1
|
Hurley J. Rebound Inverts the Staphylococcus aureus Bacteremia Prevention Effect of Antibiotic Based Decontamination Interventions in ICU Cohorts with Prolonged Length of Stay. Antibiotics (Basel) 2024; 13:316. [PMID: 38666992 PMCID: PMC11047347 DOI: 10.3390/antibiotics13040316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/29/2024] Open
Abstract
Could rebound explain the paradoxical lack of prevention effect against Staphylococcus aureus blood stream infections (BSIs) with antibiotic-based decontamination intervention (BDI) methods among studies of ICU patients within the literature? Two meta-regression models were applied, each versus the group mean length of stay (LOS). Firstly, the prevention effects against S. aureus BSI [and S. aureus VAP] among 136 studies of antibiotic-BDI versus other interventions were analyzed. Secondly, the S. aureus BSI [and S. aureus VAP] incidence in 268 control and intervention cohorts from studies of antibiotic-BDI versus that among 165 observational cohorts as a benchmark was modelled. In model one, the meta-regression line versus group mean LOS crossed the null, with the antibiotic-BDI prevention effect against S. aureus BSI at mean LOS day 7 (OR 0.45; 0.30 to 0.68) inverted at mean LOS day 20 (OR 1.7; 1.1 to 2.6). In model two, the meta-regression line versus group mean LOS crossed the benchmark line, and the predicted S. aureus BSI incidence for antibiotic-BDI groups was 0.47; 0.09-0.84 percentage points below versus 3.0; 0.12-5.9 above the benchmark in studies with 7 versus 20 days mean LOS, respectively. Rebound within the intervention groups attenuated and inverted the prevention effect of antibiotic-BDI against S. aureus VAP and BSI, respectively. This explains the paradoxical findings.
Collapse
Affiliation(s)
- James Hurley
- Melbourne Medical School, University of Melbourne, Melbourne, VIC 3052, Australia;
- Ballarat Health Services, Grampians Health, Ballarat, VIC 3350, Australia
- Ballarat Clinical School, Deakin University, Ballarat, VIC 3350, Australia
| |
Collapse
|
2
|
Zhang Y, Meng W, Hu C, Dong M, Chu Y, Kang F, Li J, Chen X. Effect of Oral Care Solution on Sore Throat After I-Gel Laryngeal Mask General Anesthesia: A Randomized Controlled Trial. Ther Clin Risk Manag 2023; 19:929-936. [PMID: 38023624 PMCID: PMC10656865 DOI: 10.2147/tcrm.s433692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/06/2023] [Indexed: 12/01/2023] Open
Abstract
Background Sore throat is a common complication after general anesthesia. Oral care solutions have been used to reduce the incidence of oral complications or ventilator-associated pneumonia, but their effect on postoperative sore throat (POST) is unclear. This study aims to investigate whether oral care solution can alleviate POST in patients undergoing i-gel laryngeal mask general anesthesia. Methods A total of 120 patients who were scheduled for elective surgery under laryngeal mask general anesthesia were enrolled. The patients were randomly assigned to an experimental group (oral care solution) and a control group (0.9% saline) and gargled for 1 min with 10mL of oral care solution or saline 5 min before anesthesia induction. The primary outcomes were the overall incidence of sore throat within 24 h and incidence at 20 min, 1 h, 6 h, 24 h after removal of i-gel. The secondary outcomes were the severity of sore throat at the four time points and incidence of hoarseness, cough within 24 h after removal of i-gel. Results A total of 111 patients were included in the analysis. The overall incidence of sore throat within 24 h in the experimental group was significantly lower than that in the control group, as was the incidence at four time points (P<0.05). The VAS scores at the four time points in the experimental group were significantly lower than those in the control group (P<0.05), and the results of repeated measurement analysis of variance showed that time effect and intergroup effect were statistically significant (P<0.001). No differences were found between the groups in the incidence of hoarseness and cough. Conclusion Gargling with oral care solution before anesthesia induction can significantly reduce the incidence and severity of POST in patients undergoing i-gel laryngeal mask general anesthesia.
Collapse
Affiliation(s)
- Yan Zhang
- Department of Nursing, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People’s Republic of China
| | - Wenjun Meng
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People’s Republic of China
| | - Chengwen Hu
- Department of Nursing, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People’s Republic of China
| | - Meirong Dong
- Department of Nursing, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People’s Republic of China
| | - Youqun Chu
- Department of Nursing, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People’s Republic of China
| | - Fang Kang
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People’s Republic of China
| | - Juan Li
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People’s Republic of China
| | - Xia Chen
- Department of Nursing, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People’s Republic of China
| |
Collapse
|
3
|
Thakuria D, Khangembam VC, Pant V, Bhat RAH, Tandel RS, C. S, Pande A, Pandey PK. Anti-oomycete Activity of Chlorhexidine Gluconate: Molecular Docking and in vitro Studies. Front Vet Sci 2022; 9:909570. [PMID: 35782554 PMCID: PMC9247576 DOI: 10.3389/fvets.2022.909570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/09/2022] [Indexed: 11/28/2022] Open
Abstract
Saprolegniosis is one of the most catastrophic oomycete diseases of freshwater fish caused by the members of the genus Saprolegnia. The disease is responsible for huge economic losses in the aquaculture industry worldwide. Until 2002, Saprolegnia infections were effectively controlled by using malachite green. However, the drug has been banned for use in aquaculture due to its harmful effect. Therefore, it has become important to find an alternate and safe anti-oomycete agent that is effective against Saprolegnia. In this study, we investigated the anti-oomycete activity of chlorhexidine gluconate (CHG) against Saprolegnia. Before in vitro evaluation, molecular docking was carried out to explore the binding of CHG with vital proteins of Saprolegnia, such as S. parasitica host-targeting protein 1 (SpHtp1), plasma membrane ATPase, and TKL protein kinase. In silico studies revealed that CHG binds with these proteins via hydrogen bonds and hydrophobic interactions. In an in vitro study, the minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC) of CHG against S. parasitica were found to be 50 mg/L. Further, it was tested against S. australis, another species of Saprolegnia, and the MIC and MFC were found to be 100 and 200 mg/L, respectively. At 500 mg/L of CHG, there was complete inhibition of the radial growth of Saprolegnia hyphae. In propidium iodide (PI) uptake assay, CHG treated hyphae had bright red fluorescence of PI indicating the disruption of the cell membrane. The results of the present study indicated that CHG could effectively inhibit Saprolegnia and hence can be used for controlling Saprolegniasis in cultured fish.
Collapse
|
4
|
Han SY, Roh J, Jung YS, Kim KR. Evaluation of antimicrobial activity of chlorhexidine-containing oral gels against aspiration pneumonia-inducing bacteria: An In Vitro study. Indian J Dent Res 2022; 33:90-93. [PMID: 35946252 DOI: 10.4103/ijdr.ijdr_591_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Aim Hospitalised patients have a high risk of developing aspiration pneumonia because of poor oral care and oral microbial flora changes. Chlorhexidine (CHX) solution has been used to reduce inflammation and prevent infections in oral cavity, but it is difficult to use in inpatients. Gel-type antimicrobial agents rather than the liquid form may be effective for the oral management of hospitalised patients. Therefore, we evaluated the in vitro antimicrobial effects of CHX-containing oral gels on aspiration pneumonia-inducing bacteria compared to the CHX solution. Materials and Methods The experimental products of two oral gel types containing 1% and 0.1% CHX, respectively, were selected. Hexamedine, a 0.12% CHX solution, was used as a positive control. The antimicrobial activity of CHX agents against six pneumonia-causing bacteria and Streptococcus mutans, one of the most common oral bacteria, was comparatively analysed using the agar disk diffusion method. Results In the disk diffusion assay, the 1% CHX gels showed the highest inhibitory effect on all bacteria. All CHX agents including gels and solution had the highest antibacterial activity against Staphylococcus aureus compared with other bacteria. Conclusions We confirmed the significant antimicrobial effects of the 1% CHX oral gels on aspiration pneumonia-inducing bacteria. These results suggest that CHX gels may be an effective oral care method for preventing infection in inpatients who have difficulty using the solution.
Collapse
Affiliation(s)
- Sun-Young Han
- Department of Dental Hygiene, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Korea
| | - Jiyeon Roh
- Forensic Science Training and R&D Center, National Forensic Service, Wonju, Korea
| | - Yun-Sook Jung
- Department of Dental Hygiene, Kyungpook National University, Sangju, Korea
| | - Ki-Rim Kim
- Department of Dental Hygiene, Kyungpook National University, Sangju, Korea
| |
Collapse
|
5
|
Gunasekharan M, Choi TI, Rukayadi Y, Mohammad Latif MA, Karunakaran T, Mohd Faudzi SM, Kim CH. Preliminary Insight of Pyrrolylated-Chalcones as New Anti-Methicillin-Resistant Staphylococcus aureus (Anti-MRSA) Agents. Molecules 2021; 26:molecules26175314. [PMID: 34500755 PMCID: PMC8434082 DOI: 10.3390/molecules26175314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/27/2021] [Accepted: 08/28/2021] [Indexed: 11/16/2022] Open
Abstract
Bacterial infections are regarded as one of the leading causes of fatal morbidity and death in patients infected with diseases. The ability of microorganisms, particularly methicillin-resistant Staphylococcus aureus (MRSA), to develop resistance to current drugs has evoked the need for a continuous search for new drugs with better efficacies. Hence, a series of non-PAINS associated pyrrolylated-chalcones (1–15) were synthesized and evaluated for their potency against MRSA. The hydroxyl-containing compounds (8, 9, and 10) showed the most significant anti-MRSA efficiency, with the MIC and MBC values ranging from 0.08 to 0.70 mg/mL and 0.16 to 1.88 mg/mL, respectively. The time-kill curve and SEM analyses exhibited bacterial cell death within four hours after exposure to 9, suggesting its bactericidal properties. Furthermore, the docking simulation between 9 and penicillin-binding protein 2a (PBP2a, PDB ID: 6Q9N) suggests a relatively similar bonding interaction to the standard drug with a binding affinity score of −7.0 kcal/mol. Moreover, the zebrafish model showed no toxic effects in the normal embryonic development, blood vessel formation, and apoptosis when exposed to up to 40 µM of compound 9. The overall results suggest that the pyrrolylated-chalcones may be considered as a potential inhibitor in the design of new anti-MRSA agents.
