Article

European Journal of Clinical Microbiology & Infectious Diseases

, Volume 31, Issue 10, pp 2621-2629

Ventilator-associated pneumonia with or without toothbrushing: a randomized controlled trial

  • L. LorenteAffiliated withDepartment of Critical Care, Hospital Universitario de Canarias Email author 
  • , M. LecuonaAffiliated withDepartment of Microbiology, Hospital Universitario de Canarias
  • , A. JiménezAffiliated withResearch Unit, Hospital Universitario de Canarias
  • , S. PalmeroAffiliated withDepartment of Critical Care, Hospital Universitario de Canarias
  • , E. PastorAffiliated withDepartment of Critical Care, Hospital Universitario de Canarias
  • , N. LafuenteAffiliated withDepartment of Critical Care, Hospital Universitario de Canarias
  • , M. J. RamosAffiliated withDepartment of Microbiology, Hospital Universitario de Canarias
  • , M. L. MoraAffiliated withDepartment of Critical Care, Hospital Universitario de Canarias
  • , A. SierraAffiliated withDepartment of Microbiology, Hospital Universitario de Canarias

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Abstract

Certain guidelines for the prevention of ventilator-associated pneumonia (VAP) recommend oral care with chlorhexidine, but none refer to the use of a toothbrush for oral hygiene. The role of toothbrush use has received scant attention. Thus, the objective of this study was to compare the incidence of VAP in critical care patients receiving oral care with and without manual brushing of the teeth. This was a randomized clinical trial developed in a 24-bed medical-surgical intensive care unit (ICU). Patients undergoing invasive mechanical ventilation for than 24 h were included. Patients were randomly assigned to receive oral care with or without toothbrushing. All patients received oral care with 0.12 % chlorhexidine digluconate. Tracheal aspirate samples were obtained during endotracheal intubation, then twice a week, and, finally, on extubation. There were no significant differences between the two groups of patients in the baseline characteristics. We found no statistically significant differences between the groups regarding the incidence of VAP (21 of 217 [9.7 %] with toothbrushing vs. 24 of 219 [11.0 %] without toothbrushing; odds ratio [OR] = 0.87, 95 % confidence interval [CI] = 0.469–1.615; p = 0.75). Adding manual toothbrushing to chlorhexidine oral care does not help to prevent VAP in critical care patients on mechanical ventilation.