Comparison of Oropharyngeal and Respiratory Nosocomial Bacteria between Two Methods of Oral Care: A Randomized Control Trial

Abstract

Introduction. To compare changes in oral and respiratory nosocomial colonization during the first week of mechanical ventilation in adult Neuroscience ICU patients randomized to a standard or comprehensive oral care protocol. Development of ventilator associated pneumonia (VAP) within each protocol was also investigated.
Material and methods. Patients were randomized to one of two groups. The standard oral care protocol included a manual pediatric toothbrush, toothpaste, and watersoluble lubricant. The comprehensive protocol consisted of tongue scraping, an electric toothbrush with a non-foaming toothpaste, followed by a moisturizing agent. Both groups received the assigned oral care protocol twice daily, with tooth brushing lasting two minutes per occasion. Oral and sputum cultures were obtained on admission and every 48 hours while intubated.
Results. Data from a total of 78 patients were analyzed. The standard protocol included 40 patients (mean age 51 ± 18 years); the comprehensive protocol 38 patients (mean age 51 ± 18 years). No significant differences in Glasgow Coma Score, diagnosis, or co-morbidities were found on admission. Oral colonization on admission was noted in 25% of patients in each protocol. There was a trend of reduced oral and respiratory nosocomial colonization among those in the comprehensive protocol but no significant differences were noted between groups. Incidence of VAP was equivalent (p=0.61) for the standard and comprehensive groups at day six.
Conclusions. Use of a tongue scraper, electric toothbrush, and oral gel resulted in less oral and respiratory colonization by known nosocomial pathogens. Larger studies are necessary to further investigate comprehensive oral care. (PNN 2012;1(1):10-18)