Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia

Article


Shi, Zongdao, Xie, Huixu, Wang, Ping, Zhang, Qi, Wu, Yan, Chen, E., Ng, Linda, Worthington, Helen V., Needleman, Ian and Furness, Susan. 2013. "Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia." Cochrane Database of Systematic Reviews. 2013 (8). https://doi.org/10.1002/14651858.CD008367.pub2
Article Title

Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia

ERA Journal ID15305
Article CategoryArticle
AuthorsShi, Zongdao (Author), Xie, Huixu (Author), Wang, Ping (Author), Zhang, Qi (Author), Wu, Yan (Author), Chen, E. (Author), Ng, Linda (Author), Worthington, Helen V. (Author), Needleman, Ian (Author) and Furness, Susan (Author)
Journal TitleCochrane Database of Systematic Reviews
Journal Citation2013 (8)
Number of Pages127
Year2013
PublisherJohn Wiley & Sons
Place of PublicationUnited Kingdom
ISSN1469-493X
1361-6137
Digital Object Identifier (DOI)https://doi.org/10.1002/14651858.CD008367.pub2
Web Address (URL)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008367.pub2/full
Abstract

Background: Ventilator-associated pneumonia (VAP) is defined as pneumonia developing in persons who have received mechanical ventilation for at least 48 hours. VAP is a potentially serious complication in these patients who are already critically ill. Oral hygiene care (OHC), using either a mouth rinse, gel, toothbrush, or combination, together with aspiration of secretions may reduce the risk of VAP in these patients.

Objectives: To assess the effects of OHC on the incidence of VAP in critically ill patients receiving mechanical ventilation in intensive care units (ICUs) in hospitals.

Search methods: We searched the Cochrane Oral Health Group's Trials Register (to 14 January 2013), CENTRAL (The Cochrane Library 2012, Issue 12), MEDLINE (OVID) (1946 to 14 January 2013), EMBASE (OVID) (1980 to 14 January 2013), LILACS (BIREME) (1982 to 14 January 2013), CINAHL (EBSCO) (1980 to 14 January 2013), Chinese Biomedical Literature Database (1978 to 14 January 2013), China National Knowledge Infrastructure (1994 to 14 January 2013), Wan Fang Database (January 1984 to 14 January 2013), Open Grey and ClinicalTrials.gov (to 14 January 2013). There were no restrictions regarding language or date of publication. Selection criteria: We included randomised controlled trials (RCTs) evaluating the effects of OHC (mouth rinse, swab, toothbrush or combination) in critically ill patients receiving mechanical ventilation.

Data collection and analysis: Two review authors independently assessed all search results, extracted data and undertook risk of bias. We contacted study authors for additional information. Trials with similar interventions and outcomes were pooled reporting odds ratios (OR) for dichotomous outcomes and mean differences (MD) for continuous outcomes using random-effects models unless there were fewer than four studies.

