Comparison the effect of comprehensive oral care program and combination of toothbrush and mouthwash with chlorhexidine 0.2% on the incidence of ventilator-associated pneumonia and oral health status in patients undergoing mechanical ventilation

Comparison of the effect of comprehensive oral care program and combined toothbrush and mouthwash program with 0.2% chlorhexidine on the incidence of ventilator-associated pneumonia and oral health status

Clinical trial with control group, with parallel groups, double-blind, randomized, on 90 patients, with permutation blocks were assigned to three groups

Intensive care unit of Khatam Al-Anbia Hospital in Zahedan. The anesthesiologist interpreting the chest photograph will not know about the patients in the three groups, the person performing the oral health assessment know about the groups.

Hospitalized patients with mechanically ventilated endotracheal tube

Comprehensive oral care program: wash hands and wear gloves, control endotracheal tube cuff pressure, raise the head of the bed by 30 to 45 degrees, brush the inner and outer surfaces of teeth, gums and tongue for 2 minutes using a baby toothbrush and Toothpaste with rotational movements, deep throat and mouth suction for 30 seconds while 0.9% normal saline is poured into the patient's mouth and teeth, mouthwash with 0.2% chlorhexidine antibacterial solution with a swab, moisturizing all mucosal surfaces The patient's mouth, gums and tongue are swabbed and vitamin A + D is used to lubricate the lips. Combined program of toothbrush and mouthwash with chlorhexidine 0.2%: The intervention is performed during 5 days of study for 5 minutes each time of oral care. With a baby toothbrush and antimicrobial toothpaste containing half a centimeter of fluoride, all the outer and inner surfaces of the teeth and gums are gently brushed with a circular motion. The teeth, tongue and palate surfaces are then brushed back and forth.

Ventilator-associated pneumonia,oral health status

Using permutation blocks, patients were assigned to three groups: comprehensive oral care program, combined toothbrush and mouthwash program, and control. Considering that three groups were considered in the study, patients were divided into fifteen cases of six blocks, A group of comprehensive oral care program and B group of toothbrush and mouthwash and C control group (for example: (AABBCC, ABABCC, BBAACC,…). There were two people in each block from each group. The order of the blocks was determined randomly using a random number table and then the patients entered the comprehensive care, toothbrush, mouthwash and control group based on the blocks.

The ambiguity of the study was that the anesthesiologist interpreting the chest X-ray, which is part of the MCPIS instrument, did not know the patients in the three groups and confirmed the presence or absence of infiltration without knowing which group the patient was in. . Also, the person conducting the oral health assessment has no information about the patients' inclusion in the study groups.