Effectiveness of a Dental Care Intervention in the Prevention of Lower Respiratory Tract Nosocomial Infections among Intensive Care Patients: A Randomized Clinical Trial

Autor(es)

Bellissimo-Rodrigues, Wanessa T. ^[1] ; Menegueti, Mayra G. ^[2] ; Gaspar, Gilberto G. ^[2] ; Nicolini, Edson A. ^[3] ; Auxiliadora-Martins, Maria ^[3] ; Basile-Filho, Anibal ^[3] ; Martinez, Roberto ^[1] ; Bellissimo-Rodrigues, Fernando ^{[2, 4]}

Afiliação do(s) autor(es)

^[1] Univ Sao Paulo, Div Infect Dis, Dept Internal Med, Ribeirao Preto Med Sch, BR-14048900 Sao Paulo - Brazil

^[2] Univ Sao Paulo, Hosp Infect Control Serv, Ribeirao Preto Med Sch, Univ Hosp, BR-14048900 Sao Paulo - Brazil

^[3] Univ Sao Paulo, Intens Care Div, Ribeirao Preto Med Sch, Dept Surg & Anat, BR-14048900 Sao Paulo - Brazil

^[4] Univ Sao Paulo, Dept Social Med, Ribeirao Preto Med Sch, BR-14048900 Sao Paulo - Brazil

• Tipo de documento: Artigo Científico
• Fonte: INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY; v. 35, n. 11, p. 1342-1348, NOV 2014.
• Citações Web of Science: 11

Resumo

OBJECTIVE. To evaluate whether dental treatment may enhance oral antisepsis, thus preventing more effectively lower respiratory tract infections (LRTIs) among critically ill patients. DESIGN. Observer-blind randomized clinical trial. SETTING. General intensive care unit (ICU) for adult patients. PATIENTS. We analyzed data from 254 adult patients who stayed for at least 48 hours in the ICU. INTERVENTION. Patients were randomized by means of rolling dice. The experimental group (n = 127) had access to dental care provided by a dental surgeon, 4-5 times a week. Besides routine oral hygiene, care also included teeth brushing, tongue scraping, removal of calculus, atraumatic restorative treatment of caries, and tooth extraction. The control group (n = 127) had access to routine oral hygiene only, which included the use of chlorhexidine as a mouth rinse, which was performed by the ICU nurse staff. RESULTS. The primary study outcome was the LRTI incidence, which was 8.7% in the experimental group and 18.1% in the control group (adjusted relative risk {[}RR], 0.44 {[}95% confidence interval (CI), 0.20-0.96]; P = .04). Ventilator-associated pneumonia rates per 1,000 ventilator-days were 16.5 (95% CI, 9.8-29.5) in the control group and 7.6 (95% CI, 3.3-15.0) in the experimental group (P < .05). Mortality rates were similar between both study groups: 31.5% in the control group versus 29.1% in the experimental group (adjusted RR, 0.93 {[}95% CI, 0.52-1.65]; P = .796). No severe adverse events related to oral care were observed during the study. CONCLUSION. Dental treatment was safe and effective in the prevention of LRTI among critically ill patients who were expected to stay at least 48 hours in the ICU. (AU)

• Processo FAPESP: 10/51063-4 - Impacto do tratamento odontologico sobre a incidencia de infeccoes respiratorias nosocomiais em terapia intensiva.
• Beneficiário: Wanessa Teixeira Bellissimo Rodrigues
• Modalidade de apoio: Bolsas no Brasil - Pós-Doutorado