Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia

Cochrane Database of Systematic Reviews

Volumn 2013, Issue 8, 2013, Pages

  Shi, Zongdao ^a   Xie, Huixu ^a   Wang, Ping ^a   Zhang, Qi ^a   Wu, Yan ^b   Chen, E ^a   Ng, Linda ^c   Worthington, Helen V ^d   Needleman, Ian ^e   Furness, Susan ^d  

^a SICHUAN UNIVERSITY   (China)

^b CHONGQING MEDICAL UNIVERSITY   (China)

^c UNIVERSITY OF QUEENSLAND   (Australia)

^d UNIVERSITY OF MANCHESTER   (United Kingdom)

^e UNIVERSITY COLLEGE LONDON   (United Kingdom)

Author keywords

[No Author keywords available]

Indexed keywords

CHLORHEXIDINE; MOUTHWASH;

ARTIFICIAL VENTILATION; CLINICAL EFFECTIVENESS; CRITICALLY ILL PATIENT; HUMAN; INFECTION PREVENTION; INTENSIVE CARE; LENGTH OF STAY; MICROBIAL COLONIZATION; MORTALITY; MOUTH HYGIENE; OUTCOME ASSESSMENT; PRIORITY JOURNAL; REVIEW; SYSTEMATIC REVIEW; TOOTH BRUSHING; VENTILATOR ASSOCIATED PNEUMONIA; VULNERABLE POPULATION; ADULT; CHILD; CRITICAL ILLNESS; EQUIPMENT; INTENSIVE CARE UNIT; META ANALYSIS; METHODOLOGY; RANDOMIZED CONTROLLED TRIAL (TOPIC); DEVICES; PNEUMONIA, VENTILATOR-ASSOCIATED; PROCEDURES;

ADULT; CHILD; CHLORHEXIDINE; CRITICAL ILLNESS; HUMANS; INTENSIVE CARE UNITS; MOUTHWASHES; ORAL HYGIENE; PNEUMONIA, VENTILATOR-ASSOCIATED; RANDOMIZED CONTROLLED TRIALS AS TOPIC; RESPIRATION, ARTIFICIAL; TOOTHBRUSHING;

EID: 84893466850     PISSN: None     EISSN: 1469493X     Source Type: Journal    
DOI: 10.1002/14651858.CD008367.pub2     Document Type: Review

References (111)

