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Weiss S, Tinsky N, Oren L, Chodick G, Spierer S, Yarom N, Ashkenazi M. Effect of prolonged hospitalization on the maintenance of oral health: A self-report survey. Int J Dent Hyg 2024; 22:870-877. [PMID: 38575751 DOI: 10.1111/idh.12804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 03/16/2024] [Accepted: 03/21/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVES This study aims to evaluate the effect of prolonged hospitalization on the maintenance of dental health and to assess the nursing staff's approach to addressing these concerns. METHODS A survey questionnaire explored changes in the routine dental care of patients hospitalized for over a month. The involvement of nursing staff in addressing dental care was also evaluated. RESULTS Fifty adult patients aged 18-89 years (mean age 62.4 ± 20.54 years), 27 (54%) males, completed the survey. During hospitalization (mean 58.59 ± 38.63 days) 26% and 18%, increased consumption of sweets and sugary beverages, between meals, respectively; 26% and 20% of the patients reduced the frequency of tooth brushing in the morning and in the evening, respectively, and 42.2% of them, reduced the quality of their toothbrushing during hospitalization. Nevertheless, 95.9% and 93.9% of them were never instructed during hospitalization to limit their consumption of sweets and sugary beverages and 83.3% and 62.5% of them had never been reminded or offered assistance during hospitalization in performing toothbrushing, respectively. The lower frequency of morning toothbrushing was significantly correlated with a lack of nurses' assistance (p = 0.004). In contrast, 62.6% reported they were reminded every day to shower. Patients in the rehabilitation and geriatrics departments reported a greater need for a brush/toothpaste (p < 0.0001) and assistance in toothbrushing (p < 0.0001). CONCLUSIONS Prolonged hospitalization leads to significant deterioration in inpatients' dental health maintenance. Raising awareness among nurses regarding their inpatient's oral health maintenance is warranted. Providing patients with toothbrushes, toothpaste and educational materials upon hospitalization is recommended.
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Affiliation(s)
| | | | - Liat Oren
- Sheba Medical Center, Tel Hashomer, Israel
| | - Gabi Chodick
- School of Dental Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Noam Yarom
- Sheba Medical Center, Tel Hashomer, Israel
- School of Dental Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Choi SR, Kwon JW, Suk KS, Kim HS, Moon SH, Park SY, Moon SE, Lee BH. Effectiveness of Toothbrushing Technique for Biofilm Removal and Postoperative Infection Control after Spinal Fusion Surgery: A Retrospective Study. Bioengineering (Basel) 2023; 10:1143. [PMID: 37892873 PMCID: PMC10604172 DOI: 10.3390/bioengineering10101143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 09/25/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023] Open
Abstract
This retrospective study was designed to investigate the effectiveness of using a toothbrush, which is commonly used in our daily life, for biofilm removal and infection control in the treatment of spinal infections occurring after spinal fusion surgery. Currently, a biofilm is thought to form on the surface of the metal inserted during spine fusion surgery. We aim to determine the differences in clinical outcomes between using and not using a toothbrush to remove biofilm while performing conventional drainage, curettage, and debridement. A total of 1081 patients who underwent anterior or posterior spinal fusion surgery between November 2018 and October 2022 were screened. The study included 60 patients who developed surgical site infection and underwent incision and drainage surgery either with a toothbrush (n = 20) or without a toothbrush (n = 40). Failure of infection control that requires revision surgery occurred in 2 patients (10%) in the Toothbrush group and in 14 patients (35%) in the No-Toothbrush group (p = 0.039). Thus, the rate of additional surgery was significantly lower in the Toothbrush group. Additionally, normalization of c-reactive protein levels occurred significantly faster in the Toothbrush group (p = 0.044). Therefore, using a toothbrush to treat spinal infections following spinal fusion surgery appears to have beneficial mechanical debridement effects, resulting in improved clinical results, which were also confirmed based on the electron microscopic images.
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Affiliation(s)
- Sung-Ryul Choi
- Department of Orthopedic Surgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Ji-Won Kwon
- Department of Orthopedic Surgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Kyung-Soo Suk
- Department of Orthopedic Surgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Hak-Sun Kim
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Seong-Hwan Moon
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Si-Young Park
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Seung-Eon Moon
- Department of Orthopedic Surgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Byung-Ho Lee
- Department of Orthopedic Surgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
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Kim Y, Ku HM, Jun MK. Knowledge Evaluation of Oral Diseases and Perception of Cooperation with Dental Experts for Oral Care of Nurses in Intensive Care Units in Korea: A Preliminary Study. NURSING REPORTS 2023; 13:528-538. [PMID: 36976700 PMCID: PMC10051949 DOI: 10.3390/nursrep13010048] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/12/2023] [Accepted: 03/16/2023] [Indexed: 03/29/2023] Open
Abstract
The aim of this study was to identify the status of education and knowledge concerning oral diseases for oral care as they relate to intensive care unit (ICU) nurses, as well as to investigate the perception of oral care education and practice, as led by dental experts. This study conducted a self-report survey consisting of 33 questions on education and knowledge about oral diseases, as well as perception of dental expert-led education and practice, targeting 240 nurses in the ICU. Finally, 227 questionnaires were analyzed, and 75.3% of the participants were staff nurses, and 41.4% were in the medical ICU. In the area of education and knowledge of major oral diseases, more than 50% of the respondents treating gingivitis, periodontitis, and dental caries did not complete dental education, and it was found that more than half of the respondents were unable to distinguish diseases of the mouth. It was recognized that more than half of nurses required dental expert-led education and practice. In this study, the education and knowledge of oral diseases of ICU nurses were found to be insufficient, and the need for the cooperation of dental experts was high. Therefore, collaboration to improve oral care practical guidelines for realistically applicable ICU patients will be needed.
