuco, Recife, Pernambuco Brazil
| | - Ana Paula Trindade Henriques
- Committee on Infection Control, Real Hospital Português de Beneficência em Pernambuco, Recife, Pernambuco Brazil
| | - Márcia Oliveira
- Intensive Care Unit, Hospital Agamenon Magalhães, Secretaria de Saúde de Pernambuco, Recife, Pernambuco Brazil
| | - Michele Godoy
- Intensive Care Unit, Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Pernambuco Brazil
| | - Mirella Coutinho
- Intensive Care Unit, Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Pernambuco Brazil
| | - Pollyanna Dutra Sobral
- Intensive Care Unit, Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Pernambuco Brazil
| | - Claudia Ângela Vilela
- Intensive Care Unit, Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Pernambuco Brazil
| | - Bárbara Gomes
- Intensive Care Unit, Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Pernambuco Brazil
| | - Marta Amorim Leandro
- Committee on Infection Control of Hospital das Clinicas, Universidade Federal de Pernambuco, Recife, Pernambuco Brazil
| | - Ulisses Montarroyos
- Institute of Biological Sciences, Universidade de Pernambuco, Recife, Pernambuco Brazil
| | - Ricardo de Alencar Ximenes
- Faculty of Medical Sciences, Tropical Medicine Health Sciences Center, Universidade Federal de Pernambuco, Recife, Pernambuco Brazil
| | - Heloísa Ramos Lacerda
- Department of Infectious and Parasitic Diseases, Faculty of Medical Sciences, Tropical Medicine Health Sciences Center, Universidade Federal de Pernambuco, Recife, Pernambuco Brazil
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Marino PJ, Hannigan A, Haywood S, Cole JM, Palmer N, Emanuel C, Kinsella T, Lewis MAO, Wise MP, Williams DW. Comparison of foam swabs and toothbrushes as oral hygiene interventions in mechanically ventilated patients: a randomised split mouth study. BMJ Open Respir Res 2016; 3:e000150. [PMID: 27843549 PMCID: PMC5073587 DOI: 10.1136/bmjresp-2016-000150] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 08/15/2016] [Accepted: 08/21/2016] [Indexed: 01/14/2023] Open
Abstract
Introduction During critical illness, dental plaque may serve as a reservoir of respiratory pathogens. This study compared the effectiveness of toothbrushing with a small-headed toothbrush or a foam-headed swab in mechanically ventilated patients. Methods This was a randomised, assessor-blinded, split-mouth trial, performed at a single critical care unit. Adult, orally intubated patients with >20 teeth, where >24 hours of mechanical ventilation was expected were included. Teeth were cleaned 12-hourly using a foam swab or toothbrush (each randomly assigned to one side of the mouth). Cleaning efficacy was based on plaque scores, gingival index and microbial plaque counts. Results High initial plaque (mean=2.1 (SD 0.45)) and gingival (mean=2.0 (SD 0.54)) scores were recorded for 21 patients. A significant reduction compared with initial plaque index occurred using both toothbrushes (mean change=−1.26, 95% CI −1.57 to −0.95; p<0.001) and foam swabs (mean change=−1.28, 95% CI −1.54 to −1.01; p<0.001). There was significant reduction in gingival index over time using toothbrushes (mean change=−0.92; 95% CI −1.19 to −0.64; p<0.001) and foam swabs (mean change=−0.85; 95% CI −1.10 to −0.61; p<0.001). Differences between cleaning methods were not statistically significant (p=0.12 for change in gingival index; p=0.24 for change in plaque index). There was no significant change in bacterial dental plaque counts between toothbrushing (mean change 3.7×104 colony-forming units (CFUs); minimum to maximum (−2.5×1010 CFUs, 8.7×107 CFUs)) and foam swabs (mean change 9×104 CFUs; minimum to maximum (−3.1×1010 CFUs, 3.0×107 CFUs)). Conclusions Patients admitted to adult intensive care had poor oral health, which improved after brushing with a toothbrush or foam swab. Both interventions were equally effective at removing plaque and reducing gingival inflammation. Trial registration number NCT01154257; Pre-results.