1. Bellissimo-Rodrigues F, Bellissimo-Rodrigues WT, Viana JM, Teixeira GC, Nicolini E, Auxiliadora-Martins M, et al. Effectiveness of oral rinse with chlorhexidine in preventing nosocomial respiratory tract infections among intensive care unit patients. Infection Control & Hospital Epidemiology 2009;30(10):952-8.
2. Berry AM, Davidson PM, Masters J, Rolls K, Ollerton R. Effects of three approaches to standardized oral hygiene to reduce bacterial colonization and ventilator associated pneumonia in mechanically ventilated patients: A randomised control trial. International Journal of Nursing Studies 2011;48(6):681-8.
3. Bopp M, Darby M, Loftin KC, Broscious S. Effects of daily oral care with 0.12% chlorhexidine gluconate and a standard oral care protocol on the development of nosocomial pneumonia in intubated patients: a pilot study. Journal of Dental Hygiene 2006;80(3):9.
4. Cabov T, Macan D, Husedzinovic I, Skrlin-Subic J, Bosnjak D, Sestan-Crnek S, et al. The impact of oral health and 0.2% chlorhexidine oral gel on the prevalence of nosocomial infections in surgical intensive-care patients: a randomized placebo-controlled study. Wiener Klinische Wochenschrift 2010;122(13-14):397-404.
5. Caruso P, Denari S, Ruiz SAL, Demarzo SE, Deheinzelin D. Saline instillation before tracheal suctioning decreases the incidence of ventilator-associated pneumonia. Critical Care Medicine 2009;37(1):32-8.
6. Chen QL, Ye XF, Jiang YZ, Yan MQ. Application of new oral care method to orotracheal intubation. Fujian Medical Journal 2008;30(5):155-7.
7. DeRiso AJ 2nd, Ladowski JS, Dillon TA, Justice JW, Peterson AC. Chlorhexidine gluconate 0.12% oral rinse reduces the incidence of total nosocomial respiratory infection and nonprophylactic systemic antibiotic use in patients undergoing heart surgery. Chest 1996;109(6):1556-61.
8. Feng S, Sun X, Chen Y. Application of different mouthwashes in oral nursing for patients with orotracheal intubation. China Medicine and Pharmacy 2012;8(2):100-1.
9. Fields LB. Oral care intervention to reduce incidence of ventilator-associated pneumonia in the neurologic intensive care unit. Journal of Neuroscience Nursing 2008;40(5):291-8.
10. Fourrier F, Cau-Pottier E, Boutigny H, Roussel-Delvallez M, Jourdain M, Chopin C. Effects of dental plaque antiseptic decontamination on bacterial colonization and nosocomial infections in critically ill patients. Intensive Care Medicine 2000;26(9):1239-47.
11. Fourrier F, Dubois D, Pronnier P, Herbecq P, Leroy O, Desmettre T, et al. Effect of gingival and dental plaque antiseptic decontamination on nosocomial infections acquired in the intensive care unit: a double-blind placebo-controlled multicenter study. Critical Care Medicine 2005;33(8):1728-35.
12. Grap MJ, Munro CL, Elswick RK Jr, Sessler CN, Ward KR. Duration of action of a single, early oral application of chlorhexidine on oral microbial flora in mechanically ventilated patients: a pilot study. Heart & Lung 2004;33(2):83-91.
13. Grap MJ, Munro CL, Hamilton VA, Elswick RK Jr, Sessler CN, Ward KR. Early, single chlorhexidine application reduces ventilator-associated pneumonia in trauma patients. Heart & Lung 2011;40(5):e115-22.
14. Hu X, Chen X. Application of improved oral nursing method to orotracheal intubation. Chinese Journal of Misdiagnostics 2009;9(17):4058-9.
15. Jacomo AD, Carmona F, Matsuno AK, Manso PH, Carlotti AP. Effect of oral hygiene with 0.12% chlorhexidine gluconate on the incidence of nosocomial pneumonia in children undergoing cardiac surgery. Infection Control & Hospital Epidemiology 2011;32(6):591-6.
16. Koeman M, van der Ven AJ, Hak E, Joore HC, Kaasjager K, de Smet AG, et al. Oral decontamination with chlorhexidine reduces the incidence of ventilator-associated pneumonia. American Journal of Respiratory & Critical Care Medicine 2006;173(12):1348-55.