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Affiliation(s)
- Yesel Kim
- Department of Dental Hygiene, Jeonju Kijeon College, Jeonju 54989, Republic of Korea
| | - Hye-Min Ku
- Department of Preventive Dentistry & Public Oral Health, BK21 FOUR Project, Yonsei University College of Dentistry, Seoul 03722, Republic of Korea
| | - Mi-Kyoung Jun
- Department of Dental Hygiene, Dongnam Health University, Suwon 16328, Republic of Korea
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Xiang Y, Ren X, Xu Y, Cheng L, Cai H, Hu T. Anti-Inflammatory and Anti-Bacterial Effects of Mouthwashes in Intensive Care Units: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:733. [PMID: 36613055 PMCID: PMC9819176 DOI: 10.3390/ijerph20010733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/25/2022] [Accepted: 12/27/2022] [Indexed: 06/17/2023]
Abstract
Mouthwashes are used as oral care for critical care patients to prevent infections. However, there are conflicting data concerning whether mouthwashes are needed as a part of daily oral care for critical care patients. This study aimed to evaluate the anti-inflammatory and anti-bacterial effects of mouthwashes for critical care patients. The PubMed, EMBASE, CENTRAL, and grey literature databases were searched by descriptors combining population (intensive care unit patients) and intervention (mouthwashes). After the screening, only randomized controlled trials (RCTs) evaluating the anti-inflammatory and anti-bacterial effects of mouthwashes in patient critical care were included. From the 1531 articles, 16 RCTs satisfied the eligibility criteria for systematic review and 10 were included in the meta-analyses. A significant difference was found in the incidence of ventilator associated pneumonia (VAP) (odds ratio [OR] 0.53, 95% confidential interval [95% CI] 0.33 to 0.86) between the mouthwash and placebo groups, while no significant difference was found in the mortality (OR 1.49, 95%CI 0.92 to 2.40); the duration of mechanical ventilation (weighted mean difference [WMD] -0.10, 95%CI -2.01 to 1.81); and the colonization of Staphylococcus aureus (OR 0.88, 95%CI 0.34 to 2.30), Escherichia coli (OR 1.19, 95%CI 0.50 to 2.82), and Pseudomonas aeruginosa (OR 1.16, 95%CI 0.27 to 4.91) between the two groups. In conclusion, mouthwashes were effective in decreasing the incidence of VAP. Thus, mouthwashes can be used as part of daily oral care for critical care patients.
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Affiliation(s)
| | | | | | | | - He Cai
- Correspondence: (H.C.); (T.H.); Tel.: +86-028-8550-3486 (H.C.); +86-028-8550-3486 (T.H.)
| | - Tao Hu
- Correspondence: (H.C.); (T.H.); Tel.: +86-028-8550-3486 (H.C.); +86-028-8550-3486 (T.H.)
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Griessl T, Zechel-Gran S, Olejniczak S, Weigel M, Hain T, Domann E. High-resolution taxonomic examination of the oral microbiome after oil pulling with standardized sunflower seed oil and healthy participants: a pilot study. Clin Oral Investig 2021; 25:2689-2703. [PMID: 32949257 PMCID: PMC8060239 DOI: 10.1007/s00784-020-03582-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/10/2020] [Indexed: 01/12/2023]
Abstract
OBJECTIVES We aimed at the high-resolution examination of the oral microbiome depending on oil pulling, compared it with saline pulling, and analyzed whether the method is capable of reducing the overall microbial burden of the oral cavity. MATERIALS AND METHODS The study was a cohort study with three healthy subjects. Oil pulling samples, saline pulling samples, and saliva samples were microscoped and cultured under microaerophilic and anaerobic conditions; colony-forming units were counted; and cultivated bacteria were identified employing MALDI-TOF MS. The oral microbiomes (saliva) and the microbiota incorporated in oil and saline pulling samples were determined in toto by using 16S rDNA next-generation sequencing (NGS) and bioinformatics. RESULTS Microscopy revealed that oral epithelial cells are ensheathed with distinct oil droplets during oil pulling. Oil pulling induced a higher production of saliva and the oil/saliva emulsion contained more bacteria than saline pulling samples. Oil pulling resulted in a significant and transient reduction of the overall microbial burden in comparison to saliva examined prior to and after pulling. Both oil and saline pulling samples mirrored the individual oral microbiomes in saliva. CONCLUSIONS Within the limitations of this pilot study, it might be concluded that oil pulling is able to reduce the overall microbial burden of the oral cavity transiently and the microbiota in oil pulling samples are representative to the oral microbiome. CLINICAL RELEVANCE Within the limitations of this pilot study, it might be concluded that oil pulling can be considered as an enlargement of standard oral hygiene techniques since it has the characteristic of an oral massage, enwrapping epithelial cells carrying bacteria in oil vesicles and reaching almost all unique habitats in oral cavity.
