Strategies to Prevent Pneumonia (SToP Pneumonia)

This study tests whether special oral care provided by nurses to critically ill patients who are on a breathing machine (mechanical ventilator) can help to reduce the build-up of dental plaque on the teeth and reduce the risk of pneumonia.

Pneumonia is the leading cause of death from hospital-acquired infections. Intubation and mechanical ventilation greatly increase the risk of bacterial ventilator associated pneumonia. Growth of potentially pathogenic bacteria in dental plaque of critically ill patients provides a nidus of infection for microorganisms that have been shown to be responsible for the development of Ventilator Associated Pneumonia. Since these organisms are concentrated in dental plaque, removal of organisms from the oral cavity by oral care interventions is a theoretically attractive method to reduce the risk of development of Ventilator Associated Pneumonia. However, evidence-based protocols for oral care of mechanically ventilated patients are not available. Results of the study have the potential to improve nursing care, and to positively affect patient well-being, morbidity, mortality, and health care costs.

• Other: Control
  No toothbrushing and no chlorhexidine
• Procedure: Toothbrushing only
  Toothbrushing three times per 24 hours without chlorhexidine
• Procedure: Chlorhexidine only
  Chlorhexidine oral rinse twice per 24 hours without toothbrushing
• Procedure: Toothbrushing and Chlorhexidine
  Toothbrushing three times per 24 hours plus chlorhexidine twice per 24 hours.

• No Intervention: 1
  Intervention: Other: Control
• Active Comparator: 2
  Intervention: Procedure: Toothbrushing only
• Active Comparator: 3
  Intervention: Procedure: Chlorhexidine only
• Active Comparator: 4
  Intervention: Procedure: Toothbrushing and Chlorhexidine

Inclusion Criteria:

• 18 years or older, admitted to one of four intensive care units at the study hospital, breathing tube in place, and on a breathing machine (mechanical ventilator)

Exclusion Criteria:

• Breathing tube in place for more than 24 hours prior to entry into the study, absence of teeth, or a medical diagnosis of pneumonia when the breathing tube is put in.