Zasler et al. (1993)

RCT

USA

PEDro=4

N=20

Population: TBI; Mean Age=30 yr; Gender: Male=14, Female=6; Time Post-Injury >1 mo; Intervention Group (n=10): Mean GCS=7; Control Group (n=10): Mean GCS=6.

Intervention: Patients in the intervention group received verbal oral hygiene instructions and were supervised in the removal of plaque. Those in the control group did not receive any oral hygiene instructions. Assessments were done at baseline and follow-up (5-6 wk).

Outcome Measure: Plaque index score.

1.        No differences were found between the intervention and control group when examining the mean plaque scores at baseline (1.94 versus 2.12, p>0.05).

2.        Following intervention, the mean plaque index scores for the treatment group was significantly lower than those of control group (1.06 versus 2.19, p<0.01).

Seguin et al. (2014)

France

RCT

PEDro=7

N=167

Population: Povidone-Iodine group (n=85): TBI=62, Stroke=23; Mean Age=48 yr; Gender: Male=60, Female=25; Mean Time Post Injury=6 hr; Mean GCS=6. Placebo group (n=82): TBI=61, Stroke=21; Mean Age=48 yr; Gender: Male=64, Female=18; Mean Time Post Injury=6 hr; Mean GCS=6.

Intervention: Patients were randomly assigned to either receive povidone-iodine for decontamination of the oropharyngeal tract, or placebo.

Outcome Measure: Incidence of Ventilator-Associated Pneumonia (VAP).

Cabov et al. (2010)

Croatia

RCT

PEDro=8

N=60

Population: Neoplasms (61.7%), Head trauma (28.3%), Polytrauma (10%).

Intervention: Patients were randomized to either the chlorhexidine group or the placebo group. Those in the chlorhexidine group had antiseptic decontamination of dental plaque and the oral mucosa by applying the gel to their oral cavity. The gel was not rinsed off after application.

Outcome Measures: Rate of infections, Plaque score.

1.        The plaque score significantly increased in the placebo group and decreased in the chlorhexidine group (p<0.05).

2.        Post treatment results indicate that the placebo group acquired nosocomial infections, including nosocomial pneumonia, more often than in the chlorhexidine group.

3.        Mortality in the treatment group was lower (3.3% versus 10%), as was the length of stay (5.1±1.6 versus 6.8±3.5, p=0.0187), compared to the placebo group.

Yoneyama et al. (2002)

Japan

RCT

PEDro=6

N=366

Population: Nursing home patients.

Intervention: Patients were randomly allocated to receive oral care (n=184) or no oral care (n=182).

Outcome Measures: Pneumonia, febrile days, death from pneumonia, Activities of Daily Living Scale, Mini Mental State Exam (MMSE).

1.        Pneumonia was more common in those who did not receive oral care, compared to those that did (34 cases versus 21 cases).

2.        Scores on the activities of daily living scale and the MMSE improved in those receiving oral care.

3.        During follow up 54 (29%) patients had febrile days in the non-oral care group, and 27 (15%) in the oral care group.

4.        Of those who had pneumonia, 30 (16%) in the non-oral care group, and 14 (7%) in the oral care group died.

Fourrier et al. (2000)

France

RCT

PEDro=5

N=60

Population: Intensive Care Unit patients.

Intervention: Chlorhexidine 0.2% (dental gel) group or the control group where dental care consisted of standard oral care including rinsing the mouth with bicarbonate isotonic serum, followed by oropharyngeal sterile aspiration 4x/day.

Outcome Measures: The development of nosocomial infections, Caries-Absent-Occluded Index.

1.        The rate of nosocomial infection acquired in the ICU was significantly higher for the control group (p=0.018).

2.        Those in the treatment groups also had a reduced ICU stay compared to the placebo group.

Robertson and Carter (2013)

Canada

Case Control

N=83

Population: TBI, Intracranial hemorrhage, tumour, Other. Standard oral care (SOC) Group (n=51): Mean Age=57 yr; Gender: Male=27, Female=24. Enhanced oral care (EOC) group (n=32): Mean Age=61 yr; Gender: Male=23, Female=9.

Intervention: Patients in the SOC group received a standard protocol for oral hygiene and were reviewed retrospectively; patients in the EOC group were prospectively studied and received an enhanced oral hygiene protocol. The oral care kit was kept beside the patient’s bed and nurses were trained prior. The EOC consisted of brushing, mouth rinse, and swabs.

Outcome Measure: Incidence of non-ventilator hospital-acquired pneumonia (NV-HAP).