Intensive Care Medicine

, Volume 32, Issue 2, pp 230–236 | Cite as

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

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



To examine whether oral care contributes to preventing ventilator-associated pneumonia (VAP) in ICU patients.


Nonrandomized trial with historical controls.


A medical-surgical ICU in a university hospital.


1,666 mechanically ventilated patients admitted to the ICU.


Oral care was provided to 1,252 patients who were admitted to the ICU during period between January 1997 and December 2002 (oral care group), while 414 patients who were admitted to the ICU during period between January1995 and December 1996 and who did not receive oral care served as historical controls (non-oral care group).

Measurements and results

Incidence of VAP(episodes of pneumonia per 1000 ventilator days) in the oral care group was significantly lower than that in the non-oral care group (3.9 vs 10.4). The relative risk of VAP in the oral care group compared to that in the non-oral care group was 0.37, with an attributable risk of −3.96%. Furthermore, length of stay in ICU before onset of VAP was greater in the oral care than in the non-oral care group (8.5 ± 4.6 vs 6.3 ± 7.5 days). However, no significant difference was observed in either duration of mechanical ventilation or length of stay between the groups (5.9 ± 10.8 vs 6.0 ± 8.8 days and 7.5 ± 11.5 vs 7.2 ± 9.5 days, respectively). Pseudomonoas aeruginosa was the most frequently detected bacteria in both groups. Number of potentially pathogenic bacteria in oral cavity was significantly reduced by single oral care procedure.


Oral care decreased the incidence of VAP in ICU patients.


Pulmonary nosocomial infection


Oral care Oral hygiene Ventilator-associated pneumonia Hospital-acquired pneumonia Nosocomial infection Critical care 



