Effects of dental plaque antiseptic decontamination on bacterial colonization and nosocomial infections in critically ill patients.
OBJECTIVE
To document in intensive care unit (ICU) patients the effect of dental plaque antiseptic decontamination on the occurrence of plaque colonization by aerobic nosocomial pathogens and nosocomial infections.


METHODS
Single-blind randomized comparative study.


METHODS
A 16-bed adult intensive care unit in a university hospital.


METHODS
Patients consecutively admitted in the ICU with a medical condition suggesting an ICU stay of 5 days and requiring mechanical ventilation.


METHODS
After randomization, the treated group received dental plaque decontamination with 0.2% chlorhexidine gel, three times a day during the ICU stay. The control group received standard oral care. SPECIFIC MEASUREMENTS: Dental status was assessed by the Caries-Absent-Occluded index; the amount of dental plaque was assessed by a semi-quantitative plaque index. Bacterial sampling of dental plaque, nasal and tracheal aspirate, blood, and urine cultures were done on days 0, 5, 10, and every week.


RESULTS
Sixty patients were included; 30 in the treated group and 30 in the control one (mean age: 51 +/- 16 years; mean Simplified Acute Physiological Score II: 35 +/- 14 points). On admission, no significant differences were found between both groups for all clinical and dental data. Compared with the control group, the nosocomial infection rate and the incidence densities related to risk exposition were significantly lower in the treated group (18 vs 33% days in the ICU and 10.7 vs 32.3% days of mechanical ventilation; P < 0.05). These results were consistent with a significant preventive effect of the antiseptic decontamination (Odds Ratio: 0.27; 95% CI: 0.09; 0.80) with a 53% relative risk reduction. There was a trend to a reduction of mortality, length of stay, and duration of mechanical ventilation.


CONCLUSIONS
An antiseptic decontamination of dental plaque with a 0.2% chlorhexidine gel decreases dental bacterial colonization, and may reduce the incidence of nosocomial infections in ICU patients submitted to mechanical ventilation.
Fourrier
F
F
Service de Réanimation Polyvalente, Hôpital Roger Salengro CHRU, Lille, France. ffourrier@nordnet.fr
Cau-Pottier
E
E
Boutigny
H
H
Roussel-Delvallez
M
M
Jourdain
M
M
Chopin
C
C
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D016009:Chi-Square Distribution; D002710:Chlorhexidine / Q000008:administration & dosage*; D003422:Critical Care / Q000379:methods*; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D004245:DMF Index; D003773:Dental Plaque / Q000382:microbiology / Q000517:prevention & control*; D003774:Dental Plaque Index; D005260:Female; D005782:Gels; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial; D012307:Risk Factors
D000891:Anti-Infective Agents, Local; D005782:Gels; D002710:Chlorhexidine