Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Apr-Jun;13(2):290-6.
doi: 10.1590/S1679-45082015RW2980. Epub 2015 May 1.

Oral care and nosocomial pneumonia: a systematic review

[Article in English, Portuguese]
Maria Carolina Nunes Vilela  1 , Gustavo Zanna Ferreira  2 , Paulo Sérgio da Silva Santos  2 , Nathalie Pepe Medeiros de Rezende  1
Affiliations

Oral care and nosocomial pneumonia: a systematic review

[Article in English, Portuguese]
Maria Carolina Nunes Vilela et al. Einstein (Sao Paulo). 2015 Apr-Jun.

Abstract
in English, Portuguese

To perform a systematic review of the literature on the control of oral biofilms and the incidence of nosocomial pneumonia, in addition to assessing and classifying studies as to the grade of recommendation and level of evidence. The review was based on PubMed, LILACS, and Scopus databases, from January 1st, 2000 until December 31st, 2012. Studies evaluating oral hygiene care related to nosocomial infections in patients hospitalized in intensive care units were selected according to the inclusion criteria. Full published articles available in English, Spanish, or Portuguese, which approached chemical or mechanical oral hygiene techniques in preventing pneumonia, interventions performed, and their results were included. After analysis, the articles were classified according to level of evidence and grade of recommendation according to the criteria of the Oxford Centre for Evidence-Based Medicine. A total of 297 abstracts were found, 14 of which were full articles that met our criteria. Most articles included a study group with chlorhexidine users and a control group with placebo users for oral hygiene in the prevention of pneumonia. All articles were classified as B in the level of evidence, and 12 articles were classified as 2B and two articles as 2C in grade of recommendation. It was observed that the control of oral biofilm reduces the incidence of nosocomial pneumonia, but the fact that most articles had an intermediate grade of recommendation makes clear the need to conduct randomized controlled trials with minimal bias to establish future guidelines for oral hygiene in intensive care units.

Apresentar revisão sistemática da literatura sobre o controle do biofilme bucal e a incidência da pneumonia nosocomial, avaliando e classificando os estudos quanto ao grau de recomendação e ao nível de evidência científica. A revisão foi realizada nas bases PubMed, LILACS e Scopus, de 1o de janeiro de 2000 até 31 de dezembro de 2012. Foram selecionados os estudos que avaliaram os cuidados com higiene bucal relacionando-os com infecções nosocomiais em paciente internados em unidades de terapia intensiva, seguindo os critérios de inclusão. Foram incluídos artigos na íntegra publicados em inglês, espanhol ou português, que abordavam alguma técnica de higiene bucal, química ou mecânica, na prevenção de pneumonia, as intervenções executadas e os resultados. Após análise dos dados, os artigos foram classificados quanto ao nível de evidência e o grau de recomendação, de acordo com os critérios da Oxford Centre for Evidence-Based Medicine. Foram encontrados 297 resumos e, destes, 14 artigos na íntegra contemplaram nossos critérios. A maioria dos artigos incluía um grupo de estudo com uso de clorexidina e um controle com o uso de placebo para higiene bucal na prevenção de pneumonia. Quanto ao nível de evidência, todos os artigos foram classificados como B; quanto ao grau de recomendação, 12 artigos foram classificados como 2B e 2 como 2C. O controle do biofilme bucal reduz a incidência de pneumonia nosocomial, porém o nível de evidência e o grau de recomendação intermediário deixam evidente a necessidade da elaboração de estudos clínicos randomizados controlados com viés mínimo para estabelecer futuros protocolos para higiene bucal em unidades de terapia intensiva.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Flow chart of the search strategy
Figura 1
Figura 1. Fluxograma da estratégia de busca
See this image and copyright information in PMC

Comment in

References

    1. David C. Infecção em UTI. Medicina (Ribeirão Preto) 1998;31:337–348.
    1. Amaral SM, Cortês Ade Q, Pires FR. Nosocomial pneumonia: importance of the oral environment. J Bras Pneumol. 2009;35(11):1116–1124. Review. - PubMed
    1. Oliveira L, Carneiro P, Fischer RG, Tinoco E. A presença de patógenos respiratórios no biofilme bucal de pacientes com pneumonia nosocomial. Rev Bras Ter Intensiva. 2007;19(4):428–433. - PubMed
    1. Chlebicki MP, Safdar N. Topical chlorhexidine for prevention of ventilator-associated pneumonia: a meta-analysis. Crit Care Med. 2007;35(2):595–602. - PubMed
    1. Chan EY, Ruest A, Meade MO, Cook DJ. Oral decontamination for prevention of pneumonia in mechanically ventilated adults: systematic review and meta-analysis. 889BMJ. 2007;334(7599) Review. - PMC - PubMed

Publication types

MeSH terms