Main results: Thirty-five RCTs (5374 participants) were included. Five trials (14%) were assessed at low risk of bias, 17 studies (49%) were at high risk of bias, and 13 studies (37%) were assessed at unclear risk of bias in at least one domain. There were four main comparisons: chlorhexidine (CHX mouth rinse or gel) versus placebo/usual care, toothbrushing versus no toothbrushing, powered versus manual toothbrushing and comparisons of oral care solutions. There is moderate quality evidence from 17 RCTs (2402 participants, two at high, 11 at unclear and four at low risk of bias) that CHX mouth rinse or gel, as part of OHC, compared to placebo or usual care is associated with a reduction in VAP (OR 0.60, 95% confidence intervals (CI) 0.47 to 0.77, P < 0.001, I2 = 21%). This is equivalent to a number needed to treat (NNT) of 15 (95% CI 10 to 34) indicating that for every 15 ventilated patients in intensive care receiving OHC including chlorhexidine, one outcome of VAP will be prevented. There is no evidence of a difference between CHX and placebo/usual care in the outcomes of mortality (OR 1.10, 95% CI 0.87 to 1.38, P = 0.44, I2 = 2%, 15 RCTs, moderate quality evidence), duration of mechanical ventilation (MD 0.09, 95% CI -0.84 to 1.01 days, P = 0.85, I2 = 24%, six RCTs, moderate quality evidence), or duration of ICU stay (MD 0.21, 95% CI -1.48 to 1.89 days, P = 0.81, I2 = 9%, six RCTs, moderate quality evidence). There was insufficient evidence to determine whether there is a difference between CHX and placebo/usual care in the outcomes of duration of use of systemic antibiotics, oral health indices, microbiological cultures, caregivers preferences or cost. Only three studies reported any adverse effects, and these were mild with similar frequency in CHX and control groups. From three trials of children aged from 0 to 15 years (342 participants, moderate quality evidence) there is no evidence of a difference between OHC with CHX and placebo for the outcomes of VAP (OR 1.07, 95% CI 0.65 to 1.77, P = 0.79, I2 = 0%), or mortality (OR 0.73, 95% CI 0.41 to 1.30, P = 0.28, I2 = 0%), and insufficient evidence to determine the effect on the outcomes of duration of ventilation, duration of ICU stay, use of systemic antibiotics, plaque index, microbiological cultures or adverse effects, in children. Based on four RCTs (828 participants, low quality evidence) there is no evidence of a difference between OHC including toothbrushing (- CHX) compared to OHC without toothbrushing (- CHX) for the outcome of VAP (OR 0.69, 95% CI 0.36 to 1.29, P = 0.24, I2 = 64%) and no evidence of a difference for mortality (OR 0.85, 95% CI 0.62 to 1.16, P = 0.31, I2 = 0%, four RCTs, moderate quality evidence). There is insufficient evidence to determine whether there is a difference due to toothbrushing for the outcomes of duration of mechanical ventilation, duration of ICU stay, use of systemic antibiotics, oral health indices, microbiological cultures, adverse effects, caregivers preferences or cost. Only one trial compared use of a powered toothbrush with a manual toothbrush providing insufficient evidence to determine the effect on any of the outcomes of this review. A range of other oral care solutions were compared. There is some weak evidence that povidone iodine mouth rinse is more effective than saline in reducing VAP (OR 0.35, 95% CI 0.19 to 0.65, P = 0.0009, I2 = 53%) (two studies, 206 participants, high risk of bias). Due to the variation in comparisons and outcomes among the trials in this group there is insufficient evidence concerning the effects of other oral care solutions on the outcomes of this review.

Authors' conclusions: Effective OHC is important for ventilated patients in intensive care. OHC that includes either chlorhexidine mouthwash or gel is associated with a 40% reduction in the odds of developing ventilator-associated pneumonia in critically ill adults. However, there is no evidence of a difference in the outcomes of mortality, duration of mechanical ventilation or duration of ICU stay. There is no evidence that OHC including both CHX and toothbrushing is different from OHC with CHX alone, and some weak evidence to suggest that povidone iodine mouth rinse is more effective than saline in reducing VAP. There is insufficient evidence to determine whether powered toothbrushing or other oral care solutions are effective in reducing VAP.

Keywordschlorhexidine; mouthwash; chlorhexidine; mouthwash
ANZSRC Field of Research 2020420501. Acute care
Public Notes

File reproduced in accordance with the copyright policy of the publisher/author.

Byline AffiliationsSichuan University, China
University of Queensland
University of Manchester, United Kingdom
University College London, United Kingdom
Institution of OriginUniversity of Southern Queensland
Permalink -

https://research.usq.edu.au/item/q51zv/oral-hygiene-care-for-critically-ill-patients-to-prevent-ventilator-associated-pneumonia

Download files


Published Version
  • 241
    total views
  • 294
    total downloads
  • 2
    views this month
  • 4
    downloads this month

