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Prevention of Healthcare-Associated Pneumonia with Oral Care in Individuals Without Mechanical Ventilation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Published online by Cambridge University Press:  10 April 2015

Asako Kaneoka ,
Jessica M. Pisegna ,
Keri V. Miloro ,
Mel Lo ,
Hiroki Saito ,
Luis F. Riquelme ,
Michael P. LaValley  and
Susan E. Langmore
Asako Kaneoka*
Affiliation:
Boston University Sargent College, Boston, Massachusetts
Jessica M. Pisegna
Affiliation:
Boston University Sargent College, Boston, Massachusetts
Keri V. Miloro
Affiliation:
Boston University Sargent College, Boston, Massachusetts
Mel Lo
Affiliation:
South Shore Hospital, Weymouth, Massachusetts
Hiroki Saito
Affiliation:
University of California Irvine School of Medicine, Department of Medicine, Division of Infectious Diseases, Irvine, California
Luis F. Riquelme
Affiliation:
New York Medical College School of Health Sciences and Practice, Valhalla, New York, and New York Methodist Hospital, Brooklyn, New York
Michael P. LaValley
Affiliation:
Boston University School of Public Health, Boston, Massachusetts
Susan E. Langmore
Affiliation:
Boston University Sargent College, Boston, Massachusetts
*
Address correspondence to Asako Kaneoka, Boston University Medical Center, FGH building, 820 Harrison Ave., Boston, MA 02118 ([email protected])
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Abstract

OBJECTIVE

Evidence is lacking on the preventive effect of oral care on healthcare-associated pneumonia in hospitalized patients and nursing home residents who are not mechanically ventilated. The primary aim of this review was to assess the effectiveness of oral care on the incidence of pneumonia in nonventilated patients.

METHODS

We searched 8 databases (MEDLINE, Embase, CENTRAL, CINAHL, Web of Science, LILACS, ICHUSHI, and CiNii), in addition to trial registries and a manual search. Eligible studies were published and unpublished randomized controlled trials examining the effect of any method of oral care on reported incidence of pneumonia and/or fatal pneumonia. Relative risks (RR) and 95% confidence intervals were calculated. Risk of bias was assessed for eligible studies.

RESULTS

We identified 5 studies consisting of 1,009 subjects that met the inclusion criteria. Of these, 2 trials assessed the effect of chlorhexidine in hospitalized patients; 3 studies examined mechanical oral cleaning in nursing home residents. A meta-analysis could only be done on 4 trials; this analysis showed a significant risk reduction in pneumonia through oral care interventions (RRfixed, 0.61; 95% CI, 0.40–0.91; P=.02). The effects of mechanical oral care alone were significant when pooled across studies. (RRfixed, 0.61; 95% CI, 0.40–0.92; P=.02). Risk reduction for fatal pneumonia from mechanical oral cleaning was also significant (RRfixed, 0.41; 95% CI, 0.23–0.71; P=.002). Most studies had a high risk of bias.

CONCLUSIONS

This analysis suggests a preventive effect of oral care on pneumonia in nonventilated individuals. This effect, however, should be interpreted with caution due to risk of bias in the included trials.

Infect Control Hosp Epidemiol 2015;36(8): 899–906

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 8 , August 2015 , pp. 899 - 906
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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References