Collapse
Affiliation(s)
- Mohanapriya Gunasekharan
- Department of Chemistry, Faculty of Science, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia;
| | - Tae-Ik Choi
- Department of Biology, Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon 34134, Korea;
| | - Yaya Rukayadi
- Natural Medicines and Product Research Laboratory, Institute of Bioscience, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia;
- Department of Food Science, Faculty of Food Science and Technology, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Muhammad Alif Mohammad Latif
- Centre of Foundation Studies for Agricultural Science, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia;
| | | | - Siti Munirah Mohd Faudzi
- Department of Chemistry, Faculty of Science, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia;
- Natural Medicines and Product Research Laboratory, Institute of Bioscience, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia;
- Correspondence: (S.M.M.F.); (C.-H.K.)
| | - Cheol-Hee Kim
- Department of Biology, Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon 34134, Korea;
- Correspondence: (S.M.M.F.); (C.-H.K.)
| |
Collapse
|
6
|
Baker NF, Hart AM, Carlson GW, Losken A. A Systematic Review of Breast Irrigation in Implant-Based Breast Surgery. Ann Plast Surg 2021; 86:359-364. [PMID: 33555689 DOI: 10.1097/sap.0000000000002481] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Aesthetic and reconstructive implant-based breast surgeries are some of the most frequently performed procedures by plastic surgeons. As such, prevention of implant infection is of high importance. However, there remains no criterion-standard protocol for irrigation of the breast pocket. This review focuses on current irrigation practices in implant-based breast surgery. METHODS Four databases were used to search for all studies, including randomized controlled trials, retrospective cohort, and prospective cohort, containing original data related to the outcomes investigated in this study. Search terms included "breast," "irrigation," and "infection" in different combinations to isolate studies that focused on irrigation methods in both reconstructive and augmentation surgeries. Our selection criteria specifically concentrated on those studies that explicitly related irrigation procedures to rates of clinical infection and/or capsular contracture. Each was compiled into a table in chronological order to make comparisons between the differing irrigation methods. RESULTS Our search returned 239 full-text articles eligible for our review. Two independent screeners identified 9 studies that met the inclusion criteria. This included 1 prospective study and 8 retrospective studies. Two studies reported the use of chlorhexidine gluconate irrigation resulting in protection from clinical infection. Two studies investigated the role of triple antibiotic solution (TAS) either alone or combined with something else on risk of infection, and 3 reported TAS use on rates of capsular contracture. Two additional studies investigated the role of single antibiotic irrigation, concluding that some antibiotic regimen for irrigation may be sufficient in the breast pocket. Interestingly, one study noted the potential use of povidone-iodine (Betadine) as a method of irrigation. CONCLUSIONS These data suggest that chlorhexidine gluconate, Betadine, and TAS irrigation of the breast pocket can provide protection against infection and implant loss in both reconstruction and augmentation surgeries.
Collapse
Affiliation(s)
| | | | | | - Albert Losken
- Division of Plastic Surgery, Emory University, Atlanta, GA
| |
Collapse
|
7
|
Zhao T, Wu X, Zhang Q, Li C, Worthington HV, Hua F. Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. Cochrane Database Syst Rev 2020; 12:CD008367. [PMID: 33368159 PMCID: PMC8111488 DOI: 10.1002/14651858.cd008367.pub4] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) is defined as pneumonia developing in people who have received mechanical ventilation for at least 48 hours. VAP is a potentially serious complication in these patients who are already critically ill. Oral hygiene care (OHC), using either a mouthrinse, gel, swab, toothbrush, or combination, together with suction of secretions, may reduce the risk of VAP in these patients. OBJECTIVES To assess the effects of oral hygiene care (OHC) on incidence of ventilator-associated pneumonia in critically ill patients receiving mechanical ventilation in hospital intensive care units (ICUs). SEARCH METHODS Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 25 February 2020), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2020, Issue 1), MEDLINE Ovid (1946 to 25 February 2020), Embase Ovid (1980 to 25 February 2020), LILACS BIREME Virtual Health Library (1982 to 25 February 2020) and CINAHL EBSCO (1937 to 25 February 2020). We also searched the VIP Database (January 2012 to 8 March 2020). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA We included randomised controlled trials (RCTs) evaluating the effects of OHC (mouthrinse, gel, swab, toothbrush or combination) in critically ill patients receiving mechanical ventilation for at least 48 hours. DATA COLLECTION AND ANALYSIS At least two review authors independently assessed search results, extracted data and assessed risk of bias in included studies. We contacted study authors for additional information. We reported risk ratio (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes, using the random-effects model of meta-analysis when data from four or more trials were combined. MAIN RESULTS We included 40 RCTs (5675 participants), which were conducted in various countries including China, USA, Brazil and Iran. We categorised these RCTs into five main comparisons: chlorhexidine (CHX) mouthrinse or gel versus placebo/usual care; CHX mouthrinse versus other oral care agents; toothbrushing (± antiseptics) versus no toothbrushing (± antiseptics); powered versus manual toothbrushing; and comparisons of other oral care agents used in OHC (other oral care agents versus placebo/usual care, or head-to-head comparisons between other oral care agents). We assessed the overall risk of bias as high in 31 trials and low in two, with the rest being unclear. Moderate-certainty evidence from 13 RCTs (1206 participants, 92% adults) shows that CHX mouthrinse or gel, as part of OHC, probably reduces the incidence of VAP compared to placebo or usual care from 26% to about 18% (RR 0.67, 95% confidence intervals (CI) 0.47 to 0.97; P = 0.03; I2 = 66%). This is equivalent to a number needed to treat for an additional beneficial outcome (NNTB) of 12 (95% CI 7 to 128), i.e. providing OHC including CHX for 12 ventilated patients in intensive care would prevent one patient developing VAP. There was no evidence of a difference between interventions for the outcomes of mortality (RR 1.03, 95% CI 0.80 to 1.33; P = 0.86, I2 = 0%; 9 RCTs, 944 participants; moderate-certainty evidence), duration of mechanical ventilation (MD -1.10 days, 95% CI -3.20 to 1.00 days; P = 0.30, I2 = 74%; 4 RCTs, 594 participants; very low-certainty evidence) or duration of intensive care unit (ICU) stay (MD -0.89 days, 95% CI -3.59 to 1.82 days; P = 0.52, I2 = 69%; 5 RCTs, 627 participants; low-certainty evidence). Most studies did not mention adverse effects. One study reported adverse effects, which were mild, with similar frequency in CHX and control groups and one study reported there were no adverse effects. Toothbrushing (± antiseptics) may reduce the incidence of VAP (RR 0.61, 95% CI 0.41 to 0.91; P = 0.01, I2 = 40%; 5 RCTs, 910 participants; low-certainty evidence) compared to OHC without toothbrushing (± antiseptics). There is also some evidence that toothbrushing may reduce the duration of ICU stay (MD -1.89 days, 95% CI -3.52 to -0.27 days; P = 0.02, I2 = 0%; 3 RCTs, 749 participants), but this is very low certainty. Low-certainty evidence did not show a reduction in mortality (RR 0.84, 95% CI 0.67 to 1.05; P = 0.12, I2 = 0%; 5 RCTs, 910 participants) or duration of mechanical ventilation (MD -0.43, 95% CI -1.17 to 0.30; P = 0.25, I2 = 46%; 4 RCTs, 810 participants). AUTHORS' CONCLUSIONS Chlorhexidine mouthwash or gel, as part of OHC, probably reduces the incidence of developing ventilator-associated pneumonia (VAP) in critically ill patients from 26% to about 18%, when compared to placebo or usual care. We did not find a difference in mortality, duration of mechanical ventilation or duration of stay in the intensive care unit, although the evidence was low certainty. OHC including both antiseptics and toothbrushing may be more effective than OHC with antiseptics alone to reduce the incidence of VAP and the length of ICU stay, but, again, the evidence is low certainty. There is insufficient evidence to determine whether any of the interventions evaluated in the studies are associated with adverse effects.
Collapse
Affiliation(s)
- Tingting Zhao
- Hubei-MOST KLOS & KLOBM, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Xinyu Wu
- Hubei-MOST KLOS & KLOBM, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Qi Zhang
- Department of Oral Implantology, The Affiliated Stomatology Hospital, Zhejiang University School of Medicine, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, China
| | - Chunjie Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Helen V Worthington
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Fang Hua
- Hubei-MOST KLOS & KLOBM, School and Hospital of Stomatology, Wuhan University, Wuhan, China
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Centre for Evidence-Based Stomatology, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| |
Collapse
|
8
|
Doğu Kökcü Ö, Terzi B. Development of an intensive care oral care frequency assessment scale. Nurs Crit Care 2020; 27:667-675. [PMID: 32633044 DOI: 10.1111/nicc.12529] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 04/22/2020] [Accepted: 06/16/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Oral care and frequency of oral care is important for intensive care patients in order to prevent the risk of ventilator-associated pneumonia. However, there are no scales to assess the frequency of oral care specific to intensive care units (ICUs). AIMS AND OBJECTIVES This study aimed to develop a valid and reliable tool, "Intensive Care Oral Care Frequency Assessment Scale (ICOCFAS)", for assessing the frequency of nurses' oral care in critical ill patients. DESIGN This was an instrument development study. METHODS The validity and reliability of the ICOCFAS, which consists of nine items, were tested using content validity (five expert opinions), construct validity (factor analysis), item analysis, and internal consistency analysis methods. The population of the research consisted of inpatients at the ICU of a hospital in Sakarya, Turkey. The research was conducted with 73 patients in the ICU. RESULTS Expert opinions on the content validity indicated that the scale was admissible. The Kaiser-Meyer-Olkin (KMO) coefficient was calculated at 0.800, and the Chi-square value of the Bartlett test was considerably significant (χ2 = 270.539; P < .001). Using a path diagram in confirmatory factor analysis, Chi-square/df ratio values were calculated as 1.49, standardized root mean square residual as 0.077, comparative fit index as 0.97, and root mean square error of approximation as 0.082. Cronbach's alpha was 0.851. The correlations between the items and total scores were 0.455 to 0.835 and were statistically significant (P < .001). CONCLUSIONS The ICOCFAS is an efficient tool with high validity and reliability for assessing oral care frequency in the ICU. RELEVANCE TO CLINICAL PRACTICE The ICOCFAS is a valid and reliable tool for Turkish society for assessing the frequency of oral care of patients in the ICU. It is recommended for various national and international studies with different patients in ICUs.
Collapse
Affiliation(s)
- Özlem Doğu Kökcü
- Faculty of Health Sciencies, Sakarya University, Sakarya, Turkey
| | - Banu Terzi
- Faculty of Nursing, Fundamentals of Nursing Department, Akdeniz University, Antalya, Turkey
| |
Collapse
|
9
|
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.
