Toothbrushing for Critically Ill Mechanically Ventilated Patients

Alhazzani, Waleed; Smith, Orla M.; Muscedere, John; Medd, James; Cook, Deborah J.

doi:10.1097/ccm.0b013e3182742d45

Cited by 95 publications

(45 citation statements)

References 57 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A study from Japan found a positive correlation between high salivary bacterial counts in nursing home residents and the incidence of pneumonia [7*], suggesting that intensive oral care regimens to reduce oral bacterial burden may help to prevent the onset of respiratory disease. Despite these promising results, meta-analyses have not shown significant overall benefit of enhanced oral care for the prevention of pneumonia in ventilated patients [19,20*]. A recent pilot study instituting twice daily chlorhexidine rinses and upright positioning during feeding for nursing home residents was terminated for futility when the intervention showed no significant reduction in the incidence of pneumonia [21**].…”

Section: Preventing Infectionmentioning

confidence: 99%

Healthcare-associated infections in the elderly: what's new

Katz

Roghmann

2016

Current Opinion in Infectious Diseases

View full text Add to dashboard Cite

Purpose of review The high risk population and current lack of knowledge regarding appropriate infection prevention in the long-term care setting has contributed to substantial rates of resistance and healthcare-associated infections in this arena. More evidence-based research on long-term care is necessary, particularly now that the elderly population is increasing. Recent findings Proposed government mandates highlight the urgent need to combat antimicrobial resistance in the long-term care setting. Recent studies focusing on unique strategies for the prevention of transmission and infection with multi drug resistant organisms in nursing homes are discussed, as well as attempts to formulate clear antimicrobial stewardship programs. Summary The long-term setting has unique challenges to instituting effective infection control precautions, therefore current accepted methods used in acute-care facilities need to be modified. Recent data suggest that prevention of transmission in long-term care (LTC) may be achieved with focus on high-risk patients or specific care-based activities rather than colonization status. Antimicrobial stewardship and consultation with specialized physicians may be important measures to combat resistance and adverse events in LTC. The prevention of unnecessary antibiotic use in palliative care may reduce rates of resistance as well as discomfort for terminal patients.

show abstract

Section: Preventing Infectionmentioning

confidence: 99%

Healthcare-associated infections in the elderly: what's new

Katz

Roghmann

2016

Current Opinion in Infectious Diseases

View full text Add to dashboard Cite

show abstract

“…A previous study showed that oral care with chlorhexidine and dental brushing alone was not superior to oral care with chlorhexidine alone for preventing postoperative pneumonia and VAP. 28 This might indicate that chlorhexidine prevents postoperative pneumonia and VAP, and that a good level of oral health is more important than an improvement in oral hygiene. Other previous studies showed that oral care with chlorhexidine along with professional oral care was superior to oral care with chlorhexidine alone.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Improving Oral Hygiene through Professional Oral Care to Reduce the Incidence of Pneumonia Post-esophagectomy in Esophageal Cancer

et al. 2018

View full text Add to dashboard Cite

Radical esophagectomy for thoracic esophageal cancer is invasive and frequently results in postoperative pulmonary complications. Postoperative pneumonia is the most common such complication and affects hospital mortality and survival rates. Oral care has been very effective in reducing pneumonia. In Japan, preoperative professional oral care is highly recommended. However, there are few studies on the effect of preoperative improvements in oral hygiene as a result of intervention on the incidence of postoperative pneumonia. The primary end-point of this retrospective study was the incidence of postoperative pneumonia after radical esophagectomy. The oral health levels of 46 patients were individually categorized, and then patients were grouped according to whether they maintained or improved their oral hygiene. At the first dental examination, oral health levels were classified as good in 22 patients and bad in 24. Of the 46 patients studied, 39 patients maintained or improved their oral hygiene (good control group), whereas 7 showed no improvement (bad control group). Postoperative pneumonia occurred in eight patients: four in the good control group and four in the bad control group. Statistical analysis with postoperative pneumonia as a dependent variable showed a significant effect of oral hygiene improvement on the incidence of pneumonia. Logistic regression analysis with this factor as an independent variable demonstrated that the risk of postoperative pneumonia was reduced in the good control group (OR 0.086, 95% CI 0.014-0.529). Therefore, preoperative professional oral care may improve oral hygiene and oral health, which may in turn reduce the incidence of postoperative pneumonia. (

show abstract

“…The latter is a marker of host immune activity in response to the elevated plaque levels and can highlight the importance of plaque scoring in critical care medicine (Wise & Williams, 2013). Oral hygiene, predominantly tooth brushing, can be effective in disrupting the plaque biofilm; however, small amounts of potentially pathogenic biomass firmly attached to the enamel surface are likely to remain (Alhazzani et al , 2013). …”

Section: Discussionmentioning

confidence: 99%

Microbial profiling of dental plaque from mechanically ventilated patients

Sands

Twigg

Lewis

et al. 2016

Journal of Medical Microbiology

View full text Add to dashboard Cite

Micro-organisms isolated from the oral cavity may translocate to the lower airways during mechanical ventilation (MV) leading to ventilator-associated pneumonia (VAP). Changes within the dental plaque microbiome during MV have been documented previously, primarily using culture-based techniques. The aim of this study was to use community profiling by high throughput sequencing to comprehensively analyse suggested microbial changes within dental plaque during MV. Bacterial 16S rDNA gene sequences were obtained from 38 samples of dental plaque sampled from 13 mechanically ventilated patients and sequenced using the Illumina platform. Sequences were processed using Mothur, applying a 97 % gene similarity cut-off for bacterial species level identifications. A significant ‘microbial shift’ occurred in the microbial community of dental plaque during MV for nine out of 13 patients. Following extubation, or removal of the endotracheal tube that facilitates ventilation, sampling revealed a decrease in the relative abundance of potential respiratory pathogens and a compositional change towards a more predominantly (in terms of abundance) oral microbiota including Prevotella spp., and streptococci. The results highlight the need to better understand microbial shifts in the oral microbiome in the development of strategies to reduce VAP, and may have implications for the development of other forms of pneumonia such as community-acquired infection.

show abstract

Toothbrushing for Critically Ill Mechanically Ventilated Patients

Cited by 95 publications

References 57 publications

Healthcare-associated infections in the elderly: what's new

Healthcare-associated infections in the elderly: what's new

The Effect of Improving Oral Hygiene through Professional Oral Care to Reduce the Incidence of Pneumonia Post-esophagectomy in Esophageal Cancer

Microbial profiling of dental plaque from mechanically ventilated patients

Contact Info

Product

Resources

About