Comparison of the Effect of Comprehensive Oral Care Program and Combined Toothbrush and Mouthwash Program on Ventilator-Associated Pneumonia: A Clinical Trial Study

Inadequate oral care in intubated patients leads to decreased salivation, dry mouth, dental plaque, gingivitis and accumulation of pathogenic bacteria in the mouth and throat and aspiration of the contents of the mouth into the trachea and subsequently causes ventilator associated pneumonia. Two mechanical and chemical methods have been recommended for oral care, and contradictory results have been reported regarding its effects on ventilator associated pneumonia. Therefore, the aim of this study was to compare the effect of comprehensive oral care program and combination of toothbrush and mouthwash with 0.2% chlorhexidine on the incidence of ventilator-associated pneumonia in intubated patients under mechanical ventilation.

Materials: 

The current study is a clinical trial that was performed in the intensive care unit of Khatam Al-Anbia Hospital in Zahedan in 2020. 90 ventilated patients who met the inclusion criteria were selected and then randomly allocated by permutation block into three groups of comprehensive oral care program, combined toothbrush program and chlorhexidine and control groups. Data collection tools were demographic information form, Modified Clinical Pulmonary Infection Score (MCPIS) and Beck Oral Assessment Scale (BOAS).

The incidence of ventilator-associated pneumonia was lower in the intervention groups than in the control group, But there was no significant difference in the incidence of pneumonia between the three groups. (P=0.168)

The incidence of ventilator-associated pneumonia in the use of a comprehensive oral care program, a combined program of toothbrush and chlorhexidine 0.2% and the control group were not different from each other and in fact these methods were not superior to each other in this regard. However, considering that clinically the incidence of pneumonia was lower in the intervention groups than in the control group, it indicates that a special care program or instruction should be used, while training health care workers based on specific instructions in the oral care is recommended.