Benefits of Oral Care for Acute and Critically Ill Children

Effect of oral care in reducing the incidence of early-onset ventilator-associated pneumonia in preterm infants

BACKGROUND

Oral care using chlorhexidine has been considered useful in reducing the incidence of ventilator-associated pneumonia (VAP) in adult patients. However, no study has proved the effect of oral care in reducing the incidence of VAP in preterm infants.

OBJECTIVES

To investigate the efficacy of oral care using a sponge brush moistened with sterile water in reducing the bacterial load in the oral cavity and the incidence of early-onset VAP in preterm infants METHODS: The bacterial number in the oral cavity was evaluated on-site with the dielectrophoretic impedance measurement system. Bacterial numbers before and after oral care were investigated prospectively. Then, the incidence of early-onset VAP was compared retrospectively between infants who received oral care before re-intubation and those who did not.

RESULTS

The mean bacterial number (cfu/ml) in the oral cavity in infants managed with endotracheal intubation (n = 23), continuous positive airway pressure (n = 38), and high-flow nasal cannula (n = 22) significantly reduced (p < .01) after versus before oral care (4.46 × 10⁷ vs. 1.25 × 10⁶ ; 1.32 × 10⁷ vs. 6.82 × 10⁵ ; and 1.68 × 10⁷ vs. 6.50 × 10⁵ ). The incidence rate of early-onset VAP after re-intubation was 51% (20/39) in patients who did not receive oral care. Then, it significantly decreased to 21% (7/33; p = .009) after receiving oral care.

CONCLUSION

Oral care with sterile water may be effective in reducing the bacterial load in the oral cavity and the incidence of early-onset VAP in preterm infants.