Effects of three approaches to standardized oral hygiene to reduce bacterial colonization and XXXX in mechanically ventilated @entity1 : a randomised control trial.

@entity1 @entity2133 @entity2489 @entity2413
BACKGROUND: @entity2489 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 @entity2413 with respiratory pathogens (primary outcome) and incidence of @entity2489 (secondary outcome). METHODS: A single blind randomised comparative study was conducted in a 20-bed adult intensive care unit in a university hospital. @entity1 with an expected duration of mechanical ventilation more than 48 h were eligible. @entity1 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 @entity1 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 @entity2489 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 @entity2133 rinses in reducing colonization of @entity2413 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 @entity2413 with respiratory pathogens. This feasibility study provides data to inform future adequately powered studies.
