Effects of dental plaque antiseptic decontamination on bacterial colonization and nosocomial infections in critically ill patients

Objectives: To document in intensive care unit (ICU) patients the effect of dental plaque antiseptic decontamination on the occurrence of plaque colonization by aerobic nosocomial pathogens and nosocomial infections. Design: Single-blind randomized comparative study. Setting: A 16-bed adult intensive care unit in a university hospital. Patients: Patients consecutively admitted in the ICU with a medical condition suggesting an ICU stay of 5 days and requiring mechanical ventilation. Interventions: After randomization, the treated group received dental plaque decontamination with 0.2 % chlorhexidine gel, three times a day during the ICU stay. The control group received standard oral care. Specific measurements: Dental status was assessed by the Caries-Absent-Occluded index; the amount of dental plaque was assessed by a semi-quantitative plaque index. Bacterial sampling of dental plaque, nasal and tracheal aspirate, blood, and urine cultures were done on days 0, 5, 10, and every week. Main results: Sixty patients were included; 30 in the treated group and 30 in the control one (mean age: 51 +/- 16 years; mean Simplified Acute Physiological Score II: 35 +/- 14 points). On admission, no significant differences were found between both groups for all clinical and dental data. Compared with the control group, the nosocomial infection rate and the incidence densities related to risk exposition were significantly lower in the treated group (18 vs 33 parts per thousand days in the ICU and 10.7 vs 32.3 parts per thousand days of mechanical ventilation; P < 0.05). These results were consistent with a significant preventive effect of the antiseptic decontamination (Odds Ratio: 0.27; 95 % CI: 0.09; 0.80) with a 53 % relative risk reduction. There was a trend to a reduction of mortality, length of stay, and duration of mechanical ventilation. Conclusions: An antiseptic decontamination of dental plaque with a 0.2 % chlorhexidine gel decreases dental bacterial colonization, and may reduce the incidence of nosocomial infections in ICU patients submitted to mechanical ventilation.