Oral hygiene protocols adopted in Intensive Care Units (ICU)

Authors

DOI:

https://doi.org/10.33448/rsd-v13i4.45560

Keywords:

Dental service, hospital; Intensive care units; Oral hygiene.

Abstract

The ecosystem of the human oral cavity is dynamic and diverse, evolving since the early stages of life. The mother plays a crucial role as the primary source of oral microflora for the baby, but as the child grows, its oral microbiota stabilizes. In hospital settings, patients with serious conditions and compromised immune systems face additional health risks. In intensive care units (ICUs), especially with intubation, the risk of pneumonia, such as ventilator-associated pneumonia (VAP), increases due to bacterial colonization in the throat resulting from inadequate oral hygiene. VAP is considered one of the main causes of prolonged ICU stays and increased mortality and costs. Various dental approaches have been implemented for mechanically ventilated patients, including dental hygiene procedures and the use of antiseptic oral hygiene solutions such as mouthwashes. However, there is still no definitive method recognized as the most effective for ensuring adequate oral health in the ICU. There is also no consensus on the subject, highlighting the continued need for research to determine best practices in dental care for critically ill patients. This work aimed to research the oral hygiene protocols adopted in ICUs, their effectiveness and benefits, highlighting VAP as one of the main concerns in this environment, through an integrative literature review.

References

Anggraeni, D. T., Hayati, A. T., & Nur'aeni, A. (2022). The effect of oral care using honey as an additional topical agent on oral health status of intubated patients in the intensive care unit. *Enferm Intensiva (Engl Ed), 33(4), 225-232. https://doi.org/10.1016/j.enfie.2021.12.004.

Baldino, M. E. L., Medina-Silva, R., Sumienski, J., Figueiredo, M. A., Salum, F. G., & Cherubini, K. (2022). Nystatin effect on chlorhexidine efficacy against Streptococcus mutans as planktonic cells and mixed biofilm with Candida albicans. *Clinical oral investigations, 26*(1), 633–642. https://doi.org/10.1007/s00784-021-04041-0.

Brookes, Z. L. S., Bescos, R., Belfield, L. A., Ali, K., & Roberts, A. (2020). Current uses of chlorhexidine for management of oral disease: a narrative review. *Journal of dentistry, 103*, 103497. https://doi.org/10.1016/j.jdent.2020.103497.

Dale, C. M., Rose, L., Carbone, S., Smith, O. M., Burry, L., Fan, E., & Cuthbertson, B. H. (2019). Protocol for a multi-centered, stepped wedge, cluster randomized controlled trial of the de-adoption of oral chlorhexidine prophylaxis and implementation of an oral care bundle for mechanically ventilated critically ill patients: the CHORAL study. *Trials, 20*(1), 603. https://doi.org/10.1186/s13063-019-3673-0.

Gregorczyk-Maga, I., Pałka, A., Fiema, M., Kania, M., Kujawska, A., Maga, P., & Wójkowska-Mach, J. (2023). Impact of tooth brushing on oral bacteriota and health care-associated infections among ventilated COVID-19 patients: an intervention study. *Antimicrobial resistance and infection control, 12*(1), 17. https://doi.org/10.1186/s13756-023-01218-y.

Haghighat, S., Mahjobipoor, H., & Gavarti, S. G. (2022). Comparative Study of the Effect of Three Oral Care Protocols on Ventilator-Associated Pneumonia in Critically Ill Patients: A Clinical Trial. *Iranian journal of nursing and midwifery research, 27*(2), 99–105. https://doi.org/10.4103/ijnmr.ijnmr_243_20.

Izadi, M., Bagheri, M., Bahrami Far, A., Bagheri-Baghdasht, M. S., Ghasemzadeh, G., Sureda, A., & Soodmand, M. (2023). Reduce the risk of ventilator-associated pneumonia in ICU patients by Ozonated water mouthwash: A double-blind randomized clinical trial. *American journal of infection control, 51*(7), 779–785. https://doi.org/10.1016/j.ajic.2022.10.015.

Jun, M. K., Ku, J. K., Kim, I. H., Park, S. Y., Hong, J., Kim, J. Y., & Lee, J. K. (2021). Hospital Dentistry for Intensive Care Unit Patients: A Comprehensive Review. *Journal of clinical medicine, 10*(16), 3681. https://doi.org/10.3390/jcm10163681.

Mun, S. J., Jeon, H. S., Choi, E. S., Lee, R., Kim, S. H., & Han, S. Y. (2021, August 13). Oral health status of inpatients with varying physical activity limitations in rehabilitation wards: A cross-sectional study. *Medicine (Baltimore), 100*(32), e26880. doi: 10.1097/MD.0000000000026880.

Paszynska, E., Gawriolek, M., Hernik, A., Otulakowska-Skrzynska, J., Winiarska, H., Springer, D., & Cofta, S. (2023). Prevalence of oral complications in the course of severe SARS-CoV-2 infection under mechanical non-invasive ventilation. *European journal of medical research, 28*(1), 293. https://doi.org/10.1186/s40001-023-01273-6.