17. Koeman M, van der Ven AJ, Hak E, Joore JC, Kaasjager HA, de Smet AM, et al. Less ventilator-associated pneumonia after oral decontamination with chlorhexidine; a randomised trial. Nederlands Tijdschrift voor Geneeskunde 2008;152(13):752-9.
18. Kusahara DM, Peterlini MA, Pedreira ML. Oral care with 0.12% chlorhexidine for the prevention of ventilator-associated pneumonia in critically ill children: Randomised, controlled and double blind trial. International Journal of Nursing Studies 2012;49(11):1354-63.
19. Kusahara DM, Peterlini MAS, Pedreira MLG. Randomized, controlled and double blinded trial of oral decontamination with 0.12% chlorhexidine for the prevention of ventilator-associated pneumonia in children. Pediatric Critical Care Medicine 2011;12(3, Suppl 1):A16.
20. Pedreira MLG, Kusahara DM, de Carvalho WB, Nunez SC, Peterlini MAS. Oral care interventions and oropharyngeal colonization in children receiving mechanical ventilation. American Journal of Critical Care 2009;18(4):319-29.
21. Long Y, Mou G, Zuo Y, lv F, Feng Q, Du J. Effect of modified oral nursing method on the patients with orotracheal intubation. Journal of Nurses Training 2012;27(24):2290-3.
22. Lorente L, Lecuona M, Jimenez A, Palmero S, Pastor E, Lafuente N, et al. Ventilator-associated pneumonia with or without toothbrushing: a randomized controlled trial. European Journal of Clinical Microbiology and Infectious Diseases 2012;31(10):2621-9.
23. McCartt PAM. Effect of Chlorhexidine Oral Spray versus Mechanical Toothbrushing and Chlorhexindine Rinse in Decreasing Ventilator Associated Pneumonia in Critically Ill Adults [PhD thesis]. Gainesville, Florida, USA: University of Florida, 2010:91.
24. Munro C, Grap M, Sessler C, McClish D. Effect of oral care interventions on dental plaque in mechanically ventilated ICU adults. American Journal of Critical Care 2007;16(3):309.
25. Munro CL, Grap MJ, Jones DJ, McClish DK, Sessler CN. Chlorhexidine, toothbrushing, and preventing ventilator-associated pneumonia in critically ill adults. American Journal of Critical Care 2009;18(5):428-37.
26. Needleman IG, Hirsch NP, Leemans M, Moles DR, Wilson M, Ready DR, et al. Randomized controlled trial of toothbrushing to reduce ventilator-associated pneumonia pathogens and dental plaque in a critical care unit. Journal of Clinical Periodontology 2011;38(3):246-52.
27. Ozcaka O, Basoglu OK, Buduneli N, Tasbakan MS, Bacakoglu F, Kinane DF. Chlorhexidine decreases the risk of ventilator-associated pneumonia in intensive care unit patients: a randomized clinical trial. Journal of Periodontal Research 2012;47(5):584-92.
28. Panchabhai TS, Dangayach NS, Krishnan A, Kothari VM, Karnad DR. Oropharyngeal cleansing with 0.2% chlorhexidine for prevention of nosocomial pneumonia in critically ill patients: an open-label randomized trial with 0.01% potassium permanganate as control. Chest 2009;135(5):1150-6.
29. Pobo A, Lisboa T, Rodriguez A, Sole R, Magret M, Trefler S, et al. A randomized trial of dental brushing for preventing ventilator-associated pneumonia. Chest 2009;136(2):433-9.
30. Prendergast V. Safety and efficacy of oral care for intubated neuroscience intensive care patients. Doctoral Dissertation Series 2012-3. Lund, Sweden: Lund University, 2012:1-86.
31. Prendergast V, Hagell P, Hallberg IR. Electric versus manual tooth brushing among neuroscience ICU patients: is it safe?. Neurocritical Care 2011;14(2):281-6.
32. Prendergast V, Hallberg IR, Jakobsson U, Renvert S, Moran A, Gonzalez O. Comparison of oropharyngeal and respiratory nosocomial bacteria between two methods of oral care: A randomized controlled trial. Journal of Neuroscience and Neurosurgical Nursing 2012;1(1):10-18.