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Affiliation(s)
- Tim Griessl
- Institute of Medical Microbiology, German Center for Infection Research (DZIF Partner Site Giessen-Marburg-Langen), Justus-Liebig-University Giessen, Schubertstrasse 81, 35392 Giessen, Germany
| | - Silke Zechel-Gran
- Institute of Medical Microbiology, German Center for Infection Research (DZIF Partner Site Giessen-Marburg-Langen), Justus-Liebig-University Giessen, Schubertstrasse 81, 35392 Giessen, Germany
| | - Stefan Olejniczak
- Institute of Medical Microbiology, German Center for Infection Research (DZIF Partner Site Giessen-Marburg-Langen), Justus-Liebig-University Giessen, Schubertstrasse 81, 35392 Giessen, Germany
| | - Markus Weigel
- Institute of Medical Microbiology, German Center for Infection Research (DZIF Partner Site Giessen-Marburg-Langen), Justus-Liebig-University Giessen, Schubertstrasse 81, 35392 Giessen, Germany
| | - Torsten Hain
- Institute of Medical Microbiology, German Center for Infection Research (DZIF Partner Site Giessen-Marburg-Langen), Justus-Liebig-University Giessen, Schubertstrasse 81, 35392 Giessen, Germany
| | - Eugen Domann
- Institute of Medical Microbiology, German Center for Infection Research (DZIF Partner Site Giessen-Marburg-Langen), Justus-Liebig-University Giessen, Schubertstrasse 81, 35392 Giessen, Germany
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Bains VK, Bains R. Is oral hygiene as important as hand hygiene during COVID-19 pandemic? ACTA ACUST UNITED AC 2020. [DOI: 10.25259/ajohas_8_2020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Oral hygiene is an integral part of personal hygiene practices and should not be neglected. Similar to hand hygiene, oral hygiene is essential in reducing infection from the oral cavity, and thus, its transfer to the upper and lower respiratory tract. Although there is no randomized clinical trial, oral hygiene may imply to reduce the morbidity and mortality related to coronavirus disease pandemic potentially. At present, standard oral hygiene measures consist of thorough cleaning of all surfaces of teeth, interdental areas, and tongue daily. Oral health-care providers should emphasize its importance. Thorough toothbrushing for “Two Times For Two Minutes” in a day is an easy key to remember.
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Affiliation(s)
- Vivek Kumar Bains
- Department of Periodontology, Saraswati Dental College and Hospital, Lucknow, Uttar Pradesh, India,
| | - Rhythm Bains
- Department of Conservative Dentistry and Endodontics, Faculty of Dental Sciences, King George’s Medical University, Lucknow, Uttar Pradesh, India,
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Association between oral health and incidence of pneumonia: a population-based cohort study from Korea. Sci Rep 2020; 10:9576. [PMID: 32533077 PMCID: PMC7293333 DOI: 10.1038/s41598-020-66312-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 05/18/2020] [Indexed: 12/12/2022] Open
Abstract
Pneumonia is related to oral health of the elderly and intensive care unit patients. However, studies on the relationship between overall oral health and pneumonia in the general population have been limited. The purpose of this study was to investigate the association between oral health and pneumonia using a nationwide population-based Korean cohort database. Data from 122,251 participants who underwent health screening and oral examinations in 2004 or 2005 were analyzed. Cox proportional hazard regression analysis was performed to evaluate the association between oral health and pneumonia. The risk of pneumonia increased significantly in groups with a higher number of dental caries and missing teeth, with respective adjusted hazard ratios (HRs) and 95% confidence interval (CI) of 1.265 (1.086–1.473; p = 0.0025) and 1.218 (1.113–1.332; p < 0.0001), and decreased significantly in frequent tooth brushing and regular professional dental cleaning groups, with respective adjusted HRs and 95% CI of 0.853 (0.786–0.926; p = 0.0001) and 0.920 (0.855–0.990; p = 0.0255). In addition, regardless of age and comorbidities, oral health status and oral hygiene behaviors were associated with pneumonia. The results indicate that improved oral health may reduce the risk of pneumonia in the general population.
