engleski

Utjecaj oralnog zdravlja i 0, 2% klorheksidin oralnoga gela na učestalost nozokomijalnih infekcija u kirurškim jedinicama intenzivnog liječenja: randomizirana placebo-kontrolirana studija

Objectives were to evaluate the impact of oral health on the evolution of nosocomial infections, and to document the effect of oral antiseptic decontamination on oral health and the rate of nosocomial infections in surgical intensive care unit (ICU). A prospective, randomized, double-blind, placebo-controlled clinical trial. Setting: Surgical ICU in a University Hospital Dubrava. Sixty nonedentulous patients consecutively admitted to the surgical intensive care unit requiring a minimum stay of three days. After randomization, antiseptic decontamination of dental plaque and oral mucosa with chlorhexidine gel was performed on the treated group. The control group was treated with placebo gel. The dental status was assessed using a "Caries-Absent-Occluded" (CAO) score and the plaque amount was assessed using a semiquantitative score. Bacterial sampling of dental plaque, oral mucosa, nasal and tracheal aspirate were carried out. The value of plaque index was significantly aggravated in the control group, while in the treated patients it decreased. Patients who had developed nosocomial infection had greater plaque index on admission and during ICU stay. The control group showed increased colonization by aerobic pathogens throught the ICU stay. Patients who had developed nosocomial infection had greater plaque index on admission and during ICU stay. The control group developed nosocomial infections (26.7%) more significantly than the treated patients (6.7%), and they stayed longer in the ICU (5.1±1.6 vs 6.8±3.5, p=0.0187). The reduction in mortality in the treated group was also noted (3.3% vs 10%). The poor oral health had a significant positive correlation on the bacterial colonization and evolution of nosocomial infections. Oral decontamination with chlorhexidine significantly decreases oropharyngeal colonization, the incidence of nosocomial infections, length of stay and mortality in surgical ICU patients.

nosocomial infection; dental plaque; oral decontamination; chlorhexidine; intensive-care patients

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