1. Vincent, JL, Rello, J, Marshall, J, et al. International study of the prevalence and outcomes of infection in intensive care units. JAMA 2009;302:2323–2329.CrossRefGoogle Scholar
2. Chawla, R. Epidemiology, etiology, and diagnosis of hospital-acquired pneumonia and ventilator-associated pneumonia in asian countries. Am J Infect Control 2008;36:S93–S100.CrossRefGoogle ScholarPubMed
3. Liapikou, A, Polverino, E, Cilloniz, C, et al. A worldwide perspective of nursing home-acquired pneumonia compared with community-acquired pneumonia. Respir Care 2014;59:1078–1085.Google Scholar
4. American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005;171:388–416.CrossRefGoogle Scholar
5. Muder, RR. Pneumonia in residents of long-term care facilities: epidemiology, etiology, management, and prevention. Am J Med 1998;105:319–330.CrossRefGoogle ScholarPubMed
6. Kollef, MH, Shorr, A, Tabak, YP, Gupta, V, Liu, LZ, Johannes, RS. Epidemiology and outcomes of health-care-associated pneumonia: results from a large US database of culture-positive pneumonia. Chest 2005;128:3854–3862.Google Scholar
7. Johanson, WG, Pierce, AK, Sanford, JP. Changing pharyngeal bacterial flora of hospitalized patients. emergence of gram-negative bacilli. N Engl J Med 1969;281:1137–1140.Google Scholar
8. El-Solh, A. Association between pneumonia and oral care in nursing home residents. Lung 2011;189:173.Google Scholar
9. Loeb, MB, Becker, M, Eady, A, Walker-Dilks, C. Interventions to prevent aspiration pneumonia in older adults: a systematic review. J Am Geriatr Soc 2003;51:1018–1022.CrossRefGoogle ScholarPubMed
10. Quagliarello, V, Juthani-Mehta, M, Ginter, S, Towle, V, Allore, H, Tinetti, M. Pilot testing of intervention protocols to prevent pneumonia among nursing home residents. J Am Geriatr Soc 2009;57:1226–1231.Google Scholar
11. van der Maarel-Wierink, CD, Vanobbergen, JNO, Bronkhorst, EM, Schols, JMGA, de Baat, C. Oral health care and aspiration pneumonia in frail older people: a systematic literature review. Gerodontology 2013;30:3–9.CrossRefGoogle ScholarPubMed
12. Pace, CC, McCullough, GH. The association between oral microorgansims and aspiration pneumonia in the institutionalized elderly: review and recommendations. Dysphagia 2010;25:307–322.CrossRefGoogle ScholarPubMed
13. Tada, A, Miura, H. Prevention of aspiration pneumonia (AP) with oral care. Arch Gerontol Geriatr 2012;55:16–21.CrossRefGoogle ScholarPubMed
14. Labeau, SO, Van de Vyver, K, Brusselaers, N, Vogelaers, D, Blot, SI. Prevention of ventilator-associated pneumonia with oral antiseptics: a systematic review and meta-analysis. Lancet Infect Dis 2011;11:845–854.Google Scholar
15. Li, J, Xie, D, Li, A, Yue, J. Oral topical decontamination for preventing ventilator-associated pneumonia: a systematic review and meta-analysis of randomized controlled trials. J Hosp Infect 2013;84:283–293.CrossRefGoogle ScholarPubMed
16. Chan, EY, Ruest, A, Meade, MO, Cook, DJ. Oral decontamination for prevention of pneumonia in mechanically ventilated adults: systematic review and meta-analysis. BMJ 2007;334:889.Google Scholar
17. Chlebicki, MP, Safdar, N. Topical chlorhexidine for prevention of ventilator-associated pneumonia: a meta-analysis. Crit Care Med 2007;35:595–602.Google Scholar
18. Price, R, MacLennan, G, Glen, J, SuDDICU Collaboration. Selective digestive or oropharyngeal decontamination and topical oropharyngeal chlorhexidine for prevention of death in general intensive care: systematic review and network meta-analysis. BMJ 2014;348:g2197.Google Scholar
19. Yao, LY, Chang, CK, Maa, SH, Wang, C, Chen, CC. Brushing teeth with purified water to reduce ventilator-associated pneumonia. J Nurs Res 2011;19:289–297.Google Scholar
20. Sjogren, P, Nilsson, E, Forsell, M, Johansson, O, Hoogstraate, J. A systematic review of the preventive effect of oral hygiene on pneumonia and respiratory tract infection in elderly people in hospitals and nursing homes: effect estimates and methodological quality of randomized controlled trials. J Am Geriatr Soc 2008;56:2124–2130.CrossRefGoogle ScholarPubMed
21. Liberati, A, Altman, DG, Tetzlaff, J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009;339:b2700.CrossRefGoogle ScholarPubMed
22. Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309–332.Google Scholar
23. Higgins, JP, Altman, DG, Gotzsche, PC, et al. The Cochrane collaboration’s tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928.CrossRefGoogle ScholarPubMed
24. Panchabhai, TS, Dangayach, NS, Krishnan, A, Kothari, VM, Karnad, DR. Oropharyngeal cleansing with 0.2% chlorhexidine for prevention of nosocomial pneumonia in critically ill patients: an open-label randomized trial with 0.01% potassium permanganate as control. Chest 2009;135:1150–1156.CrossRefGoogle ScholarPubMed
25. Lam, OL, McMillan, AS, Samaranayake, LP, Li, LS, McGrath, C. Randomized clinical trial of oral health promotion interventions among patients following stroke. Arch Phys Med Rehabil 2013;94:435–443.Google Scholar
26. Adachi, M, Ishihara, K, Abe, S, Okuda, K. Professional oral health care by dental hygienists reduced respiratory infections in elderly persons requiring nursing care. Int J Dent Hyg 2007;5:69–74.CrossRefGoogle ScholarPubMed
27. Yoneyama, T, Yoshida, M, Ohrui, T, et al. Oral care reduces pneumonia in older patients in nursing homes. J Am Geriatr Soc 2002;50:430–433.CrossRefGoogle ScholarPubMed
28. Ohsawa, Takayuki, Yoneyama, Takeyoshi, Hashimoto, Kenji, Kubota, Eiro, Ito, Mitsuhiro, Yoshida, Kazu-ichi. Effects of professional oral health care on the ADL of elderly patients in a nursing home. Bull Kanagawa Dent Coll 2003;31:51–54.Google Scholar
29. Furukawa, TA, Barbui, C, Cipriani, A, Brambilla, P, Watanabe, N. Imputing missing standard deviations in meta-analyses can provide accurate results. J Clin Epidemiol 2006;59:7–10.CrossRefGoogle ScholarPubMed
30. Higgins, JPT, Green, S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. The Cochrane Collaboration website. http://www.cochrane-handbook.org. Published 2011. Accessed March 15, 2015.Google Scholar
31. Langmore, SE, Skarupski, KA, Park, PS, Fries, BE. Predictors of aspiration pneumonia in nursing home residents. Dysphagia 2002;17:298–307.CrossRefGoogle ScholarPubMed
32. Mylotte, JM, Goodnough, S, Naughton, BJ. Pneumonia versus aspiration pneumonitis in nursing home residents: diagnosis and management. J Am Geriatr Soc 2003;51:17–23.CrossRefGoogle ScholarPubMed
33. El-Solh, AA, Aquilina, AT, Dhillon, RS, Ramadan, F, Nowak, P, Davies, J. Impact of invasive strategy on management of antimicrobial treatment failure in institutionalized older people with severe pneumonia. Am J Respir Crit Care Med 2002;166:1038–1043.Google Scholar
34. Polverino, E, Torres, A. Current perspective of the HCAP problem: is it CAP or is it HAP? Semin Respir Crit Care Med 2009;30:239–248.CrossRefGoogle ScholarPubMed