Export as

Related outputs

Scoping review of systematic reviews of nursing interventions in a neonatal intensive care unit or special care nursery
Foster, Jann, Pathrose, Sheeja Perumbil, Briguglio, Laura, Trajkovski, Suza, Lowe, Patricia, Muirhead, Renee, Jyoti, Jeewan, Ng, Linda, Bray, Nicole, Spence, Kaye, Chetty, Natasha and Broom, Margaret. 2024. "Scoping review of systematic reviews of nursing interventions in a neonatal intensive care unit or special care nursery ." Journal of Clinical Nursing. 33 (6), pp. 2123-2137. https://doi.org/10.1111/jocn.17053
Mental health and coping strategies among international health science students during the COVID-19 pandemic: A cross-sectional study
Nair, Ambili, Kalembo, Fatch, Zhou, Huaqiong, Ng, Linda, Hawley, Glenda, Grogan, Aaron, Ng, Leo, Chen, Wai, Daire, Judith and Lim, Eric. 2024. "Mental health and coping strategies among international health science students during the COVID-19 pandemic: A cross-sectional study." Teaching and Learning in Nursing. 19 (1), pp. e208-e216. https://doi.org/https://doi.org/10.1016/j.teln.2023.10.022
Exploring nursing students’ perceptions on usefulness, ease of use, and acceptability of using a simulated Electronic Medical Record: A descriptive study
Ng, Linda, Osborne, Sonya, Eley, Rob, Tuckett, Anthony and Walker, Jan. 2024. "Exploring nursing students’ perceptions on usefulness, ease of use, and acceptability of using a simulated Electronic Medical Record: A descriptive study ." Collegian: The Australian Journal of Nursing Practice, Scholarship and Research. 31 (2), pp. 120-127. https://doi.org/https://doi.org/10.1016/j.colegn.2023.12.006
Construction of an epoxidized, phosphorus-based poly (styrene butadiene styrene) and its application in high-performance epoxy resin
Wang, Cheng, Huo, Siqi, Ye, Guofeng, Wang, Bingtao, Guo, Zhenghong, Zhang, Qi, Song, Pingan, Wang, Hao and Liu, Zhitian. 2024. "Construction of an epoxidized, phosphorus-based poly (styrene butadiene styrene) and its application in high-performance epoxy resin." Composites Part B: Engineering. 268. https://doi.org/10.1016/j.compositesb.2023.111075
Embedding numeracy and medication management across the new Bachelor of Nursing curriculum to improve performance on clinical placement
Stolic, S., Ng, L. and Sheridan, G.. "Embedding numeracy and medication management across the new Bachelor of Nursing curriculum to improve performance on clinical placement." 18th Higher Education Research and Development Society of Australasia Annual Conference (HERDSA 1995). Rockhampton, Australia 04 - 08 Jul 1995
If we develop it, will they stay?
Ng, Linda. 2023. "If we develop it, will they stay?" 45th Higher Education Research and Development Society of Australasia Annual Conference (HERDSA 2023). Brisbane, Australia 09 Jun - 05 Jul 2023 Australia.
Oral care measures for preventing nursing home-acquired pneumonia (Review)
Cao, Yubin, Liu, Chang, Lin, Jie, Ng, Linda, Needleman, Ian, Walsh, Tanya and Li, Chunjie. 2022. "Oral care measures for preventing nursing home-acquired pneumonia (Review)." Cochrane Database of Systematic Reviews. 2022 (11), pp. 1-46. https://doi.org/10.1002/14651858.CD012416.pub3
Implementation of the Electronic Medical Record into the Bachelor of Nursing program: A descriptive study
Ng, Linda, Osborne, Sonya and Walker, Jan. 2022. "Implementation of the Electronic Medical Record into the Bachelor of Nursing program: A descriptive study." 44th Higher Education Research and Development Society of Australasia Annual Conference (HERDSA 2022). Melbourne, Australia 27 - 30 Jun 2022 Australia.
Educating the educators: Implementing cultural safety in the nursing and midwifery curriculum
Best, Odette, Cox, Leonie, Ward, Aletha, Graham, Coralie, Bayliss, Luke, Black, Barbara, Burton, Lucinda, Carey, Melissa, Davis, Teresa, Derrington, Kate, Elliott, Jessie, Jayasinghe, Thenuja, Luyke, Trish, Maher, Dianne, McGregor, Rowena, Ng, Linda, O'Malley, Lee, Roderick, Geraldine, Sheridan, Georgina, ..., Walker, Jan. 2022. "Educating the educators: Implementing cultural safety in the nursing and midwifery curriculum." Nurse Education Today. 117, pp. 1-6. https://doi.org/10.1016/j.nedt.2022.105473