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8
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The Effect Of Oral Care Given To Patients On Mechanical Ventilatory Support By Two Different Methods On Bacterial Colonization In Oral Mucosa And Oral Health. JOURNAL OF CONTEMPORARY MEDICINE 2019. [DOI: 10.16899/jcm.628392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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9
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Odgaard L, Kothari M. Survey of oral nursing care attitudes, knowledge and practices in a neurorehabilitation setting. J Oral Rehabil 2019; 46:730-737. [DOI: 10.1111/joor.12799] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/21/2019] [Accepted: 04/03/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Lene Odgaard
- Hammel Neurorehabilitation and University Research Clinic, Regional Hospital Hammel Denmark
| | - Mohit Kothari
- Hammel Neurorehabilitation and University Research Clinic, Regional Hospital Hammel Denmark
- Department of Clinical Medicine Aarhus University Aarhus Denmark
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10
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Dai R, Lam OLT, Lo ECM, Li LSW, McGrath C. Effect of oral hygiene programmes on oral opportunistic pathogens during stroke rehabilitation. Oral Dis 2018; 25:617-633. [PMID: 30447165 DOI: 10.1111/odi.13005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 10/28/2018] [Accepted: 11/11/2018] [Indexed: 01/30/2023]
Abstract
OBJECTIVES This study was to assess the effectiveness of a conventional oral hygiene care programme (COHCP) and an advanced oral hygiene care programme (AOHCP) on prevalence and viable counts of oral opportunistic pathogens among patients undergoing stroke rehabilitation. METHODS A total of 94 patients were randomized to two groups. Subjects were block randomized to either (a) COHCP: manual toothbrushing with oral hygiene instruction (OHI); or (b) AOHCP: powered toothbrushing, mouthrinsing with chlorhexidine and OHI. Prevalence and viable counts of oral opportunistic pathogens including yeasts, aerobic and facultative anaerobic gram-negative bacilli, Staphylococcus aureus, were assessed at baseline, the end of 3 and 6 months. RESULTS No significant difference was observed in the prevalence of oral opportunistic pathogens within each group over the clinical trial period. A significant decrease in the viable counts of S. aureus was found over the clinical trial period within AOHCP group (p < 0.05), while the viable counts of yeasts and anaerobic gram-negative bacillus (AGNB) remained stable within each group. Regression analysis failed to detect an association between intervention and the prevalence/viable counts of oral opportunistic pathogens. CONCLUSIONS Neither oral healthcare programme significantly affects AGNB, yeast or S. aureus over the study period in terms of prevalence and viable counts.
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Affiliation(s)
- Ruoxi Dai
- Dental Public Health, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong.,Key Laboratory of Oral Diseases Research of Anhui Province, Stomatologic Hospital & College, Anhui Medical University, Hefei, China
| | - Otto L T Lam
- Prosthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong
| | - Edward C M Lo
- Dental Public Health, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong
| | - Leonard S W Li
- Rehabilitation Medicine, Tung Wah Hospital, Hong Kong, Hong Kong
| | - Colman McGrath
- Dental Public Health, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong
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Baker D, Quinn B. Hospital Acquired Pneumonia Prevention Initiative-2: Incidence of nonventilator hospital-acquired pneumonia in the United States. Am J Infect Control 2018; 46:2-7. [PMID: 29050903 DOI: 10.1016/j.ajic.2017.08.036] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 08/27/2017] [Accepted: 08/28/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Because nonventilator hospital-acquired pneumonia (NV-HAP) is understudied, our purpose was to determine the incidence, overall burden, and level of documented pneumonia preventive interventions of NV-HAP in 24 U.S. hospitals. METHODS This retrospective chart review extracted NV-HAP cases as per the 2014 ICD-9-CM codes for pneumonia not present on admission and the 2013 Centers for Disease Control and Prevention case definition. Patient demographic data, outcomes, and documented preventive interventions were also collected. RESULTS We found 1,300 NV-HAP patients who acquired NV-HAP (rate, 0.12-2.28 per 1,000 patient days) across the 21 hospitals that completed the data collection. Most NV-HAP infections (70.8%) were acquired outside of intensive care units (ICUs); 18.8% required transfer into the ICU. In the 24 hours prior to diagnosis, most of the patients did not have fundamental hospital care associated with pneumonia prevention. CONCLUSIONS This multicenter, nationwide study highlights the significant burden of NV-HAP in the U.S. acute care hospital setting. We found that NV-HAP occurred on every hospital unit, including in younger, healthy patients. This indicates that although some patients are clearly at higher risk, all patients carry some NV-HAP risk. Therapeutic interventions aimed at NV-HAP prevention are frequently not provided for patients in acute care hospitals.
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12
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Williams L. Benefits of Oral Care for Acute and Critically Ill Children. AACN Adv Crit Care 2017; 27:269-273. [PMID: 27959309 DOI: 10.4037/aacnacc2016969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Lori Williams
- Lori Williams is Clinical Nurse Specialist, Universal Care Unit, American Family Children's Hospital, University of Wisconsin Hospital and Clinics, Mail Code C850, 1675 Highland Ave, Madison, WI 53792
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13
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Ory J, Raybaud E, Chabanne R, Cosserant B, Faure JS, Guérin R, Calvet L, Pereira B, Mourgues C, Guelon D, Traore O. Comparative study of 2 oral care protocols in intensive care units. Am J Infect Control 2017; 45:245-250. [PMID: 28341071 DOI: 10.1016/j.ajic.2016.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 09/06/2016] [Accepted: 09/06/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND The quality of oral care is important in limiting the emergence of ventilator-associated pneumonia (VAP) in intubated patients. Our main objective was to measure the quality improvement in oral care following the implementation of a new oral care protocol. We also monitored VAP rates. MATERIAL/METHODS This was a cohort study of patients in 5 adult ICUs covering different specialties. During period 1, caregivers used a foam stick for oral care and during period 2 a stick and tooth brushing with aspiration. Oral chlorhexidine was used during both periods. The caregivers rated improvement in oral health on the basis of 4 criteria (tongue, mucous membranes, gingivae, and teeth). Caregiver satisfaction was also assessed. The incidence of VAP was monitored. RESULTS A total of 2,030 intubated patients admitted to intensive care units benefited from oral care. The patient populations during the 2 periods were similar with regard to demographic data and VAP potential risk factors. Oral health was significantly better from the third day of oral care in period 2 onward (period 1, 6.4 ± 2.1; period 2, 5.6 ± 1.8; P = .043). Caregivers found the period 2 protocol easier to implement and more effective. VAP rates decreased significantly between the 2 periods (period 1, 12.8%; period 2, 8.5%; P = .002). CONCLUSIONS Our study showed that the implementation of a simple strategy improved the quality of oral care of patients in intensive care units, and decreased VAP rates.