33. Prendergast V, Jakobsson U, Renvert S, Hallberg IR. Effects of a standard versus comprehensive oral care protocol among intubated neuroscience ICU patients: results of a randomized controlled trial. Journal of Neuroscience Nursing 2012;44(3):134-46.
34. Roca Biosca A, Anguera Saperas L, García Grau N, Rubio Rico L, Velasco Guillén MC. Prevention of mechanical ventilator-associated pneumonia: a comparison of two different oral hygiene methods. Enfermería Intensiva 2011;22(3):104-11.
35. Scannapieco FA, Yu J, Raghavendran K, Vacanti A, Owens SI, Wood K, et al. A randomized trial of chlorhexidine gluconate on oral bacterial pathogens in mechanically ventilated patients. Critical Care 2009;13(4):R117.
36. Sebastian MR, Lodha R, Kapil A, Kabra SK. Oral mucosal decontamination with chlorhexidine for the prevention of ventilator-associated pneumonia in children - a randomized, controlled trial. Pediatric Critical Care Medicine 2012;13:e305-10.
37. Seguin P, Tanguy M, Laviolle B, Tirel O, Malledant Y. Effect of oropharyngeal decontamination by povidone-iodine on ventilator-associated pneumonia in patients with head trauma. Critical Care Medicine 2006;34(5):1514-9.
38. Silvestri L, van Saene HK, Milanese M, Zei E, Blazic M. Prevention of ventilator-associated pneumonia by use of oral chlorhexidine. Infection Control & Hospital Epidemiology 2009;30(1):101-3.
39. Tantipong H, Morkchareonpong C, Jaiyindee S, Thamlikitkul V. Randomized controlled trial and meta-analysis of oral decontamination with 2% chlorhexidine solution for the prevention of ventilator-associated pneumonia. Infection Control & Hospital Epidemiology 2008;29(2):131-6.
40. Xu J, Feng B, He L, Shen H, Chen XY. Influence of different oral nursing methods on ventilator-associated pneumonia and oral infection in the patients undergoing mechanical ventilation. Journal of Nursing Science 2007;7(22):56-7.
41. Xu HL. Application of improved oral nursing method to the prevention of ventilator-associated pneumonia. Journal of Qilu Nursing 2008;14(19):15-6.
42. Yao L, Chang C, Wang C, Chen C. Effect of an oral care protocol in preventing ventilator associated pneumonia in ICU patients. Critical Care 2008;12(Suppl 2):Abs No P48.
43. Yao LY, Chang CK, Maa SH, Wang C, Chen CC. Brushing teeth with purified water to reduce ventilator-associated pneumonia. Journal of Nursing Research 2011;19(4):289-97.
44. Zhao Y. Research on application of Yikou gargle in prevention of ventilation associated pneumonia. Chinese Journal of Nosocomiology 2012;23(22):5232-3.
45. Abusibeih A, Lev A. Randomized control trial comparing oral care methods and VAP. Intensive Care Medicine 2010;36:S329.
46. Bordenave C. Evaluation of the effectiveness of a protocol of intensification of mouth care (teeth brushing and chlorhexidine 0.12%) on the colonisation of tracheal aspirations in intubated and ventilated patients in intensive care. Recherche en Soins Infirmiers 2011;(106):92-8.
47. Chao YC, Chen Y, Wang KK, Lee R, Tsai H. Removal of oral secretion prior to position change can reduce the incidence of ventilator-associated pneumonia for adult ICU patients: a clinical controlled trial study. Journal of Clinical Nursing 2009;18(1):22-8.
48. Epstein J, Ransier A, Lunn R, Spinelli J. Enhancing the effect of oral hygiene with the use of a foam brush with chlorhexidine. Oral Surgery, Oral Medicine, Oral Pathology 1994;77(3):242-7.
49. Fan T. The effect of a modified oral nursing care method on prevention of ventilator associated pneumonia. Nursing Practice and Research 2012;9(12):99-100.
50. Ferozali F, Johnson G, Cavagnaro A. Health benefits and reductions in bacteria from enhanced oral care. Special Care in Dentistry 2007;27(5):168-76.
51. Genuit T, Bochicchio G, Napolitano LM, McCarter RJ, Roghman MC. Prophylactic chlorhexidine oral rinse decreases ventilator-associated pneumonia in surgical ICU patients. Surgical Infections 2001;2(1):5-18.