Electronic medication administration records and nursing administration of medications: An integrative review
Stolic, Snezana, Ng, Linda and Sheridan, Georgina. 2022. "Electronic medication administration records and nursing administration of medications: An integrative review." Collegian: The Australian Journal of Nursing Practice, Scholarship and Research. 30 (1), pp. 163-189. https://doi.org/10.1016/j.colegn.2022.06.005
Medication errors by nursing students on clinical practice: an integrative review
Stolic, Snezana, Ng, Linda, Southern, Joanne and Sheridan, Georgina. 2022. "Medication errors by nursing students on clinical practice: an integrative review." Nurse Education Today. 112, pp. 1-9. https://doi.org/10.1016/j.nedt.2022.105325
Interventions for colorectal cancer survivors: a systematic review of intervention reviews
Ralph, Nicholas, Arthur, Thomas, McDonald, Suzanne, Ng, Linda, Singh, Kamal, Elliott, Jessica and Gow, Jeffery. 2021. "Interventions for colorectal cancer survivors: a systematic review of intervention reviews." PROSPERO: International Prospective Register of Systematic Reviews. 24 May 2021, pp. 1-4.
Integration of an Academic Electronic Medical Record into the Bachelor of Nursing program: A pilot project
Ng, Linda, Osborne, Sonya and Walker, Jan. 2021. "Integration of an Academic Electronic Medical Record into the Bachelor of Nursing program: A pilot project." Sigma's 32nd International Nursing Research VIRTUAL Congress. Toowoomba, Australia 21 - 23 Jul 2021 Toowoomba, Australia.
Address an unmet need: establishing the prevalence of metabolic syndrome in Darling Down region
Gardiner, P., Aung, N., Ng, L., Stolic, S., Bliss, E., Gyawali, P. and Roberts, M.. 2022. "Address an unmet need: establishing the prevalence of metabolic syndrome in Darling Down region." Toowoomba, Darling Downs Health Services Research Symposium.
Facilitating neonatal MARSI evidence into practice: investigating multimedia resources with Australian neonatal nurses – a participatory action research project
August, Deanne, Chapple, Lynette, Flint, Andrea, Macey, Judith, Ng, Linda and New, Karen. 2021. "Facilitating neonatal MARSI evidence into practice: investigating multimedia resources with Australian neonatal nurses – a participatory action research project." Journal of Neonatal Nursing. 27, pp. 291-297. https://doi.org/10.1016/j.jnn.2020.12.001
Recycle of magnesium alloy scrap for improving fire resistance, thermal stability, and water tolerance of intumescent fire-retardant coatings
Wang, Cheng, Huo, Siqi, Liu, Shi, Hu, Qinghua, Zhang, Qi and Liu, Zhitian. 2021. "Recycle of magnesium alloy scrap for improving fire resistance, thermal stability, and water tolerance of intumescent fire-retardant coatings." Journal of Coatings Technology and Research. 18 (2), pp. 447-458. https://doi.org/10.1007/s11998-020-00413-5
Exfoliated and functionalized boron nitride nanosheets towards improved fire resistance and water tolerance of intumescent fire retardant coating
Wang, Cheng, Huo, Siqi, Liu, Shi, Zhang, Qi and Liu, Zhitian. 2021. "Exfoliated and functionalized boron nitride nanosheets towards improved fire resistance and water tolerance of intumescent fire retardant coating." Journal of Applied Polymer Science. 138 (15). https://doi.org/10.1002/app.50177
Telling it like it is: What do we really know about replacing clinical practice with simulation?
Bogossian, F., Cant, R., Ballard, E., Cooper, S., Levett-Jones, T., McKenna, L., Ng, L. and Seaton, P.. 2019. "Telling it like it is: What do we really know about replacing clinical practice with simulation?" 8th International Clinical Skills Conference (ICSC 2019). Prato, Italy 19 - 22 May 2019
Talking the talk and walking the walk: Are patient safety priorities addressed by simulation-based education?