Collapse
|
10
|
Lewis SR, Schofield‐Robinson OJ, Rhodes S, Smith AF. Chlorhexidine bathing of the critically ill for the prevention of hospital-acquired infection. Cochrane Database Syst Rev 2019; 8:CD012248. [PMID: 31476022 PMCID: PMC6718196 DOI: 10.1002/14651858.cd012248.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Hospital-acquired infection is a frequent adverse event in patient care; it can lead to longer stays in the intensive care unit (ICU), additional medical complications, permanent disability or death. Whilst all hospital-based patients are susceptible to infections, prevalence is particularly high in the ICU, where people who are critically ill have suppressed immunity and are subject to increased invasive monitoring. People who are mechanically-ventilated are at infection risk due to tracheostomy and reintubation and use of multiple central venous catheters, where lines and tubes may act as vectors for the transmission of bacteria and may increase bloodstream infections and ventilator-associated pneumonia (VAP). Chlorhexidine is a low-cost product, widely used as a disinfectant and antiseptic, which may be used to bathe people who are critically ill with the aim of killing bacteria and reducing the spread of hospital-acquired infections. OBJECTIVES To assess the effects of chlorhexidine bathing on the number of hospital-acquired infections in people who are critically ill. SEARCH METHODS In December 2018 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trial registries for ongoing and unpublished studies, and checked reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared chlorhexidine bathing with soap-and-water bathing of patients in the ICU. DATA COLLECTION AND ANALYSIS Two review authors independently assessed study eligibility, extracted data and undertook risk of bias and GRADE assessment of the certainty of the evidence . MAIN RESULTS We included eight studies in this review. Four RCTs included a total of 1537 individually randomised participants, and four cluster-randomised cross-over studies included 23 randomised ICUs with 22,935 participants. We identified one study awaiting classification, for which we were unable to assess eligibility.The studies compared bathing using 2% chlorhexidine-impregnated washcloths or dilute solutions of 4% chlorhexidine versus soap-and-water bathing or bathing with non-antimicrobial washcloths.Eight studies reported data for participants who had a hospital-acquired infection during the ICU stay. We are uncertain whether using chlorhexidine for bathing of critically ill people reduces the rate of hospital-acquired infection, because the certainty of the evidence is very low (rate difference 1.70, 95% confidence interval (CI) 0.12 to 3.29; 21,924 participants). Six studies reported mortality (in hospital, in the ICU, and at 48 hours). We cannot be sure whether using chlorhexidine for bathing of critically-ill people reduces mortality, because the certainty of the evidence is very low (odds ratio 0.87, 95% CI 0.76 to 0.99; 15,798 participants). Six studies reported length of stay in the ICU. We noted that individual studies found no evidence of a difference in length of stay; we did not conduct meta-analysis because data were skewed. It is not clear whether using chlorhexidine for bathing of critically ill people reduced length of stay in the ICU, because the certainty of the evidence is very low. Seven studies reported skin reactions as an adverse event, and five of these reported skin reactions which were thought to be attributable to the bathing solution. Data in these studies were reported inconsistently and we were unable to conduct meta-analysis; we cannot tell whether using chlorhexidine for bathing of critically ill people reduced adverse events, because the certainty of the evidence is very low.We used the GRADE approach to downgrade the certainty of the evidence of each outcome to very low. For all outcomes, we downgraded evidence because of study limitations (most studies had a high risk of performance bias, and we noted high risks of other bias in some studies). We downgraded evidence due to indirectness, because some participants in studies may have had hospital-acquired infections before recruitment. We noted that one small study had a large influence on the effect for hospital-acquired infections, and we assessed decisions made in analysis of some cluster-randomised cross-over studies on the effect for hospital-acquired infections and for mortality; we downgraded the evidence for these outcomes due to inconsistency. We also downgraded the evidence on length of stay in the ICU, because of imprecision. Data for adverse events were limited by few events and so we downgraded for imprecision. AUTHORS' CONCLUSIONS Due to the very low-certainty evidence available, it is not clear whether bathing with chlorhexidine reduces hospital-acquired infections, mortality, or length of stay in the ICU, or whether the use of chlorhexidine results in more skin reactions.
Collapse
Affiliation(s)
- Sharon R Lewis
- Royal Lancaster InfirmaryLancaster Patient Safety Research UnitPointer Court 1, Ashton RoadLancasterUKLA1 4RP
| | - Oliver J Schofield‐Robinson
- Royal Lancaster InfirmaryLancaster Patient Safety Research UnitPointer Court 1, Ashton RoadLancasterUKLA1 4RP
| | - Sarah Rhodes
- University of ManchesterDivision of Population Health, Health Services Research & Primary Care, Faculty of Biology, Medicine and HealthManchesterUKM13 9PL
| | - Andrew F Smith
- Royal Lancaster InfirmaryDepartment of AnaesthesiaAshton RoadLancasterLancashireUKLA1 4RP
| | | |
Collapse
|
11
|
Abstract
The use of next-generation sequencing and multiomic analysis reveals new insights on the identity of microbes in the lower airways blurring the lines between commensals and pathogens. Microbes are not found in isolation; rather they form complex metacommunities where microbe-host and microbe-microbe interactions play important roles on the host susceptibility to pathogens. In addition, the lower airway microbiota exert significant effects on host immune tone. Thus, this review highlights the roles that microbes in the respiratory tract play in the development of pneumonia.
Collapse
Affiliation(s)
- Benjamin G Wu
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, NYU Human Microbiome Program, New York University School of Medicine, New York, NY 10028, USA
| | - Leopoldo N Segal
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, NYU Human Microbiome Program, New York University School of Medicine, New York, NY 10028, USA.
| |
Collapse
|
12
|
Scannapieco FA, Cantos A. Oral inflammation and infection, and chronic medical diseases: implications for the elderly. Periodontol 2000 2018; 72:153-75. [PMID: 27501498 DOI: 10.1111/prd.12129] [Citation(s) in RCA: 172] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2015] [Indexed: 12/12/2022]
Abstract
Oral diseases, such as caries and periodontitis, not only have local effects on the dentition and on tooth-supporting tissues but also may impact a number of systemic conditions. Emerging evidence suggests that poor oral health influences the initiation and/or progression of diseases such as atherosclerosis (with sequelae including myocardial infarction and stoke), diabetes mellitus and neurodegenerative diseases (such as Alzheimer's disease, rheumatoid arthritis and others). Aspiration of oropharyngeal (including periodontal) bacteria causes pneumonia, especially in hospitalized patients and the elderly, and may influence the course of chronic obstructive pulmonary disease. This article addresses several pertinent aspects related to the medical implications of periodontal disease in the elderly. There is moderate evidence that improved oral hygiene may help prevent aspiration pneumonia in high-risk patients. For other medical conditions, because of the absence of well-designed randomized clinical trials in elderly patients, no specific guidance can be provided regarding oral hygiene or periodontal interventions that enhance the medical management of older adults.
Collapse
|
13
|
Unusually High Incidences of Staphylococcus aureus Infection within Studies of Ventilator Associated Pneumonia Prevention Using Topical Antibiotics: Benchmarking the Evidence Base. Microorganisms 2018; 6:microorganisms6010002. [PMID: 29300363 PMCID: PMC5874616 DOI: 10.3390/microorganisms6010002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 12/29/2017] [Accepted: 01/02/2018] [Indexed: 01/08/2023] Open
Abstract
Selective digestive decontamination (SDD, topical antibiotic regimens applied to the respiratory tract) appears effective for preventing ventilator associated pneumonia (VAP) in intensive care unit (ICU) patients. However, potential contextual effects of SDD on Staphylococcus aureus infections in the ICU remain unclear. The S. aureus ventilator associated pneumonia (S. aureus VAP), VAP overall and S. aureus bacteremia incidences within component (control and intervention) groups within 27 SDD studies were benchmarked against 115 observational groups. Component groups from 66 studies of various interventions other than SDD provided additional points of reference. In 27 SDD study control groups, the mean S. aureus VAP incidence is 9.6% (95% CI; 6.9–13.2) versus a benchmark derived from 115 observational groups being 4.8% (95% CI; 4.2–5.6). In nine SDD study control groups the mean S. aureus bacteremia incidence is 3.8% (95% CI; 2.1–5.7) versus a benchmark derived from 10 observational groups being 2.1% (95% CI; 1.1–4.1). The incidences of S. aureus VAP and S. aureus bacteremia within the control groups of SDD studies are each higher than literature derived benchmarks. Paradoxically, within the SDD intervention groups, the incidences of both S. aureus VAP and VAP overall are more similar to the benchmarks.
Collapse
|
14
|
Survey of Extent of Translation of Oral Healthcare Guidelines for ICU Patients into Clinical Practice by Nursing Staff. Crit Care Res Pract 2017; 2017:1348372. [PMID: 29181195 PMCID: PMC5664266 DOI: 10.1155/2017/1348372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 09/17/2017] [Indexed: 11/30/2022] Open
Abstract
Nosocomial infections in critically ill/ventilated patients result from bacterial load in oropharyngeal regions. Oral decontamination serves as the easiest effective means of controlling infections. Knowledge, attitude, and practices followed by healthcare personnel in intensive care settings need to be assessed to implement concrete measures in health-care. Survey questionnaire was constructed and implemented following its validation on seventy nursing and paramedical staff working in government and private intensive care units throughout Lucknow city. 21-item questionnaire consisted of three parts of seven questions each. 78% of respondents had knowledge regarding oral care and its importance in critical settings but 44% of respondents considered it to be unpleasant task. 36% of respondents claimed to have provided oral care to all patients in ICU. Uniform guidelines for translation of oral healthcare in ICU settings are not being implemented. Previous studies in literature from various geographic diverse regions also point out to similar lacunae. Based on present survey, most respondents were aware of importance of oral care with protocols covered in academic curriculum. Attitude towards oral care is positive but respondents feel a need for specialised training. Practice for oral care is not sufficient and needs improvement and proper implementation.
Collapse
|
15
|
Frisch NB, Kadri OM, Tenbrunsel T, Abdul-Hak A, Qatu M, Davis JJ. Intraoperative chlorhexidine irrigation to prevent infection in total hip and knee arthroplasty. Arthroplast Today 2017; 3:294-297. [PMID: 29204500 PMCID: PMC5712016 DOI: 10.1016/j.artd.2017.03.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 03/08/2017] [Accepted: 03/10/2017] [Indexed: 11/30/2022] Open
Abstract
Background Surgical site irrigation during total hip (THA) and total knee (TKA) arthroplasty is a routine practice among orthopaedic surgeons to prevent periprosthetic joint infection. The purpose of this study was to evaluate the effect of chlorhexidine gluconate (CHG) irrigation on infection rates following THA and TKA. Methods Arthroplasties performed before September 2014 served as controls. THA performed before September 2014 (N = 253) underwent intraoperative irrigation with 0.9% saline followed by a 2-minute soak with <2% dilute povidone-iodine. TKA (N = 411) patients underwent only intraoperative saline irrigation. After October 2014, all patients (248 TKA and 138 THA) received intraoperative irrigation with 0.9% saline and periodic 0.05% CHG solution followed by a final 1-minute soak in CHG with immediate closure afterward. Results In this 2:1 comparison of consecutive patients, there were no differences in patient demographics between the 2 groups. No difference was noted in wound healing concerns subjectively, and no statistically significant association in nonsurgical site infections, superficial surgical site infection, and deep surgical site infection rates between the 2 groups (nonsurgical site infections [THA: P = .244, TKA: P = .125]; superficial surgical site infection [THA: P = .555, TKA: P = .913]; and deep surgical site infection [THA: P = .302, TKA: P = .534]). Conclusions We were unable to discern a difference in infection rates between chlorhexidine irrigation and our prior protocols using dilute Betadine for THA and 0.9% saline for TKA. The theoretic advantages of dilute CHG retention during closure appear to be safe without infectious concerns.