52. Guo MJ. Study on the new oral nursing for the patient of acute lung brain-storm through tracheal. Chinese Journal of Modern Nursing 2007;13(26):2537-8.
53. Houston S, Hougland P, Anderson JJ, LaRocco M, Kennedy V, Gentry LO. Effectiveness of 0.12% chlorhexidine gluconate oral rinse in reducing prevalence of nosocomial pneumonia in patients undergoing heart surgery. American Journal of Critical Care 2002;11(6):567-70.
54. Lai M, Huang H. Toothpaste mouth care for critically ill patients. Journal of Nursing Science 1997;12(2):106-7.
55. Li W, Ma X, Peng Y, Cao J, Loo WTY, Hao L, et al. Application of a Nano-antimicrobial film to prevent ventilator-associated pneumonia: A pilot study. African Journal of Biotechnology 2011;10(10):1926-31.
56. Li S, Zhang H, Zhang B. Application of different oral nursing methods to prevent ventilation associated pneumonia. Practical Clinical Medicine 2012;13(5):92-3.
57. Liang YL, Lu LQ, Liang JT. Oral cavity nursing study in endotracheal intubation with the Baihu decoction. Journal of Nurses Training 2007;1(22):79-80.
58. Liwu A. Oral hygiene in intubated patients. The Australian Journal of Advanced Nursing 1990;7(2):4-7.
59. MacNaughton PD, Bailey J, Donlin N, Branfield P, Williams A, Rowswell H. A randomised controlled trial assessing the efficacy of oral chlorhexidine in ventilated patients (029). Intensive Care Medicine 2004;30(Suppl):S12.
60. McCoy T, Fields W, Kent N. Evaluation of emergency department evidence-based practices to prevent the incidence of ventilator-acquired pneumonia. Journal of Nursing Care Quality 2012;27(1):83-8.
61. Ogata J, Minami K, Miyamoto H, Horishita T, Ogawa M, Sata T, et al. Gargling with povidone-iodine reduces the transport of bacteria during oral intubation. Canadian Journal of Anaesthesia 2004;51(9):932-6.
62. Pawlak D, Semar R, Cantos K. Improving frequency of oral care in the medical intensive care unit. American Journal of Infection Control 2005;33(5):E147.
63. Santos PSdS, Mello WR, Wakim RCS, Paschoal MÂG. Use of oral rinse with enzymatic system in patients totally dependent in the intensive care unit [Uso de solução bucal com sistema enzimático em pacientes totalmente dependentes de cuidados em unidade de terapia intensiva]. Revista Brasileira de Terapia Intensiva 2008;20(2):154-9.
64. Segers P, Speekenbrink RG, Ubbink DT, van Ogtrop ML, de Mol BA. Prevention of nosocomial infection in cardiac surgery by decontamination of the nasopharynx and oropharynx with chlorhexidine gluconate: a randomized controlled trial. JAMA 2006;296(20):2460-6.
65. Ueda K, Yamada Y, Toyosato A, Nomura S, Saitho E. Effects of functional training of dysphagia to prevent pneumonia for patients on tube feeding. Gerodontology 2004;21(2):108-11.
66. Wang MM. The improvement of oral care in ICU intubated patients. Journal of Mudanjiang Medical College 2006;27(5):80-1.
67. Wang YX, He LY, Gao MR, Wang ZW, Li XY. Application of oral nursing care bundle to prevent VAP for critically surgically ill patients. Chinese Archives of General Surgery 2012;6(5):448-50.
68. Yin XR, Liao Y. The improvement of the oral care for patients with orotracheal intubation. West China Medical Journal 2004;19(3):482.
69. Zouka M, Soultati I, Hari H, Pourzitaki C, Paroutsidou G, Thomaidou E, et al. Oral dental hygiene and ventilator-associated pneumonia prevention in an ICU setting: Comparison between two methods (preliminary data of a randomised prospective study). Intensive Care Medicine 2010;36:S103.
70. Anon. EB57 Development of an oral care-based programme for prevention of ventilator-associated pneumonia. Critical Care Nurse 2012;32(2):e34.
71. Baradari AG, Khezri HD, Arabi S. Comparison of antibacterial effects of oral rinses chlorhexidine and herbal mouth wash in patients admitted to intensive care unit. Bratislavske Lekarske Listy 2012;113(9):556-60.
