title: The Effect of Brushing with a Soft Toothbrush and Distilled Water on the Incidence of Ventilator-Associated Pneumonia in the Intensive Care Unit.
abstract: BACKGROUND
  Ventilator-associated pneumonia (VAP) is a common nosocomial infection, which results in longer hospitalization, increased treatment costs, and higher mortality rates. One major cause of VAP is colonization and microaspiration of oropharyngeal secretions following the formation of dental plaque, which is due to poor oral hygiene and failure to mechanically remove these microorganisms from the teeth. This study was conducted to determine the effect of brushing teeth with distilled water on the incidence of VAP in patients admitted to intensive care unit (ICU).
  
  
  METHODS
  In this randomized clinical trial, 168 intubated patients, who had at least 20 teeth were randomly assigned to two groups. In the experimental group, the patients' teeth were brushed twice a day with a children's toothbrush and distilled water in addition to the routine oral care. The clinical pulmonary infection score (CPIS) was used to diagnose VAP. The data were analyzed using SPSS version 16 software.
  
  
  RESULTS
  A total of 38.6% of the patients in each group developed VAP. There was a significant difference in incidence of VAP on day five between the two groups (P<0.05). The incidence of VAP had a significant relationship with smoking (P<0.001), underlying diseases (P<0.001), duration of hospitalization (P=0.002), and age (P<0.001). Enterobacter was the most common microorganism identified in both groups.
  
  
  CONCLUSIONS
  According to our results, tooth brushing twice daily with distilled water reduced the incidence of VAP in patients admitted to the ICU. Therefore, it is recommended that nurses caring for ventilator-dependent patients brush the patients' teeth with distilled water as a part of their routine oral care.
authors.affiliation: Nursing Department, Nursing - Midwifery School, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd-Iran.
authors.forename: Khadijeh
authors.initials: K
authors.lastname: Nasiriani
authors.affiliation: Nursing Department, Nursing - Midwifery School, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd-Iran.
authors.forename: Fakhri
authors.initials: F
authors.lastname: Torki
authors.affiliation: Anesthesiology and Critical Care Department, Medical School, Shahid Sadooghi University of Medical Sciences and Health Services, Yazd, Iran.
authors.forename: Mohammad Hossein
authors.initials: MH
authors.lastname: Jarahzadeh
authors.affiliation: Periodontology Department, Dental School, Shahid Sadoughi University Of Medical Sciences School, Yazd, Iran.
authors.forename: Fahimeh
authors.initials: F
authors.lastname: Rashidi Maybodi
keywords: Distilled water; Oral hygiene; Tooth brushing; Ventilator associated pneumonia (VAP)