Bogossian, Fiona, Seaton, Philippa, Levett-Jones, Tracy, Cant, Robyn, Cooper, Simon, Kelly, Michelle and Ng, Linda. 2019. "Talking the talk and walking the walk: Are patient safety priorities addressed by simulation-based education?" 8th International Clinical Skills Conference (ICSC 2019). Prato, Italy 19 - 22 May 2019
Is a successful research career compatible with scholarship in nursing education?
Cooper, S., Seaton, P., Absalom, I., Bogossian, F., Cant, R., Levett-Jones, T. and Ng, L.. 2018. "Is a successful research career compatible with scholarship in nursing education?" 7th International Nurse Education Conference: Research, Scholarship and Evaluation: Ensuring Nursing Leadership in Education Practice and Healthcare. Banff, Canada 06 - 09 May 2018 United States.
Exploring facilitators and barriers to nurses’ uptake of postgraduate education in Australia
Ng, L., Tuckett, A. and Eley, R.. 2018. "Exploring facilitators and barriers to nurses’ uptake of postgraduate education in Australia." 7th International Nurse Education Conference: Research, Scholarship and Evaluation: Ensuring Nursing Leadership in Education Practice and Healthcare. Banff, Canada 06 - 09 May 2018 United States.
Enhancing students’ confidence, competence and knowledge with Integrated Skills Challenge
Ng, L. and Bogossian, F.. 2017. "Enhancing students’ confidence, competence and knowledge with Integrated Skills Challenge." 2017 Australian & New Zealand Association for Health Professional Educators Conference (ANZAHPE 2017). Adelaide, South Australia 11 - 14 Jul 2017 Australia.
Exploring registered nurses’ attitudes towards postgraduate education
Ng, Linda, Eley, Rob and Tuckett, Anthony. 2016. "Exploring registered nurses’ attitudes towards postgraduate education." 24th Australian College of Neonatal Nurses National Conference. Melbourne, Victoria Sep 2016
Exploring factors affecting registered nurses’ pursuit of postgraduate education in Australia
Ng, Linda, Eley, Robert and Tuckett, Anthony. 2016. "Exploring factors affecting registered nurses’ pursuit of postgraduate education in Australia." Nursing and Health Sciences. 18 (4), pp. 435-441. https://doi.org/10.1111/nhs.12289
Intumescent fire retardant coating with recycled powder from industrial effluent optimized using response surface methodology
Liu, Shi, Wang, Cheng, Hu, Qinghua, Huo, Siqi, Zhang, Qi and Liu, Zhitian. 2020. "Intumescent fire retardant coating with recycled powder from industrial effluent optimized using response surface methodology." Progress in Organic Coatings. 140. https://doi.org/10.1016/j.porgcoat.2019.105494
A facile strategy to fabricate an intumescent fire-retardant coating with improved fire resistance and water tolerance for steel structure
Huo, Siqi, Wang, Cheng, Hu, Qinghua, Liu, Shi, Zhang, Qi and Liu, Zhitian. 2020. "A facile strategy to fabricate an intumescent fire-retardant coating with improved fire resistance and water tolerance for steel structure." Journal of Coatings Technology and Research. 17 (5), pp. 1401-1411. https://doi.org/10.1007/s11998-020-00360-1
Oral care measures for preventing nursing home-acquired pneumonia (Protocol)
Li, Chunjie, Zhang, Qi, Ng, Linda, Needleman, Ian, Lin, Jie and Walsh, Tanya. 2016. "Oral care measures for preventing nursing home-acquired pneumonia (Protocol)." Cochrane Database of Systematic Reviews. 2016 (10), pp. 1-12. https://doi.org/10.1002/14651858.CD012416
Exploring registered nurses’ attitudes towards post graduate education in Australia: a pilot study
Ng, L., Tuckett, A., Fox-Young, S., Kain, V. and Eley, R.. 2015. "Exploring registered nurses’ attitudes towards post graduate education in Australia: a pilot study." 25th International Nursing Research Congress. Hong Kong, China 24 - 28 Jul 2014 Indianapolis, IN, United States.
NATPGE: understanding registered nurses’ attitudes towards post graduate education
