title: 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.
abstract: 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.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Clinical Hospital Center Rijeka, School of Medicine, University of Rijeka, Rijeka, Croatia. tomislav.cabov@medri.hr
authors.forename: Tomislav
authors.initials: T
authors.lastname: Cabov
authors.forename: Darko
authors.initials: D
authors.lastname: Macan
authors.forename: Ino
authors.initials: I
authors.lastname: Husedzinović
authors.forename: Jasenka
authors.initials: J
authors.lastname: Skrlin-Subić
authors.forename: Danica
authors.initials: D
authors.lastname: Bosnjak
authors.forename: Sandra
authors.initials: S
authors.lastname: Sestan-Crnek
authors.forename: Berislav
authors.initials: B
authors.lastname: Perić
authors.forename: Zoran
authors.initials: Z
authors.lastname: Kovac
authors.forename: Vesna
authors.initials: V
authors.lastname: Golubović
mesh_terms: 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
chemical_list: D005782:Gels; D002710:Chlorhexidine