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Affiliation(s)
| | - Ailish Hannigan
- Graduate Entry Medical School, University of Limerick , Limerick , Ireland
| | - Sean Haywood
- School of Dentistry, Cardiff University , Cardiff , UK
| | - Jade M Cole
- Adult Critical Care , University Hospital of Wales , Cardiff , UK
| | - Nicki Palmer
- Adult Critical Care , University Hospital of Wales , Cardiff , UK
| | | | | | | | - Matt P Wise
- Adult Critical Care , University Hospital of Wales , Cardiff , UK
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Sands KM, Twigg JA, Lewis MAO, Wise MP, Marchesi JR, Smith A, Wilson MJ, Williams DW. Microbial profiling of dental plaque from mechanically ventilated patients. J Med Microbiol 2015; 65:147-159. [PMID: 26690690 PMCID: PMC5115166 DOI: 10.1099/jmm.0.000212] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Micro-organisms isolated from the oral cavity may translocate to the lower airways during mechanical ventilation (MV) leading to ventilator-associated pneumonia (VAP). Changes within the dental plaque microbiome during MV have been documented previously, primarily using culture-based techniques. The aim of this study was to use community profiling by high throughput sequencing to comprehensively analyse suggested microbial changes within dental plaque during MV. Bacterial 16S rDNA gene sequences were obtained from 38 samples of dental plaque sampled from 13 mechanically ventilated patients and sequenced using the Illumina platform. Sequences were processed using Mothur, applying a 97 % gene similarity cut-off for bacterial species level identifications. A significant ‘microbial shift’ occurred in the microbial community of dental plaque during MV for nine out of 13 patients. Following extubation, or removal of the endotracheal tube that facilitates ventilation, sampling revealed a decrease in the relative abundance of potential respiratory pathogens and a compositional change towards a more predominantly (in terms of abundance) oral microbiota including Prevotella spp., and streptococci. The results highlight the need to better understand microbial shifts in the oral microbiome in the development of strategies to reduce VAP, and may have implications for the development of other forms of pneumonia such as community-acquired infection.
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Affiliation(s)
- Kirsty M Sands
- Oral and Biomedical Sciences, School of Dentistry, Cardiff University, UK
| | - Joshua A Twigg
- Oral and Biomedical Sciences, School of Dentistry, Cardiff University, UK
| | - Michael A O Lewis
- Oral and Biomedical Sciences, School of Dentistry, Cardiff University, UK
| | - Matt P Wise
- Adult Critical Care, University Hospital of Wales, Heath Park, Cardiff, UK
| | - Julian R Marchesi
- School of Biosciences, Main Building, Park Place, Cardiff University, Cardiff, Wales, UK.,Centre for Digestive and Gut Health, Imperial College London, London, UK
| | - Ann Smith
- School of Biosciences, Main Building, Park Place, Cardiff University, Cardiff, Wales, UK
| | - Melanie J Wilson
- Oral and Biomedical Sciences, School of Dentistry, Cardiff University, UK
| | - David W Williams
- Oral and Biomedical Sciences, School of Dentistry, Cardiff University, UK
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Kuo YW, Yen M, Fetzer S, Chiang LC, Shyu YIL, Lee TH, Ma HI. A home-based training programme improves family caregivers’ oral care practices with stroke survivors: a randomized controlled trial. Int J Dent Hyg 2015; 14:82-91. [DOI: 10.1111/idh.12138] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2015] [Indexed: 01/30/2023]
Affiliation(s)
- Y-W Kuo
- Department of Nursing; Asia University; Taichung Taiwan
| | - M Yen
- Department of Nursing and Institute of Allied Health Sciences; College of Medicine; National Cheng Kung University; Tainan Taiwan
| | - S Fetzer
- Department of Nursing, College of Health and Human Services; University of New Hampshire; Durham NH USA
| | - L-C Chiang
- School of Nursing; National Defense; Medical Center; Taipei Taiwan
| | - Y-IL Shyu
- School of Nursing and Healthy Aging Research Center; Chang Gung University; Taoyuan Taiwan
| | - T-H Lee
- College of Medicine; Chang Gung University College of Medicine; Taoyuan Taiwan
- Department of Neurology; Chang Gung Memorial Hospital; Taoyuan Taiwan
| | - H-I Ma
- Department of Occupational and Institute of Allied Health Sciences; College of Medicine; National Cheng Kung University; Tainan Taiwan
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