Collapse
Affiliation(s)
- Nicholas B Frisch
- Henry Ford Health System, Department of Orthopaedic Surgery, Detroit, MI, USA
| | - Omar M Kadri
- Henry Ford Health System, Department of Orthopaedic Surgery, Detroit, MI, USA
| | | | | | - Mossub Qatu
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Jason J Davis
- Henry Ford Health System, Department of Orthopaedic Surgery, Detroit, MI, USA
| |
Collapse
|
16
|
Hobbins S, Chapple IL, Sapey E, Stockley RA. Is periodontitis a comorbidity of COPD or can associations be explained by shared risk factors/behaviors? Int J Chron Obstruct Pulmon Dis 2017; 12:1339-1349. [PMID: 28496317 PMCID: PMC5422335 DOI: 10.2147/copd.s127802] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
COPD is recognized as having a series of comorbidities potentially related to common inflammatory processes. Periodontitis is one of the most common human inflammatory diseases and has previously been associated with COPD in numerous observational studies. As periodontitis and COPD are both chronic, progressive conditions characterized by neutrophilic inflammation with subsequent proteolytic destruction of connective tissue, it has been proposed that they share common pathophysiological processes. The mechanisms proposed to link COPD and periodontitis include mechanical aspiration of oral contents into the respiratory tree, overspill of locally produced inflammatory mediators into the systemic circulation or oral or lung-derived bacteremia activating an acute-phase response and also reactive oxygen species (ROS) and cytokine release by systemic neutrophils at distant sites. Studies of systemic neutrophils in COPD and chronic periodontitis describe altered cellular functions that would predispose to inflammation and tissue destruction both in the lung and in the mouth, again potentially connecting these conditions. However, COPD and periodontitis also share risk factors such as age, chronic tobacco smoke exposure, and social deprivation that are not always considered in observational and interventional studies. Furthermore, studies reporting associations have often utilized differing definitions of both COPD and periodontitis. This article reviews the current available evidence supporting the hypothesis that COPD and inflammatory periodontal disease (periodontitis) could be pathologically associated, including a review of shared inflammatory mechanisms. It highlights the potential limitations of previous studies, in particular, the lack of uniformly applied case definitions for both COPD and periodontitis and poor recognition of shared risk factors. Understanding associations between these conditions may inform why patients with COPD suffer such a burden of comorbid illness and new therapeutic strategies for both the diseases. However, further research is needed to clarify factors that may be directly causal as opposed to confounding relationships.
Collapse
Affiliation(s)
| | | | - Elizabeth Sapey
- Institute of Inflammation and Aging.,Centre for Translational Inflammation Research, Institute of Inflammation and Aging, Queen Elizabeth Hospital
| | - Robert A Stockley
- University Hospital Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK
| |
Collapse
|
17
|
Wang EW, Layon AJ. Chlorhexidine gluconate use to prevent hospital acquired infections-a useful tool, not a panacea. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:14. [PMID: 28164099 DOI: 10.21037/atm.2017.01.01] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Elizabeth Wenqian Wang
- Department of Hospital Medicine, The Medicine Institute, The Geisinger Health System, Danville, PA 17822-2037, USA
| | - A Joseph Layon
- Department of Critical Care Medicine, The Medicine Institute, The Geisinger Health System, Danville, PA 17822-2037, USA
| |
Collapse
|
18
|
Edmiston CE, Leaper DJ. Intra-Operative Surgical Irrigation of the Surgical Incision: What Does the Future Hold—Saline, Antibiotic Agents, or Antiseptic Agents? Surg Infect (Larchmt) 2016; 17:656-664. [DOI: 10.1089/sur.2016.158] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
| | - David J. Leaper
- Department of Surgery, University of Newcastle upon Tyne, and Institute of Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield, United Kingdom
| |
Collapse
|
19
|
Hua F, Xie H, Worthington HV, Furness S, Zhang Q, Li C. Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. Cochrane Database Syst Rev 2016; 10:CD008367. [PMID: 27778318 PMCID: PMC6460950 DOI: 10.1002/14651858.cd008367.pub3] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) is defined as pneumonia developing in people who have received mechanical ventilation for at least 48 hours. VAP is a potentially serious complication in these patients who are already critically ill. Oral hygiene care (OHC), using either a mouthrinse, gel, toothbrush, or combination, together with aspiration of secretions, may reduce the risk of VAP in these patients. OBJECTIVES To assess the effects of oral hygiene care on incidence of ventilator-associated pneumonia in critically ill patients receiving mechanical ventilation in hospital intensive care units (ICUs). SEARCH METHODS We searched the following electronic databases: Cochrane Oral Health's Trials Register (to 17 December 2015), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2015, Issue 11), MEDLINE Ovid (1946 to 17 December 2015), Embase Ovid (1980 to 17 December 2015), LILACS BIREME Virtual Health Library (1982 to 17 December 2015), CINAHL EBSCO (1937 to 17 December 2016), Chinese Biomedical Literature Database (1978 to 14 January 2013), China National Knowledge Infrastructure (1994 to 14 January 2013), Wan Fang Database (January 1984 to 14 January 2013) and VIP Database (January 2012 to 4 May 2016). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials to 17 December 2015. We placed no restrictions on the language or date of publication when searching the electronic databases. SELECTION CRITERIA We included randomised controlled trials (RCTs) evaluating the effects of OHC (mouthrinse, swab, toothbrush or combination) in critically ill patients receiving mechanical ventilation for at least 48 hours. DATA COLLECTION AND ANALYSIS At least two review authors independently assessed search results, extracted data and assessed risk of bias in included studies. We contacted study authors for additional information. We pooled data from trials with similar interventions and outcomes. We reported risk ratio (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes, using random-effects models unless there were fewer than four studies. MAIN RESULTS We included 38 RCTs (6016 participants). There were four main comparisons: chlorhexidine (CHX) mouthrinse or gel versus placebo/usual care; toothbrushing versus no toothbrushing; powered versus manual toothbrushing; and comparisons of oral care solutions. We assessed the overall risk of bias as low in five trials (13%), high in 26 trials (68%), and unclear in seven trials (18%). We did not consider the risk of bias to be serious when assessing the quality of evidence (GRADE) for VAP incidence, but we downgraded other outcomes for risk of bias.High quality evidence from 18 RCTs (2451 participants, 86% adults) shows that CHX mouthrinse or gel, as part of OHC, reduces the risk of VAP compared to placebo or usual care from 25% to about 19% (RR 0.74, 95% confidence intervals (CI) 0.61 to 0.89, P = 0.002, I2 = 31%). This is equivalent to a number needed to treat for an additional beneficial outcome (NNTB) of 17 (95% CI 10 to 33), which indicates that for every 17 ventilated patients in intensive care receiving OHC including chlorhexidine, one outcome of VAP would be prevented. There is no evidence of a difference between CHX and placebo/usual care for the outcomes of mortality (RR 1.09, 95% CI 0.96 to 1.23, P = 0.18, I2 = 0%, 15 RCTs, 2163 participants, moderate quality evidence), duration of mechanical ventilation (MD -0.09 days, 95% CI -1.73 to 1.55 days, P = 0.91, I2 = 36%, five RCTs, 800 participants, low quality evidence), or duration of intensive care unit (ICU) stay (MD 0.21 days, 95% CI -1.48 to 1.89 days, P = 0.81, I2 = 9%, six RCTs, 833 participants, moderate quality evidence). There is insufficient evidence to determine the effect of CHX on duration of systemic antibiotics, oral health indices, caregivers' preferences or cost. Only two studies reported any adverse effects, and these were mild with similar frequency in CHX and control groups.We are uncertain as to the effects of toothbrushing (± antiseptics) on the outcomes of VAP (RR 0.69, 95% CI 0.44 to 1.09, P = 0.11, I2 = 64%, five RCTs, 889 participants, very low quality evidence) and mortality (RR 0.87, 95% CI 0.70 to 1.09, P = 0.24, I2 = 0%, five RCTs, 889 participants, low quality evidence) compared to OHC without toothbrushing (± antiseptics). There is insufficient evidence to determine whether toothbrushing affects duration of mechanical ventilation, duration of ICU stay, use of systemic antibiotics, oral health indices, adverse effects, caregivers' preferences or cost.Only one trial (78 participants) compared use of a powered toothbrush with a manual toothbrush, providing insufficient evidence to determine the effect on any of the outcomes of this review.Fifteen trials compared various other oral care solutions. There is very weak evidence that povidone iodine mouthrinse is more effective than saline/placebo (RR 0.69, 95% CI 0.50 to 0.95, P = 0.02, I2 = 74%, three studies, 356 participants, high risk of bias), and that saline rinse is more effective than saline swab (RR 0.47, 95% CI 0.37 to 0.62, P < 0.001, I2 = 84%, four studies, 488 participants, high risk of bias) in reducing VAP. Due to variation in comparisons and outcomes among trials, there is insufficient evidence concerning the effects of other oral care solutions. AUTHORS' CONCLUSIONS OHC including chlorhexidine mouthwash or gel reduces the risk of developing ventilator-associated pneumonia in critically ill patients from 25% to about 19%. However, there is no evidence of a difference in the outcomes of mortality, duration of mechanical ventilation or duration of ICU stay. There is no evidence that OHC including both antiseptics and toothbrushing is different from OHC with antiseptics alone, and some weak evidence to suggest that povidone iodine mouthrinse is more effective than saline/placebo, and saline rinse is more effective than saline swab in reducing VAP. There is insufficient evidence to determine whether powered toothbrushing or other oral care solutions are effective in reducing VAP. There is also insufficient evidence to determine whether any of the interventions evaluated in the studies are associated with adverse effects.
