title: Impact of oral hygiene involving toothbrushing versus chlorhexidine in the prevention of ventilator-associated pneumonia: a randomized study.
abstract: Nosocomial pneumonia has correlated to dental plaque and to oropharynx colonization in patients receiving mechanical ventilation. The interruption of this process, by preventing colonization of pathogenic bacteria, represents a potential procedure for the prevention of ventilator-associated pneumonia (VAP).
  
  
  
  The study design was a prospective, randomized trial to verify if oral hygiene through toothbrushing plus chlorhexidine in gel at 0.12% reduces the incidence of ventilatior-associated pneumonia, the duration of mechanical ventilation, the length of hospital stay and the mortality rate in ICUs, when compared to oral hygiene only with chlorhexidine, solution of 0.12%, without toothbrushing, in adult individuals under mechanical ventilation, hospitalized in Clinical/Surgical and Cardiology Intensive Care Units (ICU). The study protocol was approved by the Ethical Committee of Research of the Health Sciences Center of the Federal University of Pernambuco - Certificate of Ethical Committee Approval (CAAE) 04300012500005208. Because it was a randomized trial, the research used CONSORT 2010 checklist criteria.
  
  
  
  Seven hundred sixteen patients were admitted into the ICU; 219 fulfilled the criteria for inclusion and 213 patients were included; 108 were randomized to control group and 105 to intervention group. Toothbrushing plus 0.12% chlorhexidine gel demonstrated a lower incidence of VAP throughout the follow up period, although the difference was not statistically significant (p = 0.084). There was a significant reduction of the mean time of mechanical ventilation in the toothbrushing group (p = 0.018). Regarding the length of hospital stay in the ICU and mortality rates, the difference was not statistically significant (p = 0.064).
  
  
  
  The results obtained showed that, among patients undergoing toothbrushing there was a significant reduction in duration of mechanical ventilation, and a tendency to reduce the incidence of VAP and length of ICU stay, although without statistical significance.
  
  
  
  Retrospectively registered in the Brazilian Clinical Trials Registry (Registro Brasileiro de Ensaios Clínicos) - RBR-4TWH4M (4 September 2016).
authors.affiliation: Tropical Medicine Health Sciences Center, Committee on Infection Control of Hospital das Clinicas, Universidade Federal de Pernambuco, Av. Professor Moraes Rego, 1235 Hospital das Clínicas - Cidade Universitária, Recife, Pernambuco, 50670-901, Brazil. vidal.claudia@gmail.com.
authors.forename: Claudia Fernanda
authors.initials: CF
authors.lastname: de Lacerda Vidal
authors.affiliation: Department of Pathology, Institute of Biological Sciences, Universidade de Pernambuco, Hospital de Câncer de Pernambuco, Real Hospital Português de Beneficência em Pernambuco, Recife, Pernambuco, Brazil.
authors.forename: Aurora Karla de Lacerda
authors.initials: AK
authors.lastname: Vidal
authors.affiliation: Cardiac Intensive Care Unit, Pronto-Socorro Cardiológico de Pernambuco, Universidade de Pernambuco, Recife, Pernambuco, Brazil.
authors.forename: José Gildo de Moura
authors.initials: JG
authors.lastname: Monteiro
authors.affiliation: Committee on Infection Control, Pronto-Socorro Cardiológico de Pernambuco, Universidade de Pernambuco, Recife, Pernambuco, Brazil.
authors.forename: Aracele
authors.initials: A
authors.lastname: Cavalcanti
authors.affiliation: Committee on Infection Control, Real Hospital Português de Beneficência em Pernambuco, Recife, Pernambuco, Brazil.
authors.forename: Ana Paula da Costa
authors.initials: APC
authors.lastname: Henriques
authors.affiliation: Intensive Care Unit, Hospital Agamenon Magalhães, Secretaria de Saúde de Pernambuco, Recife, Pernambuco, Brazil.
authors.forename: Márcia
authors.initials: M
authors.lastname: Oliveira
authors.affiliation: Intensive Care Unit, Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.
authors.forename: Michele
authors.initials: M
authors.lastname: Godoy
authors.affiliation: Intensive Care Unit, Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.
authors.forename: Mirella
authors.initials: M
authors.lastname: Coutinho
authors.affiliation: Intensive Care Unit, Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.
authors.forename: Pollyanna Dutra
authors.initials: PD
authors.lastname: Sobral
authors.affiliation: Intensive Care Unit, Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.
authors.forename: Claudia Ângela
authors.initials: CÂ
authors.lastname: Vilela
authors.affiliation: Intensive Care Unit, Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.
authors.forename: Bárbara
authors.initials: B
authors.lastname: Gomes
authors.affiliation: Committee on Infection Control of Hospital das Clinicas, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.
authors.forename: Marta Amorim
authors.initials: MA
authors.lastname: Leandro
authors.affiliation: Institute of Biological Sciences, Universidade de Pernambuco, Recife, Pernambuco, Brazil.
authors.forename: Ulisses
authors.initials: U
authors.lastname: Montarroyos
authors.affiliation: Faculty of Medical Sciences, Tropical Medicine Health Sciences Center, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.
authors.forename: Ricardo de Alencar
authors.initials: RA
authors.lastname: Ximenes
authors.affiliation: Department of Infectious and Parasitic Diseases, Faculty of Medical Sciences, Tropical Medicine Health Sciences Center, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.
authors.forename: Heloísa Ramos
authors.initials: HR
authors.lastname: Lacerda
mesh_terms: D001938:Brazil; D002710:Chlorhexidine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D017053:Infection Control; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009067:Mouthwashes / Q000008:administration & dosage*; D009910:Oral Hygiene; D053717:Pneumonia, Ventilator-Associated / Q000382:microbiology / Q000517:prevention & control*; D011446:Prospective Studies; D014099:Toothbrushing; D016896:Treatment Outcome
chemical_list: D009067:Mouthwashes; D002710:Chlorhexidine
keywords: Chlorhexidine; Intensive care; Mechanical ventilator; Oral hygiene; Pneumonia; Toothbrushing