The impact of oral health and 0.2% chlorhexidine oral gel on the prevalence of nosocomial infections in surgical intensive-care patients: a randomized placebo-controlled study.
OBJECTIVE
To evaluate the impact of oral health on the evolution of nosocomial infections and to document the effects of oral antiseptic decontamination on oral health and on the rate of nosocomial infections in patients in a surgical intensive-care unit (ICU).


METHODS
A prospective, randomized, double-blind, placebo-controlled clinical trial.


METHODS
Surgical ICU in University Hospital Dubrava.


METHODS
The study included 60 nonedentulous patients consecutively admitted to the surgical ICU and requiring a minimum stay of three days.


METHODS
After randomization, the treatment group underwent antiseptic decontamination of dental plaque and the oral mucosa with chlorhexidine gel. The control group was treated with placebo gel. Dental status was assessed using a caries-absent-occluded (CAO) score, and the amount of plaque was assessed using a semi-quantitative score. Samples of dental plaque, oral mucosa and nasal and tracheal aspirates were collected for bacterial culture, and nosocomial infections were assessed.


RESULTS
The plaque score significantly increased in the control group and decreased in the treated patients. Patients who developed a nosocomial infection had higher plaque scores on admission and during their ICU stay. The control group showed increased colonization by aerobic pathogens throughout their ICU stay and developed nosocomial infections (26.7%) significantly more often than the treated patients (6.7%); the control group also stayed longer in the ICU (5.1 +/- 1.6 vs. 6.8 +/- 3.5 days, P = 0.019). Furthermore, a trend in reduction of mortality was noted in the treated group (3.3% vs. 10%).


CONCLUSIONS
Among surgical ICU patients, poor oral health had a significant positive correlation with bacterial colonization and the evolution of nosocomial infections. Oral decontamination with chlorhexidine significantly decreased oropharyngeal colonization, the incidence of nosocomial infections, length of ICU stay, and mortality in these patients.
Cabov
Tomislav
T
Department of Oral and Maxillofacial Surgery, Clinical Hospital Center Rijeka, School of Medicine, University of Rijeka, Rijeka, Croatia. tomislav.cabov@medri.hr
Macan
Darko
D
Husedzinović
Ino
I
Skrlin-Subić
Jasenka
J
Bosnjak
Danica
D
Sestan-Crnek
Sandra
S
Perić
Berislav
B
Kovac
Zoran
Z
Golubović
Vesna
V
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000453:epidemiology* / Q000517:prevention & control* / Q000635:transmission; D001930:Brain Injuries / Q000601:surgery; D002710:Chlorhexidine / Q000008:administration & dosage*; D003422:Critical Care; D017523:Croatia; D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control* / Q000635:transmission; D003430:Cross-Sectional Studies; D004245:DMF Index; D003774:Dental Plaque Index; D005260:Female; D005782:Gels; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000601:surgery; D009369:Neoplasms / Q000601:surgery; D009910:Oral Hygiene; D012121:Respiration, Artificial; D055815:Young Adult
D005782:Gels; D002710:Chlorhexidine