Collapse
Affiliation(s)
- Fang Hua
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of ManchesterCochrane Oral HealthOxford RoadManchesterUKM13 9PL
| | - Huixu Xie
- West China College of Stomatology, Sichuan UniversityDepartment of Oral and Maxillofacial Surgery, State Key Laboratory of Oral DiseasesNo. 14, Section Three, Ren Min Nan RoadChengduSichuanChina610041
| | - Helen V Worthington
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of ManchesterCochrane Oral HealthOxford RoadManchesterUKM13 9PL
| | - Susan Furness
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of ManchesterCochrane Oral HealthOxford RoadManchesterUKM13 9PL
| | - Qi Zhang
- State Key Laboratory of Oral Diseases, West China College of Stomatology, Sichuan UniversityDepartment of Oral ImplantologyNo. 14, Section Three, Ren Min Nan RoadChengduSichuanChina610041
| | - Chunjie Li
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan UniversityDepartment of Head and Neck OncologyNo. 14, Section Three, Ren Min Nan RoadChengduSichuanChina610041
| | | |
Collapse
|
20
|
Lewis SR, Butler AR, Evans DJW, Alderson P, Smith AF. Chlorhexidine bathing of the critically ill for the prevention of hospital-acquired infection. Hippokratia 2016. [DOI: 10.1002/14651858.cd012248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Sharon R Lewis
- Royal Lancaster Infirmary; Patient Safety Research Department; Pointer Court 1, Ashton Road Lancaster UK LA1 1RP
| | - Andrew R Butler
- Royal Lancaster Infirmary; Patient Safety Research Department; Pointer Court 1, Ashton Road Lancaster UK LA1 1RP
| | - David JW Evans
- Royal Lancaster Infirmary; Patient Safety Research Department; Pointer Court 1, Ashton Road Lancaster UK LA1 1RP
| | - Phil Alderson
- National Institute for Health and Care Excellence; Level 1A, City Tower, Piccadilly Plaza Manchester UK M1 4BD
| | - Andrew F Smith
- Royal Lancaster Infirmary; Department of Anaesthesia; Ashton Road Lancaster Lancashire UK LA1 4RP
| |
Collapse
|
21
|
Azimi M, Jouybari L, Moghadam S, Ghaemi E, Behnampoor N, Sanagoo A, Hesam M. Antimicrobial effects of chlorhexidine, matrica drop mouthwash (chamomile extract), and normal saline on hospitalized patients with endotracheal tubes. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2016; 21:458-463. [PMID: 27904627 PMCID: PMC5114788 DOI: 10.4103/1735-9066.193390] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background: The functions and use of mouthwashes are variable depending on their type. Oral care in patients with endotracheal tubes is important to prevent side effects such as pneumonia. The aim of this study was to determine the antimicrobial effects of chlorhexidine, drop of Matrica mouthwash (chamomile extract), and normal saline on hospitalized patients with endotracheal tube in an intensive care unit (ICU). Materials and Methods: In this clinical trial, 39 patients admitted to the ICU were selected by convenience sampling, were matched based on age and sex, and randomly assigned to three groups (chlorhexidine, Matrica, saline). Mouth washing was performed every 8 to 48 hours. The samples were taken at time zero (before the intervention) and 48 hours after the intervention for bacterial culture. Antibacterial activity of each mouthwash on microorganisms was measured based on the growth of Staphylococcus aureus, Pneumococcal, Enterococcus, Pseudomonas, and Escherichia coli. The obtained data were then analyzed using Chi-square and Fisher's exact tests with the Statistical Package for the Social Sciences Package version 18. Results: Chlorhexidine mouthwash was more effective in preventing colonization of bacteria in the mouth (point probability = 0.06) in comparison with chamomile and saline mouthwashes. Nevertheless, none of the tested mouthwashes were able to remove pathogens, including Staphylococcus aureus, Pseudomonas, Klebsiella, and Acinetobacter. Conclusions: 0.2% chlorhexidine mouthwash has a significant effect on the bacterial colonization rate in comparison with Matrica and normal saline mouthwashes in ICU hospitalized patients with endotracheal tube.
Collapse
Affiliation(s)
- Maryam Azimi
- Department of Nursing, School of Nursing and Midwifery, Golestan University of Medical Sciences, Gorgan, Iran
| | - Leila Jouybari
- Nursing Research Centre, Golestan University of Medical Sciences, Gorgan, Iran
| | - Shahram Moghadam
- Department of Anesthesiology, School of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Ezatolah Ghaemi
- Department of Microbiology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Naser Behnampoor
- Department of Biostatistics, Faculty of Health, Golestan University of Medical Sciences, Gorgan, Iran
| | - Akram Sanagoo
- Nursing Research Centre, Golestan University of Medical Sciences, Gorgan, Iran
| | - Moslem Hesam
- Department of Nursing, School of Nursing and Midwifery, Golestan University of Medical Sciences, Gorgan, Iran
| |
Collapse
|
22
|
The Two-Way Association of Periodontal Infection with Systemic Disorders: An Overview. Mediators Inflamm 2015; 2015:793898. [PMID: 26339142 PMCID: PMC4539125 DOI: 10.1155/2015/793898] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Revised: 03/02/2015] [Accepted: 03/05/2015] [Indexed: 11/29/2022] Open
Abstract
Oral cavity that harbors diverse bacterial populations could also act as a site of origin for spread of pathogenic microorganisms to different body sites, particularly in immunocompromised hosts, patients, the elderly, or the underprivileged. A number of recent publications have advocated that patients with periodontal diseases are more susceptible to metabolic endotoxemia, inflammation, obesity, type 2 diabetes, and other related systemic complications, concluding that periodontal diseases could be a potential contributing risk factor for a wide array of clinically important systemic diseases. However, despite a significant increase in the prevalence of periodontal infections and systemic diseases in the past few decades, the fundamental biological mechanisms of connection between these ailments are still not fully explicated. Consequently, the mechanisms by which this bidirectional damage occurs are being explored with a concentric vision to develop strategies that could prevent or control the complications of these ailments. This paper attempts to summarize and hypothesize the diverse mechanisms that hint to a certain connection between the two prevalent chronic situations.
Collapse
|
23
|
Wendel SO, Menon S, Alshetaiwi H, Shrestha TB, Chlebanowski L, Hsu WW, Bossmann SH, Narayanan S, Troyer DL. Cell Based Drug Delivery: Micrococcus luteus Loaded Neutrophils as Chlorhexidine Delivery Vehicles in a Mouse Model of Liver Abscesses in Cattle. PLoS One 2015; 10:e0128144. [PMID: 26011247 PMCID: PMC4444037 DOI: 10.1371/journal.pone.0128144] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 04/22/2015] [Indexed: 01/13/2023] Open
Abstract
The recent WHO report on antibiotic resistances shows a dramatic increase of microbial resistance against antibiotics. With only a few new antibiotics in the pipeline, a different drug delivery approach is urgently needed. We have obtained evidence demonstrating the effectiveness of a cell based drug delivery system that utilizes the innate immune system as targeting carrier for antibacterial drugs. In this study we show the efficient loading of neutrophil granulocytes with chlorhexidine and the complete killing of E. coli as well as Fusobacterium necrophorum in in-vitro studies. Fusobacterium necrophorum causes hepatic abscesses in cattle fed high grain diets. We also show in a mouse model that this delivery system targets infections of F. necrophorum in the liver and reduces the bacterial burden by an order of magnitude from approximately 2•106 to 1•105.
Collapse
Affiliation(s)
- Sebastian O. Wendel
- Department of Chemical Engineering, Kansas State University, Manhattan, Kansas, United States of America
| | - Sailesh Menon
- Department of Diagnostic Medicine and Pathobiology, Kansas State University, Manhattan, Kansas, United States of America
| | - Hamad Alshetaiwi
- Department of Anatomy and Physiology, Kansas State University, Manhattan, Kansas, United States of America
- University of Ha'il, Ha'il, Saudi Arabia
| | - Tej B. Shrestha
- Department of Anatomy and Physiology, Kansas State University, Manhattan, Kansas, United States of America
| | - Lauren Chlebanowski
- Department of Chemistry, Augustana College, Rock Island, Illinois, United States of America
| | - Wei-Wen Hsu
- Department of Statistics, Kansas State University, Manhattan, Kansas, United States of America
| | - Stefan H. Bossmann
- Department of Chemistry, Kansas State University, Manhattan, Kansas, United States of America
| | - Sanjeev Narayanan
- Department of Diagnostic Medicine and Pathobiology, Kansas State University, Manhattan, Kansas, United States of America
| | - Deryl L. Troyer
- Department of Anatomy and Physiology, Kansas State University, Manhattan, Kansas, United States of America
| |
Collapse
|
24
|
Vuotto C, Donelli G. Anaerobes in Biofilm-Based Healthcare-Associated Infections. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 830:97-112. [DOI: 10.1007/978-3-319-11038-7_6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
25
|
Alotaibi AK, Alshayiqi M, Ramalingam S. Does the presence of oral care guidelines affect oral care delivery by intensive care unit nurses? A survey of Saudi intensive care unit nurses. Am J Infect Control 2014; 42:921-2. [PMID: 25087146 DOI: 10.1016/j.ajic.2014.05.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 05/20/2014] [Accepted: 05/20/2014] [Indexed: 11/24/2022]
Abstract
Mechanically ventilated patients rely on nurses for their oral care needs, signifying the importance of nurses in intensive care units (ICUs). This study aimed to evaluate the impact of oral care guidelines on the oral care delivered to mechanically ventilated patients by ICU nurses. A total of 215 nurses were enrolled. Demographic data and oral care practices were recorded through a self-administered survey. Participants governed by oral care guidelines had significantly higher oral care practice scores than their counterparts from ICUs without similar guidelines (P = .034; t = 2.13). Oral care guidelines in ICUs can contribute to reduction of morbidity and mortality caused by ventilator-associated pneumonia.
Collapse
|
26
|
Scannapieco FA, Shay K. Oral health disparities in older adults: oral bacteria, inflammation, and aspiration pneumonia. Dent Clin North Am 2014; 58:771-82. [PMID: 25201541 DOI: 10.1016/j.cden.2014.06.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Poor oral hygiene has been suggested to be a risk factor for aspiration pneumonia in the institutionalized and disabled elderly. Control of oral biofilm formation in these populations reduces the numbers of potential respiratory pathogens in the oral secretions, which in turn reduces the risk for pneumonia. Together with other preventive measures, improved oral hygiene helps to control lower respiratory infections in frail elderly hospital and nursing home patients.
Collapse
Affiliation(s)
- Frank A Scannapieco
- Department of Oral Biology, School of Dental Medicine, University at Buffalo - The State University of New York, Foster Hall, Buffalo, NY 14214, USA.
| | - Kenneth Shay
- Geriatrics and Extended Care Services (10P4G), US Department of Veterans Affairs, PO Box 134002, Ann Arbor, MI 48113-4002, USA
| |
Collapse
|
27
|
Hall MR, McGillicuddy E, Kaplan LJ. Biofilm: Basic Principles, Pathophysiology, and Implications for Clinicians. Surg Infect (Larchmt) 2014; 15:1-7. [DOI: 10.1089/sur.2012.129] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Michael R. Hall
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | | | | |
Collapse
|
28
|
|
29
|
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.
Collapse
Affiliation(s)
- Eun-Kyong Kim
- Department of Dentistry, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu 705-703, Korea.
| | | | | | | | | | | | | |
Collapse
|
30
|
Oshodi TO, Bench S. Ventilator-associated pneumonia, liver disease and oral chlorhexldine. ACTA ACUST UNITED AC 2013; 22:751-8. [PMID: 24261090 DOI: 10.12968/bjon.2013.22.13.751] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
As part of the ventilator care bundle, the Department of Health (DH) in the U.K. recommends the use of chlorhexidine (CHX) for oral care to prevent the occurrence of ventilator-associated pneumonia (VAP) in all mechanically ventilated patients. Due to the heterogenous nature of this population, however, it is important to consider whether such recommendations are also relevant to specific critical care patient population groups. This article reviews the available scientific evidence on the use of CHX in the prevention of VAP, with a focus on critically ill mechanically ventilated patients who have liver dysfunction. Findings will be discussed with reference to the wider research literature in order to make recommendations for future practice.
