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Effectiveness of a Dental Care Intervention in the Prevention of Lower Respiratory Tract Nosocomial Infections among Intensive Care Patients: A Randomized Clinical Trial

Published online by Cambridge University Press:  10 May 2016

Wanessa T. Bellissimo-Rodrigues ,
Mayra G. Menegueti ,
Gilberto G. Gaspar ,
Edson A. Nicolini ,
Maria Auxiliadora-Martins ,
Anibal Basile-Filho ,
Roberto Martinez  and
Fernando Bellissimo-Rodrigues
Wanessa T. Bellissimo-Rodrigues
Affiliation:
Infectious Diseases Division, Internal Medicine Department, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
Mayra G. Menegueti
Affiliation:
Hospital Infection Control Service, University Hospital of Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
Gilberto G. Gaspar
Affiliation:
Hospital Infection Control Service, University Hospital of Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
Edson A. Nicolini
Affiliation:
Intensive Care Division, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
Maria Auxiliadora-Martins
Affiliation:
Intensive Care Division, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
Anibal Basile-Filho
Affiliation:
Intensive Care Division, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
Roberto Martinez
Affiliation:
Infectious Diseases Division, Internal Medicine Department, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
Fernando Bellissimo-Rodrigues*
Affiliation:
Hospital Infection Control Service, University Hospital of Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil Social Medicine Department, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
*
Social Medicine Department, Ribeirão Preto Medical School, University of São Paulo Campus Universitário, s/n, Monte Alegre, CEP 14048-900, Ribeirão Preto, São Paulo, Brazil (fbellissimo@fmrp.usp.br).
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Abstract

Objective.

To evaluate whether dental treatment may enhance oral antisepsis, thus preventing more effectively lower respiratory tract infections (LRTIs) among critically ill patients

Design.

Observer-blind randomized clinical trial.

Setting.

General intensive care unit (ICU) for adult patients.

Patients.

We analyzed data from 254 adult patients who stayed for at least 48 hours in the ICU.

Intervention.

Patients were randomized by means of rolling dice. The experimental group (n = 127) had access to dental care provided by a dental surgeon, 4–5 times a week. Besides routine oral hygiene, care also included teeth brushing, tongue scraping, removal of calculus, atraumatic restorative treatment of caries, and tooth extraction. The control group (n = 127) had access to routine oral hygiene only, which included the use of chlorhexidine as a mouth rinse, which was performed by the ICU nurse staff.

Results.

The primary study outcome was the LRTI incidence, which was 8.7% in the experimental group and 18.1% in the control group (adjusted relative risk [RR], 0.44 [95% confidence interval (CI), 0.20–0.96]; P = .04). Ventilator-associated pneumonia rates per 1,000 ventilator-days were 16.5 (95% CI, 9.8–29.5) in the control group and 7.6 (95% CI, 3.3–15.0) in the experimental group (P < .05). Mortality rates were similar between both study groups: 31.5% in the control group versus 29.1% in the experimental group (adjusted RR, 0.93 [95% CI, 0.52–1.65]; P = .796). No severe adverse events related to oral care were observed during the study.

Conclusion.

Dental treatment was safe and effective in the prevention of LRTI among critically ill patients who were expected to stay at least 48 hours in the ICU.

Trial registration.

Brazilian Clinical Trials Registry, affiliated with the World Health Organization’s International Clinical Trial Registry Platform: U1111-1152-2671.

Infect Control Hosp Epidemiol 2014;35(11):1342–1348

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 11 , November 2014 , pp. 1342 - 1348
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved.

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