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14
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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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Sampaio-Maia B, Caldas IM, Pereira ML, Pérez-Mongiovi D, Araujo R. The Oral Microbiome in Health and Its Implication in Oral and Systemic Diseases. ADVANCES IN APPLIED MICROBIOLOGY 2016; 97:171-210. [PMID: 27926431 DOI: 10.1016/bs.aambs.2016.08.002] [Citation(s) in RCA: 159] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The oral microbiome can alter the balance between health and disease, locally and systemically. Within the oral cavity, bacteria, archaea, fungi, protozoa, and viruses may all be found, each having a particular role, but strongly interacting with each other and with the host, in sickness or in health. A description on how colonization occurs and how the oral microbiome dynamically evolves throughout the host's life is given. In this chapter the authors also address oral and nonoral conditions in which oral microorganisms may play a role in the etiology and progression, presenting the up-to-date knowledge on oral dysbiosis as well as the known underlying pathophysiologic mechanisms involving oral microorganisms in each condition. In oral pathology, oral microorganisms are associated with several diseases, namely dental caries, periodontal diseases, endodontic infections, and also oral cancer. In systemic diseases, nonoral infections, adverse pregnancy outcomes, cardiovascular diseases, and diabetes are among the most prevalent pathologies linked with oral cavity microorganisms. The knowledge on how colonization occurs, how oral microbiome coevolves with the host, and how oral microorganisms interact with each other may be a key factor to understand diseases etiology and progression.
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Affiliation(s)
| | - I M Caldas
- Universidade do Porto, Portugal; Institute of Research and Advanced Training in Health Sciences and Technologies, University Institute of Health Sciences (IUCS), CESPU, CRL, Gandra, Portugal; Universidade de Coimbra, Portugal
| | | | - D Pérez-Mongiovi
- Institute of Research and Advanced Training in Health Sciences and Technologies, University Institute of Health Sciences (IUCS), CESPU, CRL, Gandra, Portugal
| | - R Araujo
- Universidade do Porto, Portugal; Flinders University, Adelaide, SA, Australia
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16
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Rezaei S, Rezaei K, Mahboubi M, Jarahzadeh MH, Momeni E, Bagherinasab M, Targhi MG, Memarzadeh MR. Comparison the efficacy of herbal mouthwash with chlorhexidine on gingival index of intubated patients in Intensive Care Unit. J Indian Soc Periodontol 2016; 20:404-408. [PMID: 28298822 PMCID: PMC5341315 DOI: 10.4103/0972-124x.194269] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: Intubated patients in Intensive Care Unit (ICU) are not able to take care of their mouth health, so they are at risk of bacterial colonization and dental plaques formation that can lead to systemic diseases such as pneumonia and gingivitis. Aims: In randomized, double-blind clinical study, the efficacy of natural herbal mouthwash containing Salvadora persica ethanol extract and Aloe vera gel was compared with chlorhexidine on gingival index (GI) of intubated patients in ICU. Materials and Methods: Seventy-six intubated patients (18–64 years old with mean age 40.35 ± 13.2) in ICU were admitted to this study. The patients were randomly divided into two groups: (1) Herbal mouthwash and (2) chlorhexidine solution. Before the intervention, the GIs was measured by modified GI device into two groups. The mouth was rinsed by mouthwashes every 2–3 h for 4 days. 2 h after the last intervention, GIs were determined. Results: Along with mechanical methods, herbal mouthwash in reducing GI was statistically significant than that of chlorhexidine (P < 0.05). Conclusion: The results of this study introduce a new botanical extract mouthwash with dominant healing effects on GI (1.5 ± 0.6) higher than that of synthetic mouthwash, chlorhexidine (2.31 ± 0.73).