Collapse
|
31
|
Zhang TT, Tang SS, Fu LJ. The effectiveness of different concentrations of chlorhexidine for prevention of ventilator-associated pneumonia: a meta-analysis. J Clin Nurs 2013; 23:1461-75. [PMID: 23952970 DOI: 10.1111/jocn.12312] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2013] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To evaluate the effectiveness of chlorhexidine for the prevention of ventilator-associated pneumonia and explore the preferred concentration of chlorhexidine. BACKGROUND The implementation of effective oral care measures could reduce the incidence of ventilator-associated pneumonia, but among several randomised controlled trials, whether using chlorhexidine is effective and which concentration is more appropriate remain controversial. DESIGN A meta-analysis was conducted. METHODS We searched the Cochrane Library, PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, China Biology Medicine disc and Chinese National Knowledge Infrastructure to collect randomised controlled trials of mechanically ventilated adult patients receiving oral care with chlorhexidine to prevent ventilator-associated pneumonia. The quality of randomised controlled trials was critically appraised, data were extracted by two reviewers independently, and disagreement was resolved by consensus. Meta-analyses were conducted for the eligible randomised controlled trials by revman 5.1. Relative risks and 95% CIs were calculated with the Mantel-Haenszel model, and heterogeneity was assessed with the I(2) test. RESULTS Eighteen randomised controlled trials were included and a meta-analysis was used. All studies indicated chlorhexidine could significantly prevent and reduce the incidence of ventilator-associated pneumonia [RR = 0·59, 95% CI (0·50-0·69), p < 0·00001]. Nine studies showed 0·12% chlorhexidine had a significant effect [RR = 0·53, 95% CI (0·43-0·67), p < 0·00001]. Three studies proved the effect of the 2% chlorhexidine on the prevention of ventilator-associated pneumonia [RR = 0·55, 95% CI (0·37-0·81), p = 0·002]. CONCLUSION Chlorhexidine can prevent and reduce the incidence of ventilator-associated pneumonia. Chlorhexidine of 0·12% has the best effect on the prevention of ventilator-associated pneumonia according to the meta-analysis, cost analysis, adverse reactions and drug resistance analysis. RELEVANCE TO CLINICAL PRACTICE Ventilator-associated pneumonia remains a leading cause of morbidity and mortality in intensive care unit, and implementing effective oral care can reduce the incidence of ventilator-associated pneumonia. Chlorhexidine of 0·12% is recommended in our study.
Collapse
Affiliation(s)
- Ting-Ting Zhang
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Jiaotong University School of Medicine, Shanghai, China
| | | | | |
Collapse
|
32
|
Shi Z, Xie H, Wang P, Zhang Q, Wu Y, Chen E, Ng L, Worthington HV, Needleman I, Furness S. Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. Cochrane Database Syst Rev 2013:CD008367. [PMID: 23939759 DOI: 10.1002/14651858.cd008367.pub2] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) is defined as pneumonia developing in persons who have received mechanical ventilation for at least 48 hours. VAP is a potentially serious complication in these patients who are already critically ill. Oral hygiene care (OHC), using either a mouthrinse, gel, toothbrush, or combination, together with aspiration of secretions may reduce the risk of VAP in these patients. OBJECTIVES To assess the effects of OHC on the incidence of VAP in critically ill patients receiving mechanical ventilation in intensive care units (ICUs) in hospitals. SEARCH METHODS We searched the Cochrane Oral Health Group's Trials Register (to 14 January 2013), CENTRAL (The Cochrane Library 2012, Issue 12), MEDLINE (OVID) (1946 to 14 January 2013), EMBASE (OVID) (1980 to 14 January 2013), LILACS (BIREME) (1982 to 14 January 2013), CINAHL (EBSCO) (1980 to 14 January 2013), Chinese Biomedical Literature Database (1978 to 14 January 2013), China National Knowledge Infrastructure (1994 to 14 January 2013), Wan Fang Database (January 1984 to 14 January 2013), OpenGrey and ClinicalTrials.gov (to 14 January 2013). There were no restrictions regarding language or date of publication. SELECTION CRITERIA We included randomised controlled trials (RCTs) evaluating the effects of OHC (mouthrinse, swab, toothbrush or combination) in critically ill patients receiving mechanical ventilation. DATA COLLECTION AND ANALYSIS Two review authors independently assessed all search results, extracted data and undertook risk of bias. We contacted study authors for additional information. Trials with similar interventions and outcomes were pooled reporting odds ratios (OR) for dichotomous outcomes and mean differences (MD) for continuous outcomes using random-effects models unless there were fewer than four studies. MAIN RESULTS Thirty-five RCTs (5374 participants) were included. Five trials (14%) were assessed at low risk of bias, 17 studies (49%) were at high risk of bias, and 13 studies (37%) were assessed at unclear risk of bias in at least one domain. There were four main comparisons: chlorhexidine (CHX mouthrinse or gel) versus placebo/usual care, toothbrushing versus no toothbrushing, powered versus manual toothbrushing and comparisons of oral care solutions.There is moderate quality evidence from 17 RCTs (2402 participants, two at high, 11 at unclear and four at low risk of bias) that CHX mouthrinse or gel, as part of OHC, compared to placebo or usual care is associated with a reduction in VAP (OR 0.60, 95% confidence intervals (CI) 0.47 to 0.77, P < 0.001, I(2) = 21%). This is equivalent to a number needed to treat (NNT) of 15 (95% CI 10 to 34) indicating that for every 15 ventilated patients in intensive care receiving OHC including chlorhexidine, one outcome of VAP will be prevented. There is no evidence of a difference between CHX and placebo/usual care in the outcomes of mortality (OR 1.10, 95% CI 0.87 to 1.38, P = 0.44, I(2) = 2%, 15 RCTs, moderate quality evidence), duration of mechanical ventilation (MD 0.09, 95% CI -0.84 to 1.01 days, P = 0.85, I(2) = 24%, six RCTs, moderate quality evidence), or duration of ICU stay (MD -0.21, 95% CI -1.48 to 1.89 days, P = 0.81, I(2) = 9%, six RCTs, moderate quality evidence). There was insufficient evidence to determine whether there is a difference between CHX and placebo/usual care in the outcomes of duration of use of systemic antibiotics, oral health indices, microbiological cultures, caregivers preferences or cost. Only three studies reported any adverse effects, and these were mild with similar frequency in CHX and control groups.From three trials of children aged from 0 to 15 years (342 participants, moderate quality evidence) there is no evidence of a difference between OHC with CHX and placebo for the outcomes of VAP (OR 1.07, 95% CI 0.65 to 1.77, P = 0.79, I(2) = 0%), or mortality (OR 0.73, 95% CI 0.41 to 1.30, P = 0.28, I(2) = 0%), and insufficient evidence to determine the effect on the outcomes of duration of ventilation, duration of ICU stay, use of systemic antibiotics, plaque index, microbiological cultures or adverse effects, in children.Based on four RCTs (828 participants, low quality evidence) there is no evidence of a difference between OHC including toothbrushing (± CHX) compared to OHC without toothbrushing (± CHX) for the outcome of VAP (OR 0.69, 95% CI 0.36 to 1.29, P = 0.24 , I(2) = 64%) and no evidence of a difference for mortality (OR 0.85, 95% CI 0.62 to 1.16, P = 0.31, I(2) = 0%, four RCTs, moderate quality evidence). There is insufficient evidence to determine whether there is a difference due to toothbrushing for the outcomes of duration of mechanical ventilation, duration of ICU stay, use of systemic antibiotics, oral health indices, microbiological cultures, adverse effects, caregivers preferences or cost.Only one trial compared use of a powered toothbrush with a manual toothbrush providing insufficient evidence to determine the effect on any of the outcomes of this review.A range of other oral care solutions were compared. There is some weak evidence that povidone iodine mouthrinse is more effective than saline in reducing VAP (OR 0.35, 95% CI 0.19 to 0.65, P = 0.0009, I(2) = 53%) (two studies, 206 participants, high risk of bias). Due to the variation in comparisons and outcomes among the trials in this group there is insufficient evidence concerning the effects of other oral care solutions on the outcomes of this review. AUTHORS' CONCLUSIONS Effective OHC is important for ventilated patients in intensive care. OHC that includes either chlorhexidine mouthwash or gel is associated with a 40% reduction in the odds of developing ventilator-associated pneumonia in critically ill adults. However, there is no evidence of a difference in the outcomes of mortality, duration of mechanical ventilation or duration of ICU stay. There is no evidence that OHC including both CHX and toothbrushing is different from OHC with CHX alone, and some weak evidence to suggest that povidone iodine mouthrinse is more effective than saline in reducing VAP. There is insufficient evidence to determine whether powered toothbrushing or other oral care solutions are effective in reducing VAP.
