Professional Oral Care and Staff Education in Critically Ill Patients

Semmelweis University161 enrolled

Overview

This study evaluated oral health in critically ill patients admitted to two intensive care units in Budapest, Hungary, and examined whether professional oral care and education of intensive care staff could improve oral hygiene. A total of 161 adult patients were included. Dentate patients in the first phase were randomly assigned to receive either professional oral care provided by dentists or standard oral care provided by ICU nursing staff. Total edentulous patients were included in a separate group. After a structured oral care education programme was provided to ICU staff, subsequently enrolled patients were included in a separate post-education group. Oral hygiene and gingival inflammation were assessed repeatedly during the ICU stay.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

SINGLE

Enrollment

161

Conditions

Critically Ill Oral Health Care Critical Illness Oral Care Performance

Interventions

Professional Oral CareBEHAVIORAL

Professional oral care was provided by calibrated dentists three times weekly using a rotary-oscillatory electric toothbrush and fluoride toothpaste. Cleaning included the occlusal, buccal, and lingual tooth surfaces, followed by oral rinsing with sterile water.

Standard Oral CareBEHAVIORAL

Standard oral care was provided by ICU nursing staff twice daily according to local clinical practice. At the Bajcsy-Zsilinszky Hospital ICU, care consisted of toothbrushing or oral swabbing with a non-chlorhexidine antiseptic solution. At the Trauma Center ICU, care consisted of chlorhexidine mouth rinsing combined with toothbrushing.

ICU Staff Oral Care EducationBEHAVIORAL

A structured educational programme was provided to ICU physicians and nurses. The programme addressed oral hygiene, current recommendations for the prevention of ventilator-associated pneumonia, and the recommended oral care protocol, including toothbrushing with toothpaste and oral rinsing. Patients enrolled after completion of the education programme constituted the post-education (upskill) group.

Outcomes

Primary Outcomes

Change in Simplified Oral Hygiene Index (OHI-S) over time

Oral hygiene was assessed using the Simplified Oral Hygiene Index (OHI-S), which ranges from 0 to 6, with higher scores indicating poorer oral hygiene. OHI-S scores were compared between study groups and across repeated examinations during the ICU stay.

Time frame: Baseline and three times weekly during the ICU stay, through ICU discharge, an average of 30 days.

Secondary Outcomes

Change in gingivitis prevalence over time

Gingival inflammation was assessed clinically at each oral examination. Gingivitis prevalence was compared between study groups and across repeated examinations during the ICU stay.

Time frame: Baseline and three times weekly during the ICU stay, through ICU discharge, an average of 30 days.

Incidence of ventilator-associated pneumonia (VAP)

Occurrence of VAP during the ICU stay, recorded as a dichotomous outcome (yes/no) at the end of the ICU stay. VAP was defined according to the diagnostic criteria used in the participating ICUs, including onset at least 48 hours after initiation of mechanical ventilation.

Time frame: Through ICU discharge, an average of 30 days.

Duration of mechanical ventilation

Duration of invasive mechanical ventilation, measured in days from initiation of mechanical ventilation until discontinuation or death, whichever occurred first.

Time frame: From initiation of invasive mechanical ventilation until discontinuation or death, whichever occurred first, assessed up to 43 days.

ICU length of stay

Duration of the intensive care unit stay, measured in days from ICU admission until ICU discharge or death, whichever occurred first.

Time frame: From ICU admission until ICU discharge or death, whichever occurred first, assessed up to 66 days.

Hospital length of stay

Duration of hospital stay, measured in days from hospital admission until hospital discharge or death, whichever occurred first.

Time frame: From hospital admission until hospital discharge or death, whichever occurred first, assessed up to 103 days.

All-cause mortality

All-cause mortality during hospitalization, recorded as a dichotomous outcome (yes/no).

Time frame: Up to 103 days after ICU admission.