Ciencia

Intensive Care Med (2006) 32:230–236 DOI 10.1007/s00134-005-0014-4

ORIGINAL

Hideo Mori Hiroyuki Hirasawa Shigeto Oda Hidetoshi Shiga Kenichi Matsuda Masataka Nakamura

Oral Care Reduces Incidence of Ventilator-Associated Pneumonia in ICU Populations

Received: 22 November 2004 Accepted: 07 November 2005 Published online: 25 January 2006 © Springer-Verlag 2005

H. Mori (u) · H.Hirasawa · S. Oda · H. Shiga · K. Matsuda · M. Nakamura Graduate School of Medicine, Chiba University, Department of Emergency and Critical Care Medicine, 1-8-1 Inohana, Chuou Chiba 260-8677, Japan e-mail: dds-mori@umin.ac.jp Tel.: +81-43-222-7171 Fax: +81-43-226-2371

Abstract Objective: To examine whether oral care contributes to preventing ventilator-associated pneumonia (VAP) in ICU patients.Design: Nonrandomized trial with historical controls. Setting: A medical-surgical ICU in a university hospital. Patients: 1,666 mechanically ventilated patients admitted to the ICU. Intervention: Oral care was provided to 1,252 patients who were admitted to the ICU during period between January 1997 and December 2002 (oral care group), while 414 patients who were admitted to the ICU during periodbetween January1995 and December 1996 and who did not receive oral care served as historical controls (non-oral care group). Measurements and results: Incidence of VAP(episodes of pneumonia per 1000 ventilator days) in the oral care group was significantly lower than that in the non-oral care group (3.9 vs 10.4). The relative risk of VAP in the oral care group compared to that in the non-oral care groupwas 0.37, with an attributable risk of –3.96%. Furthermore, length of stay in ICU

before onset of VAP was greater in the oral care than in the non-oral care group (8.5 ± 4.6 vs 6.3 ± 7.5 days). However, no significant difference was observed in either duration of mechanical ventilation or length of stay between the groups (5.9 ± 10.8 vs 6.0 ± 8.8 days and 7.5 ± 11.5 vs 7.2 ± 9.5 days,respectively). Pseudomonoas aeruginosa was the most frequently detected bacteria in both groups. Number of potentially pathogenic bacteria in oral cavity was significantly reduced by single oral care procedure. Conclusion: Oral care decreased the incidence of VAP in ICU patients. Descriptor: Pulmonary nosocomial infection Keywords Oral care · Oral hygiene · Ventilator-associated pneumonia ·Hospital-acquired pneumonia · Nosocomial infection · Critical care Abbreviations VAP: ventilatorassociated pneumonia · ICU: intensive care unit · SDD: selective digestive decontamination

Introduction
Ventilator-associated pneumonia (VAP) is defined as hospital-acquired pneumonia occurring within 48 h after the initiation of mechanical ventilation with tracheal intubation. Development of VAP results inprolonged duration of mechanical ventilation, longer ICU stay, and increased

health care costs [1]. It also increases the mortality of ICU patients to as high as 30–70% [2, 3]. Prevention of VAP is thus very important for the management of critically ill patients. Since mechanically ventilated patients cannot be fed orally, their salivary secretions decrease, and self-cleansing of the oral cavity ismarkedly reduced. As a result, oral cavity hygiene worsens, and the number

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of bacteria increases excessively, leading to bacterial colonization of the oropharynx. Several previous studies have reported a strong correlation between oropharyngeal bacterial colonization and presence of causative bacteria of VAP [4, 5, 6]. We hypothesized that oral hygiene and maintenance of cleanliness ofthe oral cavity, which is considered a reservoir of oropharyngeal colonization, contributes to prevention of VAP. We examined the effect of oral care through tooth brushing and washing on prevention of VAP without the risk of emergence of antibiotic-resistant bacteria. A preliminary report of this research was presented at the Society of Critical Care Medicine 34th Critical Care Congress in...