Collapse
Affiliation(s)
- Zongdao Shi
- Department of Oral and Maxillofacial Surgery, State Key Laboratory of Oral Diseases, West China College of Stomatology, Sichuan University, No. 14, Section Three, Ren Min Nan Road, Chengdu, Sichuan, China, 610041
| | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Oral topical decontamination for preventing ventilator-associated pneumonia: a systematic review and meta-analysis of randomized controlled trials. J Hosp Infect 2013; 84:283-93. [DOI: 10.1016/j.jhin.2013.04.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 04/22/2013] [Indexed: 10/26/2022]
|
34
|
Scannapieco FA, Binkley CJ. Modest reduction in risk for ventilator-associated pneumonia in critically ill patients receiving mechanical ventilation following topical oral chlorhexidine. J Evid Based Dent Pract 2013; 12:15-7. [PMID: 23253825 DOI: 10.1016/s1532-3382(12)70004-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
SUBJECTS The sample (N = 547) included patients older than 18 years (328 men and 219 women from a total population of 10,913) admitted to 3 intensive care units (ICUs) (medical, surgical/trauma, and neuroscience) at Virginia Commonwealth University Medical Center. The sample size required to detect an interaction (ie, the effect of chlorhexidine and toothbrushing in combination) was determined to be larger than that required to detect main effects (ie, chlorhexidine alone or toothbrushing alone) for a test at a given level of significance. The study was designed to detect an interactive effect resulting in a 0.755 difference in mean Clinical Pulmonary Infection Score (CPIS) at a power of 80% and a significance level of .05. An interim analysis was done and a Bonferroni adjustment was used to avoid inflation in the overall significance level related to interim analyses; for this reason, the level of significance for final analysis was .025. This was a randomized controlled clinical trial with a 2 × 2 factorial design. Patients were randomized to treatment within each ICU according to a permuted block design developed by the biostatistician before the start of the study. Staff who performed interventions (oral care) had no knowledge of patients' CPIS. Patients receiving mechanical ventilation were enrolled within 24 hours of intubation and were followed for up to 14 days. Dates of recruitment were not disclosed. KEY EXPOSURE/STUDY FACTOR Lung infection, resulting from aspiration of potential bacterial pathogens, such as Staphylococcus aureus, Streptococcus pneumoniae, or gram-negative rods that first colonize the oral cavity and oropharynx. Oral topical 0.12 % chlorhexidine gluconate, toothbrushing, or both (applied 4 times per day) were tested to determine their impact, if any, on incidence of lung infection in this cohort. MAIN OUTCOME MEASURE The CPIS was assessed as the primary outcome variable. This score consists of the sum of points assigned to 6 clinical and laboratory variables (yielding a score from 0 to 12): temperature, white blood cell count, tracheal secretions, oxygenation (calculated as PaO2 divided by the fraction of inspired oxygen), findings on chest radiographs (no infiltrate, diffuse infiltrate, localized infiltrate), and results of culturing of tracheal aspirates (microscopic examination and semiquantitative culture of tracheal secretions). Analysis used in this study examined the effect of interventions on both the range of CPIS scores and on dichotomous categories of the presence (CPIS ≥6) or absence (CPIS <6) of VAP. MAIN RESULTS When data on all patients were analyzed together, mixed models analysis indicated no effect of either chlorhexidine (P = .29) or toothbrushing (P = .95); however, chlorhexidine significantly reduced the incidence of pneumonia on day 3 (CPIS ≥6) among patients who had a CPIS less than 6 at baseline (P = .006). Toothbrushing had no effect on CPIS and did not enhance the effect of chlorhexidine. CONCLUSIONS Chlorhexidine oral swabbing was effective in reducing early ventilator-associated pneumonia (VAP) (after 3 days of intervention) in patients in medical, surgical/trauma, and neuroscience ICUs who did not have evidence of lung infection at baseline. This effect was not observed after day 3. Toothbrushing did not reduce the incidence of VAP, and combining toothbrushing and chlorhexidine did not provide additional benefit over use of chlorhexidine alone.
Collapse
Affiliation(s)
- Frank A Scannapieco
- Department of Oral Biology, School of Dental Medicine, University at Buffalo, The State University of New York, Foster Hall, Buffalo, New York 14214, USA.
| | | |
Collapse
|
35
|
Can chlorhexidine mouthwash twice daily ameliorate cyclosporine-induced gingival overgrowth? J Formos Med Assoc 2013; 112:131-7. [DOI: 10.1016/j.jfma.2011.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Revised: 12/13/2011] [Accepted: 12/14/2011] [Indexed: 12/30/2022] Open
|
36
|
Abstract
Critically ill patients in intensive care units are subject to many complications associated with therapy. Many of these complications are health care-associated infections and are related to indwelling devices, including ventilator-associated pneumonia, central line-associated bloodstream infection, catheter-associated urinary tract infection; surgical site infection, venous thromboembolism, deep venous thrombosis, and pulmonary embolus are other common complications. All efforts should be undertaken to prevent these complications in surgical critical care, and national efforts are under way for each of these complications. In this article, epidemiology, risk factors, diagnosis, treatment, and prevention of these complications in critically ill patients are discussed.
Collapse
Affiliation(s)
- Kathleen B To
- Division of Acute Care Surgery [Trauma, Burns, Surgical Critical Care, Emergency Surgery], Department of Surgery, University of Michigan Health System, Ann Arbor, MI 48109-5033, USA
| | | |
Collapse
|
37
|
Hillier B, Wilson C, Chamberlain D, King L. Preventing Ventilator-Associated Pneumonia Through Oral Care, Product Selection, and Application Method. AACN Adv Crit Care 2013. [DOI: 10.4037/nci.0b013e31827df8ad] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Objective:Review the literature to identify the most effective method of oral hygiene to reduce the incidence of ventilator-associated pneumonia (VAP).Background:Ventilator-associated pneumonia is the most common nosocomial infection in patients being treated with mechanical ventilation.Method:This study is a systematic literature review. The databases searched included Web of Science, Cumulative Index to Nursing and Allied Health Literature, Ovid, and MEDLINE.Results:Implementation of oral care protocols and nurse education programs reduced VAP. Although chlorhexidine was the most popular oral care product, no consensus emerged on concentration or protocols for oral care.Conclusion:No consensus on best practice for oral hygiene in patients being treated with mechanical ventilation was found. Chlorhexidine was the most popular oral care product. Implementation of an oral care protocol, ongoing nurse education, and evaluation were important in reducing the incidence of VAP. Future research should analyze chlorhexidine concentration, application techniques, and frequency of oral care, to optimize VAP prevention.
Collapse
Affiliation(s)
- Bianca Hillier
- Bianca Hillier is Intensive and Critical Care RN, Flinders Medical Centre, Adelaide, Australia. Christine Wilson is Lecturer in Paramedical Studies, Flinders University, Sturt Rd, Bedford Park, Adelaide, Australia . Di Chamberlain is Senior Lecturer in Nursing, Flinders University, Adelaide, Australia. Lindy King is Associate Dean, Higher Degrees, Flinders University, Adelaide, Australia
| | - Christine Wilson
- Bianca Hillier is Intensive and Critical Care RN, Flinders Medical Centre, Adelaide, Australia. Christine Wilson is Lecturer in Paramedical Studies, Flinders University, Sturt Rd, Bedford Park, Adelaide, Australia . Di Chamberlain is Senior Lecturer in Nursing, Flinders University, Adelaide, Australia. Lindy King is Associate Dean, Higher Degrees, Flinders University, Adelaide, Australia
| | - Di Chamberlain
- Bianca Hillier is Intensive and Critical Care RN, Flinders Medical Centre, Adelaide, Australia. Christine Wilson is Lecturer in Paramedical Studies, Flinders University, Sturt Rd, Bedford Park, Adelaide, Australia . Di Chamberlain is Senior Lecturer in Nursing, Flinders University, Adelaide, Australia. Lindy King is Associate Dean, Higher Degrees, Flinders University, Adelaide, Australia
| | - Lindy King
- Bianca Hillier is Intensive and Critical Care RN, Flinders Medical Centre, Adelaide, Australia. Christine Wilson is Lecturer in Paramedical Studies, Flinders University, Sturt Rd, Bedford Park, Adelaide, Australia . Di Chamberlain is Senior Lecturer in Nursing, Flinders University, Adelaide, Australia. Lindy King is Associate Dean, Higher Degrees, Flinders University, Adelaide, Australia
| |
Collapse
|
38
|
Scannapieco FA, Binkley CJ. Modest Reduction in Risk for Ventilator-Associated Pneumonia in Critically ill Patients Receiving Mechanical Ventilation Following Topical Oral Chlorhexidine. J Evid Based Dent Pract 2012; 12:103-6. [DOI: 10.1016/j.jebdp.2012.03.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
39
|
Sachdev G, Napolitano LM. Postoperative pulmonary complications: pneumonia and acute respiratory failure. Surg Clin North Am 2012; 92:321-44, ix. [PMID: 22414416 DOI: 10.1016/j.suc.2012.01.013] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Postoperative pulmonary complications (atelectasis, pneumonia, pulmonary edema, acute respiratory failure) are common, particularly after abdominal and thoracic surgery, pneumonia and atelectasis being the most common. Postoperative pneumonia is associated with increased morbidity, length of hospital stay, and costs. Few institutions have pneumonia prevention programs for surgical patients, and these should be strongly considered. Acute respiratory failure is a life-threatening pulmonary complication that requires institution of mechanical ventilation and admission to the intensive care unit, and is associated with increased risk for ventilator-associated pneumonia. This article discusses epidemiology, risk factors, diagnosis, treatment, and prevention of these pulmonary complications in surgical patients.
Collapse
Affiliation(s)
- Gaurav Sachdev
- Division of Acute Care Surgery (Trauma, Burns, Critical Care, Emergency Surgery), Department of Surgery, University of Michigan, Ann Arbor, MI 48109-0033, USA
| | | |
Collapse
|
40
|
Özçaka Ö, Başoğlu OK, Buduneli N, Taşbakan MS, Bacakoğlu F, Kinane DF. Chlorhexidine decreases the risk of ventilator-associated pneumonia in intensive care unit patients: a randomized clinical trial. J Periodontal Res 2012; 47:584-92. [PMID: 22376026 DOI: 10.1111/j.1600-0765.2012.01470.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVE The aim was to evaluate whether oral swabbing with 0.2% chlorhexidine gluconate (CHX) decreases the risk of ventilator-associated pneumonia (VAP) in intensive care unit (ICU) patients. MATERIAL AND METHODS Sixty-one dentate patients scheduled for invasive mechanical ventilation for at least 48 h were included in this randomized, double-blind, controlled study. As these patients were variably incapacitated, oral care was provided by swabbing the oral mucosa four times/d with CHX in the CHX group (29 patients) and with saline in the control group (32 patients). Clinical periodontal measurements were recorded, and lower-respiratory-tract specimens were obtained for microbiological analysis on admission and when VAP was suspected. Pathogens were identified by quantifying colonies using standard culture techniques. RESULTS Ventilator-associated pneumonia developed in 34/61 patients (55.7%) within 6.8 d. The VAP development rate was significantly higher in the control group than in the CHX group (68.8% vs. 41.4%, respectively; p = 0.03) with an odds ratio of 3.12 (95% confidence interval = 1.09-8.91). Acinetobacter baumannii was the most common pathogen (64.7%) of all species identified. There were no significant differences between the two groups in clinical periodontal measurements, VAP development time, pathogens detected or mortality rate. CONCLUSION The finding of the present study, that oral care with CHX swabbing reduces the risk of VAP development in mechanically ventilated patients, strongly supports its use in ICUs and indeed the importance of adequate oral hygiene in preventing medical complications.
