Comparative study of 2 oral care protocols in intensive care units

Am J Infect Control. 2017 Mar 1;45(3):245-250. doi: 10.1016/j.ajic.2016.09.006. Epub 2016 Oct 27.

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.

Keywords: Dental plaque; Intubated patients; Toothbrushing; Ventilator-associated pneumonia.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Female
  • Humans
  • Infection Control / methods*
  • Intensive Care Units*
  • Male
  • Middle Aged
  • Oral Hygiene / methods*
  • Pneumonia, Ventilator-Associated / prevention & control*
  • Respiration, Artificial / adverse effects*