Study finds toothbrushing key to preventing pneumonia in ICU patients

pneumonia prevention in ICU patients toothbrushing
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A study led by Canadian researchers has contributed to a major change in American guidelines for pneumonia prevention among ICU patients on mechanical ventilators. 

The study by team at the University of Toronto and its partner hospitals was among the first in the world to show that the oral rinse should be discontinued and oral care, including tooth brushing, should be implemented instead.

The updated US guideline governs care in all US hospitals and has been approved by the Centers for Disease Control and Prevention (CDC).

“To see the connection between oral health and systemic health bolstered by our study findings in the guideline is a long-awaited change,” Craig Dale said.

“Speaking on behalf of our research team, we are quite proud of the innovation our work proposes. It also shows how Canadian research can lead to a change in international practice.”

The use of an antimicrobial oral rinse has for many years been thought to be successful in preventing pneumonia in the ICU, but over the last eight years a series of systematic reviews began to show an excess mortality signal.

“It appeared as though oral rinse exposure could be contributing to the death of patients in the ICU,” Dale said. 

“It also appeared that the oral rinse was not doing what it was supposed to do—which was prevent pneumonia.”

To further investigate if this signal was true, Dale and his co-investigator Brian Cuthbertson designed what’s known as a de-adoption trial in collaboration with hospitals and ICU staff across the Toronto Academic Health Sciences Network. The study would swap out the use of the oral rinse but preserve oral health with an oral care bundle that included toothbrushing and moisturising the lips and mouths of patients regularly.

The study evaluated outcomes including changes in ICU mortality, respiratory infection, time spent on the ventilator and patient comfort, and concluded that the oral rinse was not needed to prevent pneumonia. Instead, the oral care bundle designed by Dale and his fellow researchers performed just as well as the rinse and appeared to do a better job in the promotion of oral health in patients overall.

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