Collapse
Affiliation(s)
- Ö Özçaka
- Department of Periodontology, School of Dentistry, Ege University, İzmir, Türkiye.
| | | | | | | | | | | |
Collapse
|
41
|
Kusahara DM, Friedlander LT, Peterlini MAS, Pedreira MLG. Oral care and oropharyngeal and tracheal colonization by Gram-negative pathogens in children. Nurs Crit Care 2012; 17:115-22. [PMID: 22497915 DOI: 10.1111/j.1478-5153.2012.00494.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Critical care nursing interventions to oral care can reduce microorganisms in the oropharynx available for translocation. OBJECTIVES To analyse the effect of 0·12% chlorhexidine digluconate on the colonization of oropharyngeal and tracheal secretions by Gram-negative pathogens in mechanically ventilated children. METHODS A randomized, controlled and double-blinded study was performed in the paediatric intensive care unit (PICU) of a Brazilian university hospital. Exclusion criteria included child age under 28 days, pneumonia diagnosis at admission, use of tracheostomy, PICU length of stay (LOS) less than 48 h and refusal to participate. Children were randomly allocated to the interventional group (IG), in which oral care with chlorhexidine was administered, or to the placebo group (PG), which received oral care without antiseptic use. The data were analysed through Pearson's χ(2) test, Fisher's exact and ANOVA tests with significance levels set at 0·05. RESULTS The demographic characteristics of the 74 children were not statistically different between groups. No between-group differences in oropharyx colonization by Gram-negative pathogens were identified (p = 0·316). Pathogens were isolated in the tracheal secretions of two (10·0%) children in the PG and four (19·0%) children in the IG (p = 0·355). CONCLUSION The use of chlorhexidine did not significantly influence the colonization of oropharyngeal and tracheal secretions by Gram-negative pathogens of the studied sample. RELEVANCE TO CLINICAL PRACTICE This study demonstrated no influence of a specific antiseptic agent on colonization profile of mechanically ventilated children in PICU. Further research in this field is necessary to promote evidence-based nursing practice on oral care of critically ill children.
Collapse
Affiliation(s)
- Denise Miyuki Kusahara
- Pediatric Nursing Department, Escola Paulista de Enfermagem - Universidade Federal de São Paulo, São Paulo, Brazil.
| | | | | | | |
Collapse
|
42
|
Miller KR, Kiraly LN, Lowen CC, Martindale RG, McClave SA. “CAN WE FEED?” A Mnemonic to Merge Nutrition and Intensive Care Assessment of the Critically Ill Patient. JPEN J Parenter Enteral Nutr 2011; 35:643-59. [DOI: 10.1177/0148607111414136] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
|
43
|
Berry AM, Davidson PM, Nicholson L, Pasqualotto C, Rolls K. Consensus based clinical guideline for oral hygiene in the critically ill. Intensive Crit Care Nurs 2011; 27:180-5. [DOI: 10.1016/j.iccn.2011.04.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Revised: 04/13/2011] [Accepted: 04/18/2011] [Indexed: 11/26/2022]
|
44
|
Prevention of ventilator-associated pneumonia with oral antiseptics: a systematic review and meta-analysis. THE LANCET. INFECTIOUS DISEASES 2011; 11:845-54. [PMID: 21798809 DOI: 10.1016/s1473-3099(11)70127-x] [Citation(s) in RCA: 183] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND We did a systematic review and random effects meta-analysis of randomised trials to assess the effect of oral care with chlorhexidine or povidone-iodine on the prevalence of ventilator-associated pneumonia versus oral care without these antiseptics in adults. METHODS Studies were identified through PubMed, CINAHL, Web of Science, CENTRAL, and complementary manual searches. Eligible studies were randomised trials of mechanically ventilated adult patients receiving oral care with chlorhexidine or povidone-iodine. Relative risks (RR) and 95% CIs were calculated with the Mantel-Haenszel model and heterogeneity was assessed with the I(2) test. FINDINGS 14 studies were included (2481 patients), 12 investigating the effect of chlorhexidine (2341 patients) and two of povidone-iodine (140 patients). Overall, antiseptic use resulted in a significant risk reduction of ventilator-associated pneumonia (RR 0.67; 95% CI 0.50-0.88; p=0.004). Chlorhexidine application was shown to be effective (RR 0.72; 95% CI 0.55-0.94; p=0.02), whereas the effect resulting from povidone-iodine remains unclear (RR 0.39; 95% CI 0.11-1.36; p=0.14). Heterogeneity was moderate (I(2)=29%; p=0.16) for the trials using chlorhexidine and high (I(2)=67%; p=0.08) for those assessing povidone-iodine use. Favourable effects were more pronounced in subgroup analyses for 2% chlorhexidine (RR 0.53, 95% CI 0.31-0.91), and in cardiosurgical studies (RR 0.41, 95% CI 0.17-0.98). INTERPRETATION This analysis showed a beneficial effect of oral antiseptic use in prevention of ventilator-associated pneumonia. Clinicians should take these findings into account when providing oral care to intubated patients. FUNDING None.
Collapse
|
45
|
Pileggi C, Bianco A, Flotta D, Nobile CGA, Pavia M. Prevention of ventilator-associated pneumonia, mortality and all intensive care unit acquired infections by topically applied antimicrobial or antiseptic agents: a meta-analysis of randomized controlled trials in intensive care units. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2011; 15:R155. [PMID: 21702946 PMCID: PMC3219029 DOI: 10.1186/cc10285] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 04/27/2011] [Accepted: 06/24/2011] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Given the high morbidity and mortality attributable to ventilator-associated pneumonia (VAP) in intensive care unit (ICU) patients, prevention plays a key role in the management of patients undergoing mechanical ventilation. One of the candidate preventive interventions is the selective decontamination of the digestive or respiratory tract (SDRD) by topical antiseptic or antimicrobial agents. We performed a meta-analysis to investigate the effect of topical digestive or respiratory tract decontamination with antiseptics or antibiotics in the prevention of VAP, of mortality and of all ICU-acquired infections in mechanically ventilated ICU patients. METHODS A meta-analysis of randomised controlled trials was performed. The U.S. National Library of Medicine's MEDLINE database, Embase, and Cochrane Library computerized bibliographic databases, and reference lists of selected studies were used. Selection criteria for inclusion were: randomised controlled trials (RCTs); primary studies; examining the reduction of VAP and/or mortality and/or all ICU-acquired infections in ICU patients by prophylactic use of one or more of following topical treatments: 1) oropharyngeal decontamination using antiseptics or antibiotics, 2) gastrointestinal tract decontamination using antibiotics, 3) oropharyngeal plus gastrointestinal tract decontamination using antibiotics and 4) respiratory tract decontamination using antibiotics; reported enough data to estimate the odds ratio (OR) or risk ratio (RR) and their variance; English language; published through June 2010. RESULTS A total of 28 articles met all inclusion criteria and were included in the meta-analysis. The overall estimate of efficacy of topical SDRD in the prevention of VAP was 27% (95% CI of efficacy = 16% to 37%) for antiseptics and 36% (95% CI of efficacy = 18% to 50%) for antibiotics, whereas in none of the meta-analyses conducted on mortality was a significant effect found. The effect of topical SDRD in the prevention of all ICU-acquired infections was statistically significant (efficacy = 29%; 95% CI of efficacy = 14% to 41%) for antibiotics whereas the use of antiseptics did not show a significant beneficial effect. CONCLUSIONS Topical SDRD using antiseptics or antimicrobial agents is effective in reducing the frequency of VAP in ICU. Unlike antiseptics, the use of topical antibiotics seems to be effective also in preventing all ICU-acquired infections, while the effectiveness on mortality of these two approaches needs to be investigated in further research.
Collapse
Affiliation(s)
- Claudia Pileggi
- Department of Clinical and Experimental Medicine, Medical School, University of Catanzaro Magna Græcia, via Tommaso Campanella, 88100 Catanzaro Italy.
| | | | | | | | | |
Collapse
|
46
|
Reed RL. Prevention of Hospital-Acquired Infections by Selective Digestive Decontamination. Surg Infect (Larchmt) 2011; 12:221-9. [DOI: 10.1089/sur.2011.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- R. Lawrence Reed
- Department of Trauma Services, IU Health Methodist Hospital, Indiana University, Indianapolis, Indiana
| |
Collapse
|
47
|
Abstract
The oral cavity of the hospitalized or bedridden elderly is often a reservoir for opportunistic pathogens associated with respiratory diseases. Commensal flora and the host interact in a balanced fashion and oral infections are considered to appear following an imbalance in the oral resident microbiota, leading to the emergence of potentially pathogenic bacteria. The definition of the process involved in colonization by opportunistic respiratory pathogens needs to elucidate the factors responsible for the transition of the microbiota from commensal to pathogenic flora. The regulatory factors influencing the oral ecosystem can be divided into three major categories: the host defense system, commensal bacteria, and external pathogens. In this article, we review the profile of these categories including the intricate cellular interaction between immune factors and commensal bacteria and the disturbance in homeostasis in the oral cavity of hospitalized or bedridden elderly, which facilitates oral colonization by opportunistic respiratory pathogens.
Collapse
Affiliation(s)
- Akio Tada
- Department of Oral Health, National Institute of Public Health, Wako, Saitama, Japan.
| | | |
Collapse
|
48
|
Effects of three approaches to standardized oral hygiene to reduce bacterial colonization and ventilator associated pneumonia in mechanically ventilated patients: a randomised control trial. Int J Nurs Stud 2010; 48:681-8. [PMID: 21185559 DOI: 10.1016/j.ijnurstu.2010.11.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Revised: 11/14/2010] [Accepted: 11/19/2010] [Indexed: 11/22/2022]
Abstract
BACKGROUND Ventilator associated pneumonia remains an important concern in the intensive care unit (ICU). An increasing body of evidence shows that mortality and morbidity can be reduced by implementing a range of preventive strategies, including optimizing oral hygiene. AIM The aim of this feasibility study was to test two oral hygiene strategies on the effects of microbial colonization of dental plaque with respiratory pathogens (primary outcome) and incidence of ventilator associated pneumonia (secondary outcome). METHODS A single blind randomised comparative study was conducted in a 20-bed adult intensive care unit in a university hospital. Patients with an expected duration of mechanical ventilation more than 48 h were eligible. Patients were randomised to one of three study regimens (Group A control, second hourly oral rinse with sterile water, Group B sodium bicarbonate mouth wash second hourly, and Group C twice daily irrigations with chlorhexidine 0.2% aqueous oral rinse and second hourly irrigations with sterile water). All study options included cleaning with a toothbrush and non foaming toothpaste. RESULTS Data from a total of 109 patients were analyzed. Group A 43, Group B 33 and Group C 33 (mean age: 58 ± 17 years, simplified acute physiology score II: 44 ± 14 points). On admission no significant differences were found between groups for all clinical data. While Group B showed a greater trend to reduction in bacterial colonization no significant differences could be demonstrated at Day 4 of admission (p=0.302). The incidence of ventilator associated pneumonia was evenly spread between Groups B and C (5%) while Group A was only 1%. CONCLUSIONS While a number of studies have advocated the use of various mouth rinses in reducing colonization of dental plaque a standardized oral hygiene protocol which includes the use of mechanical cleaning with a toothbrush may be a factor in the reduction of colonization of dental plaque with respiratory pathogens. This feasibility study provides data to inform future adequately powered studies.
Collapse
|
49
|
Evidence for Using Chlorhexidine Gluconate Preoperative Cleansing to Reduce the Risk of Surgical Site Infection. AORN J 2010; 92:509-18. [DOI: 10.1016/j.aorn.2010.01.020] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Accepted: 01/17/2010] [Indexed: 12/21/2022]
|
50
|
Vergara Messina TM. Descontaminación oral en la prevención de neumonía asociada a ventilación mecánica. Medwave 2010. [DOI: 10.5867/medwave.2010.07.4621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|