Pedersen, A., Sørensen, C. E., Proctor, G. B., & Carpenter, G. H. (2018). Salivary functions in mastication, taste and textural perception, swallowing and initial digestion. *Oral diseases, 24*(8), 1399–1416. https://doi.org/10.1111/odi.12867.

Pereira, A. S., Shitsuka, D. M., Parreira, F. J., & Shitsuka, R. (2018). Metodologia da pesquisa científica.

Samim, A., Vahedian-Azimi, A., Fathi Jouzdani, A., & Rahimi-Bashar, F. (2022). Effect of specific training course for competency in professional oral hygiene care in the intensive care unit: a quasi-experimental study for developing a standardized learning curve. *BMC anesthesiology, 22*(1), 171. https://doi.org/10.1186/s12871-022-01709-2.

Sanchez Peña, M., Orozco Restrepo, L. A., Barrios Arroyave, F. A., & Suárez Brochero, O. F. (2021). Impact of an Educational Intervention Aimed at Nursing Staff on Oral Hygiene Care on the Incidence of Ventilator-Associated Pneumonia in Adults Ventilated in Intensive Care Unit. *Investigacion y educacion en enfermeria, 39*(3), e06. https://doi.org/10.17533/udea.iee.v39n3e06.

Scquizzato, T., & Gazzato, A. (2019). Adopting a smart toothbrush with artificial intelligence may improve oral care in patients admitted to the intensive care unit. *Critical care (London, England), 23*(1), 223. https://doi.org/10.1186/s13054-019-2512-8.

Silva, P. U. J., Paranhos, L. R., Meneses-Santos, D., Blumenberg, C., Macedo, D. R., & Cardoso, S. V. (2021). Combination of toothbrushing and chlorhexidine compared with exclusive use of chlorhexidine to reduce the risk of ventilator-associated pneumonia: A systematic review with meta-analysis. *Clinics (São Paulo, Brazil), 76*, e2659. https://doi.org/10.6061/clinics/2021/e2659.

Siriyanyongwong, P., Teanpaisan, R., Pahumunto, N., Uppanisakorn, S., & Vattanavanit, V. (2022). Efficacy of Moraceae with chlorhexidine mouthwash on the microbial flora of critically ill intubated patients: a randomized controlled pilot study. *Scientific reports, 12*(1), 17261. https://doi.org/10.1038/s41598-022-21556-y.

Steinle, E. C., Pinesso, J. A. M., Bellançon, L. B., et al. A associação da saúde bucal com tempo de internação e mortalidade em unidade de terapia intensiva. *Clin Oral Invest, 27*, 3875–3884. https://doi.org/10.1007/s00784-023-05008-z.

Takahama, A. Jr, de Sousa, V. I., Tanaka, E. E., Ono, E., Ito, F. A. N., Costa, P. P., & de Maio Carrilho, C. M. D. (2021). Analysis of oral risk factors for ventilator-associated pneumonia in critically ill patients. *Clinical oral investigations, 25*(3), 1217–1222. https://doi.org/10.1007/s00784-020-03426-x.

Tovani-Palone, M. R., & Shamsoddin, E. (2021). Use of mouthwashes in the management of COVID-19 patients in intensive care units: recommendations and current evidence. *Einstein (Sao Paulo, Brazil), 19*, eCE6419. https://doi.org/10.31744/einstein_journal/2021CE641.

Vencendo, L., Lundy, F. T., Blackwood, B., et al. Assistência à saúde bucal de pessoas gravemente enfermas: uma revisão narrativa. *Cuidado crítico, 25*, 353. https://doi.org/10.1186/s13054-021-03765-5

Vieira, P. C., de Oliveira, R. B., & da Silva Mendonça, T. M. (2022). Should oral chlorhexidine remain in ventilator-associated pneumonia prevention bundles? *Medicina intensiva, 46*(5), 259–268. https://doi.org/10.1016/j.medine.2020.09.010.

Wittekamp, B. H., & Plantinga, N. L. (2021). Less daily oral hygiene is more in the ICU: no. *Intensive Care Med, 47*(3), 331-333. https://doi.org/10.1007/s00134-021-06359-5.

Xiang, Y., Ren, X., Xu, Y., Cheng, L., Cai, H., & Hu, T. (2022). Anti-Inflammatory and Anti-Bacterial Effects of Mouthwashes in Intensive Care Units: A Systematic Review and Meta-Analysis. *International journal of environmental research and public health, 20*(1), 733. https://doi.org/10.3390/ijerph20010733.

Published

22/04/2024

How to Cite

CARDOSO, J. de M. .; PINTO, B. M. G. . Oral hygiene protocols adopted in Intensive Care Units (ICU). Research, Society and Development, [S. l.], v. 13, n. 4, p. e8713445560, 2024. DOI: 10.33448/rsd-v13i4.45560. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/45560. Acesso em: 31 oct. 2024.

Issue

Section

Review Article