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Affiliation(s)
- Sahra Rezaei
- Department of Nursing, School of Nursing and Midwifery, Arak University of Medical Sciences, Arak, Iran
| | - Korosh Rezaei
- Department of Nursing, School of Nursing and Midwifery, Arak University of Medical Sciences, Arak, Iran
| | - Mohaddese Mahboubi
- Department of Microbiology, Medicinal Plant, Research Center of Barij Essence, Kashan, Iran
| | | | - Ehsan Momeni
- Department of Oral and Maxillofacial Medicine, School of Dentistry, Arak University of Medical Sciences, Arak, Iran
| | - Mostafa Bagherinasab
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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17
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Estaji Z, Alinejad M, Hassan Rakhshani M, Rad M. The Comparison of Chlorhexidine Solution and Swab With Toothbrush and Toothpaste Effect on Preventing Oral Lesions in Hospitalized Patients in Intensive Care Unit. Glob J Health Sci 2015; 8:211-6. [PMID: 26652098 PMCID: PMC4877191 DOI: 10.5539/gjhs.v8n5p211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 10/20/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Maintaining of oral hygiene has been known as one of the basic tasks of nurses working at intensive care unit. This study aimed to compare the effectiveness of chlorhexidine solution with toothbrush in prevention of oral lesions or ulcers in the different parts of the mouth. METHODS In this clinical trial study, research Society included patients hospitalized with endotracheal tube since the arrival time in intensive care unit. In this study, 30 patients were selected with target-based approach and equally divided into two groups through the permutation blocking method for oral care toothbrush and toothpaste and using chlorhexidine and swab. The modified form of Beck Oral Assessment Scale (BOAS) and MPS were used to obtain needed information. Data were analyzed by means of R software (version 3.0.2) and also multiple logistic regressions in the confidence level of 95%. RESULTS This study indicated an association between using toothbrush and the oral health level (OR: 1.52). In different parts of the mouth, there was no difference between two groups in prevention of lesions in gums, lips and tongue while, this was significant in relation to plaque, mucus and teeth with an odd ratio of 3.94 for teeth and 2.75 for mucus . In comparison, there was an association between implying chlorhexidine and saliva health level. (OR: 2.046). CONCLUSION This survey showed that using toothbrush has a noticeable impact on declining oral lesions in varied parts of the mouth.
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Kim EK, Jang SH, Choi YH, Lee KS, Kim YJ, Kim SH, Lee HK. Effect of an oral hygienic care program for stroke patients in the intensive care unit. Yonsei Med J 2014; 55:240-6. [PMID: 24339313 PMCID: PMC3874900 DOI: 10.3349/ymj.2014.55.1.240] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The effects of an oral hygienic care program (OHCP) have been reported in several diseases. However, no study exists investigating the influence of an OHCP on stroke patients or patients in the intensive care unit (ICU) has been reported, thus we sought to investigate the potential effect of an OHCP. MATERIALS AND METHODS Fifty-six consecutive stroke patients who were admitted to the ICU were randomly assigned to two groups: the intervention (29 patients) and control groups (27 patients). The OHCP included tooth brushing with an inter-dental brush and tongue cleaner and cleaning with chlorhexidine was administered to patients by one dentist once per day during admission in the ICU (mean, 2.2 weeks). The plague index, gingival index, clinical attachment loss, and colonization degree of candida albicans were assessed. RESULTS After OHCP, the plaque index, gingival index, and colonization degree of candida albicans in saliva showed a significant decrease in the intervention group compared to those of the control group (p<0.05). However, no significant difference was observed in clinical attachment loss and the colonization degree of candida albicans on the tongue (p>0.05). CONCLUSION Our OHCP was effective in improving the oral hygienic status and periodontal health of stroke patients during their stay in the ICU. Therefore, we recommend administration of the OHCP for stroke patients during their stay in the ICU.
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Affiliation(s)
- Eun-Kyong Kim
- Department of Dentistry, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu 705-703, Korea.
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19
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Infection prevention in the ICU: more than just picking one or another preventive measure. Aust Crit Care 2013; 26:151-2. [PMID: 23962741 DOI: 10.1016/j.aucc.2013.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 07/07/2013] [Indexed: 11/22/2022] Open
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20
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Salamone K, Yacoub E, Mahoney AM, Edward KL. Oral care of hospitalised older patients in the acute medical setting. Nurs Res Pract 2013; 2013:827670. [PMID: 23819046 PMCID: PMC3683489 DOI: 10.1155/2013/827670] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 02/28/2013] [Accepted: 04/30/2013] [Indexed: 11/18/2022] Open
Abstract
Oral health care is an essential aspect of nursing care. There are many variances in the quality and frequency of the oral care that is delivered to patients by nursing staff, such as oral care being given a low priority when compared to other nursing care elements, oral care being neglected, and oral care delivery being dependent on the nurse's knowledge of oral hygiene. Additionally, there are some particular patient groups known to be at risk of oral health problems or who have existing oral diseases and conditions. As people age their susceptibility increases to chronic and life-threatening diseases, and they can be at increased risk of acute infections increases compromised by ageing immune systems. The aim of this literature review was to ignite the discussion related to the oral care practices of nurses for older acute medical hospitalised patients. The review revealed that nursing staff know that good nursing includes oral health care, but this knowledge does not always mean that oral health care is administered. Oral health care seems to be separated from other nursing activities and is not discussed when nursing care plans are written, only when oral problems are obvious.
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Affiliation(s)
| | - Elaine Yacoub
- Austin Health, P.O. Box 5555, Heidelberg, 3084 VIC, Australia
| | - Anne-Marie Mahoney
- Clinical Education Unit, Austin Health, P.O. Box 5555, Heidelberg, 3084 VIC, Australia
| | - Karen-leigh Edward
- Nursing Research Unit, Faculty of Health Sciences, Street Vincent's Private Hospital, Australian Catholic University, VECCI Building, Locked Bag 4115, Fitzroy MDC, Melbourne, 3065 VIC, Australia
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21
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Grgurich PE, Hudcova J, Lei Y, Sarwar A, Craven DE. Management and prevention of ventilator-associated pneumonia caused by multidrug-resistant pathogens. Expert Rev Respir Med 2013; 6:533-55. [PMID: 23134248 DOI: 10.1586/ers.12.45] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Ventilator-associated pneumonia (VAP) due to multidrug-resistant (MDR) pathogens is a leading healthcare-associated infection in mechanically ventilated patients. The incidence of VAP due to MDR pathogens has increased significantly in the last decade. Risk factors for VAP due to MDR organisms include advanced age, immunosuppression, broad-spectrum antibiotic exposure, increased severity of illness, previous hospitalization or residence in a chronic care facility and prolonged duration of invasive mechanical ventilation. Methicillin-resistant Staphylococcus aureus and several different species of Gram-negative bacteria can cause MDR VAP. Especially difficult Gram-negative bacteria include Pseudomonas aeruginosa, Acinetobacter baumannii, carbapenemase-producing Enterobacteraciae and extended-spectrum β-lactamase producing bacteria. Proper management includes selecting appropriate antibiotics, optimizing dosing and using timely de-escalation based on antiimicrobial sensitivity data. Evidence-based strategies to prevent VAP that incorporate multidisciplinary staff education and collaboration are essential to reduce the burden of this disease and associated healthcare costs.