72. Seo H-K, Choi E-H, Kim J-H. The effect of oral hygiene for ventilator-associated pneumonia (VAP) incidence. Journal of Korean Critical Care Nursing 2011;4(2):1.
73. Yun H-Y, Lee E-S, Kim J-Y, Kim H-S, Kim K-A, Kim E-S, et al. Effect of tooth-brushing on oral health and ventilator-associated pneumonia of critically ill patients. Journal of Korean Critical Care Nursing 2011;4(2):1.
74. Implementation and evaluation of revised protocols for oral hygiene for mechanically ventilated patients. Ongoing study July 2012 (currently recruiting).
75. Alhazzani W, Smith O, Muscedere J, Medd J, Cook D. Toothbrushing for critically ill mechanically ventilated patients: a systematic review and meta-analysis of randomized trials evaluating ventilator-associated pneumonia. Critical Care Medicine 2013;41(2):646-55.
76. Apostolopoulou E, Bakakos P, Katostaras T, Gregorakos L. Incidence and risk factors for ventilator-associated pneumonia in 4 multidisciplinary intensive care units in Athens. Respiratory Care 2003;48(7):681-8.
77. American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. American Journal of J Respiratory and Critical Care Medicine 2005;171(4):388-416.
78. Azarpazhooh A, Leake JL. Systematic review of the association between respiratory diseases and oral health. Journal of Periodontology 2006;77(9):1465-82.
79. Azoulay E, Timsit JF, Tafflet M, de Lassence A, Darmon M, Zahar JR, et al. Candida colonization of the respiratory tract and subsequent pseudomonas ventilator-associated pneumonia. Chest 2006;129(1):110-7.
80. Bekaert M, Timsit JF, Vansteelandt S, Depuydt P, Vésin A, Garrouste-Orgeas M, et al. Attributable mortality of ventilator-associated pneumonia: a reappraisal using causal analysis. American Journal of Respiratory and Critical Care Medicine 2011;184(10):1133-9.
81. Berry AM, Davidson PM, Masters J, Rolls K. Systematic literature review of oral hygiene practices for intensive care patients receiving mechanical ventilation. American Journal of Critical Care 2007;16(6):552-62.
82. Cook DJ, Walter SD, Cook RJ, Griffith LE, Guyatt GH, Leasa D, et al. Incidence of and risk factors for ventilator-associated pneumonia in critically ill patients. Annals of Internal Medicine 1998;29(6):433-46.
83. D'Amico R, Pifferi S, Torri V, Brazzi L, Parmelli E, Liberati A. Antibiotic prophylaxis to reduce respiratory tract infections and mortality in adults receiving intensive care. Cochrane Database of Systematic Reviews 2009, Issue 4. [DOI: 10.1002/14651858.CD000022.pub3]
84. Edwards JR, Peterson KD, Mu Y, Banerjee S, Allen-Bridson K, Morrell G, et al. National Healthcare Safety Network (NHSN) report: data summary for 2006 through 2008, issued December 2009. American Journal of Infection Control 2009;37(10):783-805.
85. El-Solh AA, Pietrantoni C, Bhat A, Okada M, Zambon J, Aquilina A, et al. Colonization of dental plaques: a reservoir of respiratory pathogens for hospital-acquired pneumonia in institutionalized elders. Chest 2004;126(5):1575-82.
86. Estes RJ, Meduri GU. The pathogenesis of ventilator-associated pneumonia:Mechanisms of bacterial transcolonization and airway inoculation. Intensive Care Medicine 1995;21(4):365-83.
87. Fourrier F, Duvivier B, Boutigny H, Roussel-Delvallez M, Chopin C. Colonization of dental plaque: a source of nosocomial infections in intensive care unit patients. Critical Care Medicine 1998;26(2):301-8.
88. Garrouste-Orgeas M, Chevret S, Arlet G, Marie O, Rouveau M, PopoffN, et al. Oropharyngeal or gastric colonization and nosocomial pneumonia in adult intensive care unit patients. A prospective study based on genomic DNA analysis. American Journal of Respiratory and Critical Care Medicine 1997;156(5):1647-55.