ventilator-associated pneumonia


intensive care unit


selective digestive decontamination


  1. 1.
    Fagon JY, Chastre J, Hance AJ, Montravers P, Novara A, Gibert C (1993) Nosocomial pneumonia in ventilated patients: a cohort study evaluating attributable mortality and hospital stay. Am J Med 94:281–288CrossRefPubMedGoogle Scholar
  2. 2.
    Fagon JY, Chastre J, Domart Y, Trouillet JL, Pierre J, Darne C, Gibert C (1989) Nosocomial pneumonia in patients receiving continuous mechanical ventilation. Prospective analysis of 52 episodes with use of a protected specimen brush and quantitative culture techniques. Am Rev Respir Dis 139:877–884 CrossRefPubMedGoogle Scholar
  3. 3.
    George DL (1995) Epidemiology of nosocomial pneumonia in intensive care unit patients. Clin Chest Med 16:29–44 PubMedGoogle Scholar
  4. 4.
    Fourrier F, Duvivier B, Boutigny H, Roussel-Delvallez M, Chopin C (1998) Colonization of dental plaque: a source of nosocomial infections in intensive care unit patients. Crit Care Med 26:301–308CrossRefPubMedGoogle Scholar
  5. 5.
    Nardi G, Di Silvestre AD, De Monte A, Massarutti D, Proietti A, Grazia Troncon M, Lesa L, Zussino M (2001) Reduction in gram-positive pneumonia and antibiotic consumption following the use of a SDD protocol including nasal and oral mupirocin. Eur J Emerg Med 8:203–214CrossRefPubMedGoogle Scholar
  6. 6.
    El-Solh AA, Pietrantoni C, Bhat A, Okada M, Zambon J, Aquilina A, Berbary E (2004) Colonization of dental plaques: a reservoir of respiratory pathogens for hospital-acquired pneumonia in institutionalized elders. Chest 126:1575–1582CrossRefPubMedGoogle Scholar
  7. 7.
    Mori H, Hirasawa H, Oda S, Shiga H, Matsuda K, Nakamura M (2004) Oral care reduces incidence of ventilator-associated pneumonia in ICU population. Crit Care Med 32:A109CrossRefGoogle Scholar
  8. 8.
    Woske H-J, Roding T, Schulz I, Lode H (2001) Ventilator-associated pneumonia in a surgical intensive careunit: epidemiology, etiology and comparison of three bronchoscopic methods for microbiological specimen sampling. Crit Care 5:167–173CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Craven DE (2000) Epidemiology of ventilator-associated pneumonia. Chest 117:186–187CrossRefGoogle Scholar
  10. 10.
    George DL, Falk PS, Wunderink RG, Leeper KV Jr, Meduri GU, Steere EL, Corbett CE, Mayhall CG (1998) Epidemiology of ventilator-acquired pneumonia based on protected bronchoscopic sampling. Am J Respir Crit Care Med 158:1839–1847CrossRefPubMedGoogle Scholar
  11. 11.
    Neuhauser MM, Weinstein RA, Rydman R, Danziger LH, Karam G, Quinn JP (2003) Antibiotic resistance among gram-negative bacilli in US intensive care units: implications for fluoroquinolone use. JAMA 289:885–888 CrossRefPubMedGoogle Scholar
  12. 12.
    Robert R, Grollier G, Frat JP, Godet C, Adoun M, Fauchere JL, Dore P (2003) Colonization of lower respiratory tract with anaerobic bacteria in mechanically ventilated patients. Intensive Care Med 29:1062–1068CrossRefPubMedGoogle Scholar
  13. 13.
    Drakulovic MB, Torres A, Bauer TT, Nicolas JM, Nogue S, Ferrer M (1999) Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial. Lancet 354:1851–1858CrossRefPubMedGoogle Scholar
  14. 14.
    Shorr AF, O'Malley PG (2001) Continuous subglottic suctioning for the prevention of ventilator-associated pneumonia : potential economic implications. Chest 119:228–235CrossRefPubMedGoogle Scholar
  15. 15.
    Burns KE, Meade MO (2004) Noninvasive ventilation reduced duration of mechanical ventilation and ICU stay more than conventional weaning. Am J Respir Crit Care Med 168:70–76Google Scholar
  16. 16.
    Kearns PJ, Chin D, Mueller L, Wallace K, Jensen WA, Kirsch CM (2000) The incidence of ventilator-associated pneumonia and success in nutrient delivery with gastric versus small intestinal feeding: a randomized clinical trial. Crit Care Med 28:1742–1746CrossRefPubMedGoogle Scholar
  17. 17.
    Collard HR, Saint S, Matthay MA (2003) Prevention of ventilator-associated pneumonia: an evidence-based systematic review. Ann Intern Med 138:494–501CrossRefPubMedGoogle Scholar
  18. 18.
    Gastinne H, Wolff M, Delatour F, Faurisson F, Chevret S (1992) A controlled trial in intensive care units of selective decontamination of the digestive tract with nonabsorbable antibiotics. The French Study Group on Selective Decontamination of the Digestive Tract. N Engl J Med 326:594–599Google Scholar
  19. 19.
    Nardi G, Di Silvestre AD, De Monte A, Massarutti D, Proietti A, Grazia Troncon M, Lesa L, Zussino M (2001) Reduction in gram-positive pneumonia and antibiotic consumption following the use of a SDD protocol including nasal and oral mupirocin. Eur J Emerg Med. 8:203–214 CrossRefPubMedGoogle Scholar
  20. 20.
    Nieuwenhoven CA van, Buskens E, Bergmans DC, van Tiel FH, Ramsay G, Bonten MJ (2004) Oral decontamination is cost-saving in the prevention of ventilator-associated pneumonia in intensive care units. Crit Care Med 32:126–130 CrossRefPubMedGoogle Scholar
  21. 21.
    DeRiso AJ 2nd, Ladowski JS, Dillon TA, Justice JW, Peterson AC (1996) Chlorhexidine gluconate 0.12% oral rinse reduces the incidence of total nosocomial respiratory infection and nonprophylactic systemic antibiotic use in patients undergoing heart surgery. Chest 109:1556–1561CrossRefPubMedGoogle Scholar
  22. 22.
    Genuit T, Bochicchio G, Napolitano LM, McCarter RJ, Roghman MC (2001) Prophylactic chlorhexidine oral rinse decreases ventilator-associated pneumonia in surgical ICU patients. Surg Infect (Larchmt)2:5–18CrossRefGoogle Scholar
  23. 23.
    Young PJ, Rollinson M, Downward G, Henderson S (1997) Leakage of fluid past the tracheal tube cuff in a benchtop model. Br J Anaesth 78:557–562CrossRefPubMedGoogle Scholar
  24. 24.
    Nathens AB, Marshall JC (1999) Selective decontamination of the digestive tract in surgical patients: a systematic review of the evidence. Arch Surg 134:170–176CrossRefPubMedGoogle Scholar
  25. 25.
    Bonten MJ (2003) Prevention of hospital-acquired pneumonia: European perspective. Infect Dis Clin North Am17:773–784CrossRefPubMedGoogle Scholar
  26. 26.
    Scannapieco FA, Rethman MP (2003) The relationship between periodontal diseases and respiratory diseases. Dent Today 22:79–83PubMedGoogle Scholar
  27. 27.
    Yoneyama T, Yoshida M, Ohrui T, Mukaiyama H, Okamoto H, Hoshiba K, Ihara S, Yanagisawa S, Ariumi S, Morita T, Mizuno Y, Ohsawa T, Akagawa Y, Hashimoto K, Sasaki H; Oral Care Working Group (2002) Oral care reduces pneumonia in older patients in nursing homes. J Am Geriatr Soc 50:430–433CrossRefPubMedGoogle Scholar
  28. 28.
    Caton JG, Blieden TM, Lowenguth RA, Frantz BJ, Wagener CJ, Doblin JM, Stein SH, Proskin HM (1993) Comparison between mechanical cleaning and an antimicrobial rinse for the treatment and prevention of interdental gingivitis. J Clin Periodontol 20:172–178CrossRefPubMedGoogle Scholar
  29. 29.
    Drakulovic MB, Bauer TT, Torres (1999) Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial. Lancet 354:1851–1858CrossRefPubMedGoogle Scholar
  30. 30.
    Smulders K, van der Hoeven H, Weers-Pothoff I, et al. (2002) A randomized clinical trial of intermittent subglottic secretion drainage in patients receiving mechanical ventilation. Chest 121:858–862CrossRefPubMedGoogle Scholar
  31. 31.
    Combes P, Fauvage B, Oleyer C (2000) Nosocomial pneumonia in mechanically ventilated patients, a prospective randomised evaluation of the Stericath closed suctioning system. Intensive Care Med. 26:878–882CrossRefPubMedGoogle Scholar
  32. 32.
    Cook DJ, Reeve BK, Guyatt GH (1996) Stress ulcer prophylaxis in critically ill patients. Resolving discordant meta-analyses. JAMA 275:308–314PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Hideo Mori
    • 1
  • Hiroyuki Hirasawa
    • 1
  • Shigeto Oda
    • 1
  • Hidetoshi Shiga
    • 1
  • Kenichi Matsuda
    • 1
  • Masataka Nakamura
    • 1
  1. 1.Department of Emergency and Critical Care MedicineGraduate School of Medicine,Chiba UniversityChuouJapan

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