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Affiliation(s)
- Philip E Grgurich
- Department of Pharmacy, Lahey Clinic Medical Center, Burlington, MA 01805, USA
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22
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Prendergast V, Kleiman C, King M. The Bedside Oral Exam and the Barrow Oral Care Protocol: translating evidence-based oral care into practice. Intensive Crit Care Nurs 2013; 29:282-90. [PMID: 23702324 DOI: 10.1016/j.iccn.2013.04.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 03/19/2013] [Accepted: 04/05/2013] [Indexed: 10/26/2022]
Abstract
AIM To introduce the Bedside Oral Exam (BOE) and the Barrow Oral Care Protocol (BOCP) to guide oral care for intensive care unit patients. Secondary aim: To explore quality improvement data for incidence of ventilator associated pneumonia (VAP), cost effectiveness of oral hygiene supplies and staff response to change in practice. METHODS Descriptive case design for implementation and evaluation of oral assessments and oral hygiene. Incidence of VAP and the cost of oral care supplies before and after implementation was compared. Staff responses were elicited both pre- and post-implementation. RESULTS Incidence of VAP fell significantly from 4.21 to 2.1 per 1000 ventilator days (p =.04). A cost savings of 65% was noted on a monthly basis for oral hygiene supplies. Staff reported increased satisfaction in providing oral hygiene with a combination of oral care products. CONCLUSIONS A significant reduction in VAP was noted using the BOCP. The BOE guided individualised oral care with contemporary supplies, including a tongue scraper, electric toothbrush, non-foaming toothpaste and oral moisturisers. Cost-effective, comprehensive oral care appears to be effective in reducing VAP. Further studies are needed to assess impact of oral hygiene on oral health and patient comfort.
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Affiliation(s)
- Virginia Prendergast
- Division of Advanced Practice Nursing, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
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23
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Berry AM. A comparison of Listerine® and sodium bicarbonate oral cleansing solutions on dental plaque colonisation and incidence of ventilator associated pneumonia in mechanically ventilated patients: a randomised control trial. Intensive Crit Care Nurs 2013; 29:275-81. [PMID: 23692975 DOI: 10.1016/j.iccn.2013.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 01/18/2013] [Accepted: 01/19/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND Effective oral hygiene has been proposed as a key factor in the reduction of dental plaque colonisation and subsequent development of ventilator associated pneumonia (VAP). Listerine(®) oral rinse, while used extensively in dental practice has rarely been tested in mechanically ventilated patients. Sodium bicarbonate as an oral rinse has been more commonly utilised in oral hygiene regimens in intensive care patients. AIM To test the efficacies of the essential oil mouth rinse, Listerine(®) (Pfizer) and sodium bicarbonate in the reduction of dental plaque colonisation with respiratory pathogens and the subsequent development of VAP. METHODS The study design was a prospective, single blind randomised comparative study of adult patients mechanically ventilated for at least 4 days. Patients were randomised to Listerine(®) (Pfizer) oral rinse twice daily, sodium bicarbonate oral rinse 2/24 or sterile water 2/24 (control group). All groups received tooth brushing 3 times a day. Dental plaque colonisation (primary outcome) and incidence of ventilator associated pneumonia (secondary outcome) were studied. RESULTS Three hundred and ninety-eight patients were randomised to either the Listerine group (127), sodium bicarbonate group (133) or the control group (138). Baseline characteristics were similar for all groups. There were no significant differences between the control and study groups in colonisation of dental plaque at Day 4 (p=0.243). Ventilator associated pneumonia was diagnosed in 18 patients. The incidence was, Listerine(®) group 4.7%, sodium bicarbonate group 4.5% and control 4.3% [OR, 0.99; 95% CI, 0.31 to 3.16; p=0.92]. CONCLUSIONS Compared to the control group, Listerine(®) or sodium bicarbonate oral rinses were not more effective in the reduction of colonisation of dental plaque or the incidence of VAP. Given the low incidence of VAP, the common factor of a small, soft toothbrush as part of an oral hygiene regimen suggests possible benefit in mechanically ventilated patients.
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Affiliation(s)
- A M Berry
- Intensive Care Unit, Westmead Hospital, Sydney, Australia.