89. Gu WJ, Gong YZ, Pan L, Ni YX, Liu JC. Impact of oral care with versus without toothbrushing on the prevention of ventilator-associated pneumonia: a systematic review and meta-analysis of randomized controlled trials. Critical Care 2012;16:R190.
90. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008;336(7650):924-6.
91. Hao Q, Lu Z, Dong BR, Huang CQ, Wu T. Probiotics for preventing acute upper respiratory tract infections. Cochrane Database of Systematic Reviews 2011, Issue 9. [DOI: 10.1002/14651858.CD006895.pub2]
92. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org.
93. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. American Journal of Infection Control 2008;36(5):309-32.
94. Labeau SO, Van de Vyver K, Brusselaers N, Vogelaers D, Blot SI. Prevention of ventilator-associated pneumonia with oral antiseptics: a systematic review and meta-analysis. The Lancet Infectious Diseases 2011;11(11):845-54.
95. Marsh PD. Microbiology of dental plaque biofilms and their role in oral health and caries. Dental Clinics of North America 2010;54(3):441-54.
96. McCarney R, Warner J, Iliffe S, van Haselen R, Griffin M, Fisher P. The Hawthorne Effect: a randomised, controlled trial. BMC Medical Research Methodology 2007;7:30.
97. Melsen WG, Rovers MM, Koeman M, Bonten MJ. Estimating the attributable mortality of ventilator-associated pneumonia from randomized prevention studies. Critical Care Medicine 2011;39(12):2736-42.
98. Mojon P. Oral health and respiratory infection. Journal of the Canadian Dental Association 2002;68(6):340-6.
99. Muscedere J, Dodek P, Keenan S, Fowler R, Cook D, Heyland D. Comprehensive evidence-based clinical practice guidelines for ventilator-associated pneumonia: prevention. Journal of Critical Care 2008;23(1):126-37.
100. Pineda LA, Saliba RG, El Solh AA. Effect of oral decontamination with chlorhexidine on the incidence of nosocomial pneumonia: a meta-analysis. Critical Care 2006;10(1):R35.
101. Pugin J, Auckenthaler R, Mili N, Janssens JP, Lew PD, Suter PM. Diagnosis of ventilator-associated pneumonia by bacteriologic analysis of bronchoscopic and nonbronchoscopic 'blind' bronchoalveolar lavage fluid. American Review of Respiratory Disease 1991;143(5 Pt 1):1121-9.
102. Scannapieco FA, Stewart EM, Mylotte JM. Colonization of dental plaque by respiratory pathogens in medical intensive care patients. Critical Care Medicine 1992;20(6):740-5.
103. Schulz KF, Grimes DA. Generation of allocation sequences in randomised trials: chance, not choice. The Lancet 2002;359(9305):515-9.
104. Selim AG, Balalis G, Bhaskar B, van Driel ML. Antibiotics for ventilator-associated pneumonia. Cochrane Database of Systematic Reviews 2010, Issue 4. [DOI: 10.1002/14651858.CD004267]
105. Shi ZD, Yu JR, Luo R, He Y, Liu XC, Chen E. Effect of oral nursing care: a systematic review. Chinese Journal of Evidence Based Medicine 2004;4(12):837-46, 858.
106. Tablan OC, Anderson L, Besser R, Bridges C, Hajjeh R. Guidelines for preventing healthcare-associated pneumonia: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. Morbidity & Mortality Weekly Report. Recommendations & Reports 2004;55 (RR-3):1-36.
107. Terezakis E, Needleman I, Kumar N, Moles D, Agudo E. The impact of hospitalization on oral health: a systematic review. Journal of Clinical Periodontology 2011;38(7):628-36.
108. Terpenning M. Geriatric oral health and pneumonia risk. Clinical Infectious Diseases 2005;40(12):1807-10.
109. Treloar DM, Stechmiller JK. Use of a clinical assessment tool for orally intubated patients. American Journal of Critical Care 1995;4(5):355-60.
110. Whittaker CJ, Lier CM, Kolenbrander PE. Mechanisms of adhesion by oral bacteria. Annual Review of Microbiology 1996;50:513-52.
111. Zanatta FB, Bergoli AD, Werle SB, Antoniazzi RP. Biofilm removal and gingival abrasion with medium and soft toothbrushes. Oral Health and Preventive Dentistry 2011;9(2):177-83.