Ng, Linda, Fox-Young, Stephanie, Tuckett, Anthony, Eley, Robert and Kain, Victoria. 2015. "NATPGE: understanding registered nurses’ attitudes towards post graduate education." 3rd Annual Worldwide Nursing Conference. Singapore 29 - 30 Jun 2015 https://doi.org/10.5176/2315-4330_WNC15.10
Content and validity testing of the Nurses’ Attitudes Towards Postgraduate Education (NATPGE) tool in Australia
Ng, Linda and Tuckett, Anthony. 2014. "Content and validity testing of the Nurses’ Attitudes Towards Postgraduate Education (NATPGE) tool in Australia." 9th Annual ACNN Conference. Adelaide, Australia 18 - 20 Sep 2014 Camperdown, NSW, Australia.
Locating “gold standard” evidence for simulation as a substitute for clinical practice in prelicensure health professional education: A systematic review
Bogossian, Fiona E., Cant, Robyn P., Ballard, Emma L., Cooper, Simon J., Levett-Jones, Tracy L., McKenna, Lisa G., Ng, Linda C. and Seaton, Philippa C.. 2019. "Locating “gold standard” evidence for simulation as a substitute for clinical practice in prelicensure health professional education: A systematic review ." Journal of Clinical Nursing. 28 (21-22), pp. 3759-3775. https://doi.org/10.1111/jocn.14965
Exploring registered nurses’ attitudes towards postgraduate education in Australia: an overview of literature
Ng, Linda C., Tuckett, Anthony G., Fox-Young, Stephanie K. and Kain, Victoria J.. 2014. "Exploring registered nurses’ attitudes towards postgraduate education in Australia: an overview of literature." Journal of Nursing Education and Practice. 4 (2), pp. 162-170. https://doi.org/10.5430/jnep.v4n2p162
Exploring registered nurses’ attitudes towards postgraduate education in Australia: an overview of the literature
Ng, Linda, Tuckett, Anthony, Fox-Young, Stephanie and Kain, Victoria. 2014. "Exploring registered nurses’ attitudes towards postgraduate education in Australia: an overview of the literature." Journal of Nursing Education and Practice. 4 (2), pp. 162-170. https://doi.org/10.5430/jnep.v4n3p20
Oral hygiene care for critically ill patients to prevent ventilator associated pneumonia
Shi, Zongdao, Xie, Huixu, Wang, Ping, Wu, Yan, Chen, E., Ng, Linda, Worthington, Helen, Singer, Mervyn and Needleman, Ian. 2010. "Oral hygiene care for critically ill patients to prevent ventilator associated pneumonia." Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD008367
Exploring the extent to which simulation-based education addresses contemporary patient safety priorities: a scoping review
Seaton, Philippa, Levett-Jones, Tracy, Cant, Robyn, Cooper, Simon, Kelly, Michelle A., McKenna, Lisa, Ng, Linda and Bogossian, Fiona. 2019. "Exploring the extent to which simulation-based education addresses contemporary patient safety priorities: a scoping review." Collegian: The Australian Journal of Nursing Practice, Scholarship and Research. 26 (1), pp. 194-203. https://doi.org/10.1016/j.colegn.2018.04.006
Transition to practice programs: what Australian and New Zealand nursing and midwifery graduates said. A Graduate eCohort Sub-Study
Tuckett, Anthony, Eley, Robert and Ng, Linda. 2017. "Transition to practice programs: what Australian and New Zealand nursing and midwifery graduates said. A Graduate eCohort Sub-Study." Collegian: The Australian Journal of Nursing Practice, Scholarship and Research. 24 (2), pp. 101-108. https://doi.org/10.1016/j.colegn.2015.10.002
Oral care measures for preventing nursing home‐acquired pneumonia
Liu, Chang, Cao, Yubin, Ng, Linda, Lin, Jie, Needleman, Ian, Walsh, Tanya and Li, Chunjie. 2018. "Oral care measures for preventing nursing home‐acquired pneumonia." Cochrane Database of Systematic Reviews. 2018 (9), pp. 1-44. https://doi.org/10.1002/14651858.CD012416.pub2
Are nurses using best practice in tracheal suctioning of artificial airways?
Ng, Linda C. H. and Chang, Anne M.. 2009. "Are nurses using best practice in tracheal suctioning of artificial airways?" Asia Pacific Critical Care 2008 Congress. Sydney, Australia 30 Oct - 02 Nov 2008 United States. https://doi.org/10.1016/j.aucc.2008.12.028