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24
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Toothbrushing for critically ill mechanically ventilated patients: a systematic review and meta-analysis of randomized trials evaluating ventilator-associated pneumonia. Crit Care Med 2013; 41:646-55. [PMID: 23263588 DOI: 10.1097/ccm.0b013e3182742d45] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Oral care may decrease ventilator-associated pneumonia in the ICU. The objective of this review was to summarize and critically appraise randomized trials in mechanically ventilated patients in the ICU testing the effect of oral care strategies involving toothbrushing on ventilator-associated pneumonia. SEARCH METHODS We searched EMBASE, MEDLINE, and the Cochrane Controlled Trials Register and Database of Systematic Reviews from 1980 until March 2012, independently and in duplicate, as well as personal files and reference lists. In duplicate, articles were selected if they were randomized trials, enrolled adult critically ill patients, compared any kind of oral care involving toothbrushing with any other kind of oral care or control with or without toothbrushing, and examined ventilator-associated pneumonia. In duplicate, we abstracted trial characteristics and quality using the Cochrane risk of bias tool. The results were combined using a random effects model. RESULTS We included six trials enrolling 1,408 patients, five of which compared toothbrushing to usual oral care and one of which compared electric with manual toothbrushing. In four trials, there was a trend toward lower ventilator-associated pneumonia rates (risk ratio, 0.77; 95% confidence interval, 0.50-1.21; p = 0.26). This trend was also observed in one trial reporting fewer cases of ventilator-associated pneumonia per 1,000 ventilator days (20.68 vs. 25.89; p = 0.53) in patients receiving toothbrushing vs. no toothbrushing. The only trial with low risk of bias suggested that toothbrushing significantly reduced ventilator-associated pneumonia (risk ratio, 0.26; 95% confidence interval, 0.10-0.67; p = 0.006). Use of chlorhexidine antisepsis seems to attenuate the effect of toothbrushing on ventilator-associated pneumonia (p for the interaction = 0.02). One trial comparing electric vs. manual toothbrushing showed no difference in ventilator-associated pneumonia rates (risk ratio, 0.96; 95% confidence interval, 0.47-1.96; p = 0.91). Toothbrushing did not impact on length of ICU stay, or ICU or hospital mortality. CONCLUSIONS In intubated, mechanically ventilated critically ill patients, toothbrushing did not significantly reduce the risk of ventilator-associated pneumonia overall. Toothbrushing has no effect on mortality or length of stay. Electric and manual toothbrushing seem to have similar effects. More research is needed on this aspect of oral care to evaluate its potential to decrease ventilator-associated pneumonia.
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Effects of a standard versus comprehensive oral care protocol among intubated neuroscience ICU patients: results of a randomized controlled trial. J Neurosci Nurs 2012; 44:134-46; quiz 147-8. [PMID: 22555350 DOI: 10.1097/jnn.0b013e3182510688] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of the study was to compare changes in oral health during intubation until 48 hours after extubation in neuroscience intensive care unit (ICU) patients enrolled in a standard or a comprehensive oral care protocol. The effects of manual toothbrushing (standard group, n = 31) were compared with those of tongue scraping, electric toothbrushing, and moisturizing (comprehensive group, n = 25) in intubated patients in a neuroscience ICU in a 2-year randomized clinical trial. Oral health was evaluated based on the Oral Assessment Guide (OAG) on enrollment, the day of extubation, and 48 hours after extubation. There were no significant differences in the frequency of the oral care protocol. Protocol compliance exceeded 91% in both groups. The total OAG score and all eight categories significantly deteriorated (Friedman test, p < .001, Bonferroni corrected) in the standard oral care group and did not return to baseline after extubation. Large effect sizes were present at all three points in this group. The total OAG score deteriorated during intubation within the comprehensive protocol group (Friedman test, p < .004) but returned to baseline status after extubation. In four categories, the ratings on tongue, mucous membranes, gingiva, and teeth did not deteriorate significantly over time. Published oral care protocols are substandard in promoting and maintaining oral health in intubated patients. A comprehensive oral care protocol, using a tongue scraper, an electrical toothbrush, and pharmacological moisturizers, was more effective for oral hygiene throughout intubation and after extubation than manual toothbrushing alone.
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26
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Tutor JD, Gosa MM. Dysphagia and aspiration in children. Pediatr Pulmonol 2012; 47:321-37. [PMID: 22009835 DOI: 10.1002/ppul.21576] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Accepted: 08/11/2011] [Indexed: 11/08/2022]
Abstract
Aspiration is a significant cause of respiratory morbidity and sometimes mortality in children. It occurs when airway protective reflexes fail, especially, when dysphagia is also present. Clinical symptoms and physical findings of aspiration can be nonspecific. Advances in technology can lead to early diagnosis of dysphagia and aspiration, and, new therapeutic advances can significantly improve outcome and prognosis. This report first reviews the anatomy and physiology involved in the normal process of swallowing. Next, the protective reflexes that help to prevent aspiration are discussed followed by the pathophysiologic events that occur after an aspiration event. Various disease processes that can result in dysphagia and aspiration in children are discussed. Finally, the various methods for diagnosis and treatment of dysphagia in children are reviewed.
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Affiliation(s)
- James D Tutor
- Program in Pediatric Pulmonary Medicine, University of Tennessee Health Science Center, LeBonheur Children's Hospital, St. Jude Children's Research Hospital, Memphis, Tennessee 38103, USA.
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