- •Among critical patients, poor oral health is a risk factor for infections and death.
- •Adding a dentist to the intensive care team prevents respiratory tract infections.
- •The impact of that intervention on in-hospital mortality was unknown until now.
- •Dental care provided by dentists to critical patients reduced their risk of death.
- •These findings need to be confirmed by randomized clinical trials.
Abbreviations:ICU (Intensive care unit), VAP (Ventilator-associated pneumonia), ARIMA (Autoregressive integrated moving average), ITS (Interrupted time series), HC-FMRP-USP (Clinic Hospital Complex of Ribeirão Preto Medical School, University of São Paulo), REBEC (Brazilian Registry of Clinical Trials), ICF (Informed Consent Form), REC (Research Ethics Committee), IPCS (Infection Prevention and Control Service), AIC (Akike information criteria)
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- Fatores de risco associados ao agravamento de sepse em pacientes em Unidade de Terapia Intensiva.Cad Saude Colet. 2016; 24: 388-396
- Epidemiology and impact of healthcare-associated infections in trauma patients: a national data analysis.Surg Infect. 2020; 21: 871-876
- Impact of oral hygiene involving toothbrushing versus chlorhexidine in the prevention of ventilator-associated pneumonia: a randomized study.BMC Infect Dis. 2017; 17: 1-9
- Attributable mortality of ventilator-associated pneumonia: a meta-analysis of individual patient data from randomized prevention studies.Lancet Infect Dis. 2013; 13: 665-671
- Adults hospitalized with pneumonia in the United States: incidence, epidemiology, and mortality.Clin Infect Dis. 2017; 65: 1806-1812
- Incidence and prognosis of ventilator-associated tracheobronchitis (TAVeM): a multicentre, prospective, observational study.Lancet Respir Med. 2015; 3: 859-868
- The effectiveness of a bundle in the prevention of ventilator-associated pneumonia.Braz J Infect Dis. 2016; 20: 267-271
- Efficacy of ventilator-associated pneumonia care bundle for prevention of ventilator-associated pneumonia in the surgical intensive care units of a medical center.J Microbiol Immunol Infect. 2015; 48: 316-321
- Prevention of ventilator-associated pneumonia.Curr Opin in Infect Dis. 2017; 30: 214-220
- Two-state collaborative study. Two-state collaborative study of a multifaceted intervention to decrease ventilator-associated events.Crit Care Med. 2017; 45: 1208-1215
- Nosocomial infections in patients admitted in intensive care unit of a Tertiary Health Center, India.Ann Med Health Sci Res. 2014; 4: 738-741
- A systematic approach for developing a ventilator-associated pneumonia prevention bundle.Am J Infect Control. 2016; 44: 652-656
- Ventilator-associated pneumonia and oral health.Rev Soc Bras Med Trop. 2012; 45: 543-544
- Effectiveness of a dental care intervention in the prevention of lower respiratory tract nosocomial infections among intensive care patients: a randomized clinical trial.Infect Control Hosp Epidemiol. 2014; 35: 1342-1348
- Host-pathogen interface: progress in understanding the pathogenesis of infection due to multidrug-resistant bacteria in the intensive care unit.J Infect Dis. 2017; 215: s1-s8
- The periodontal war: microbes and immunity.Periodontol. 2000; 75: 52-115
- Respiratory pathogen colonization of dental plaque, the lower airways, and endotracheal tube biofilms during mechanical ventilation.J Crit Care. 2017; 37: 30-37
- Association between pathogens from tracheal aspirate and oral biofilm of patients on mechanical ventilation.Braz Oral Res. 2017; 31: e38
- Low efficacy of antibiotics against staphylococcus aureus airway colonization in ventilated patients.Clin Infect Dis. 2017; 64: 1081-1088
- Is it necessary to have a dentist within an intensive care unit team? Report of a randomised clinical trial.Int Dent J. 2018; 68: 420-427
- Dental management for patients in ICU.J Oral Health Comm Dent. 2016; 10: 80-86
- Exploration of difficulty accessing the mouths of intubated and mechanically ventilated adults for oral care: a video and photographic elicitation study.J Clin Nurs. 2020; 29: 1920-1932
Brazil. Ministry of Health. National Health Council. Resolution n°. 466, 2012. Accessed January 29, 2022. https://bvsms.saude.gov.br/bvs/saudelegis/cns/2013/res0466_12_12_2012.html.
- Nonpharmacologic measures to prevent ventilator-associated pneumonia.Clin Pulm Med. 2008; 15: 63-70
Agência Nacional de Vigilância Sanitária (ANVISA). Nota técnica n° 03 de 2019 GVIMS-GGTES. Critérios Diagnósticos das Infecções Relacionadas à Assistência à Saúde. Accessed August 27, 2021. https://www.gov.br/anvisa/pt-br/centraisdeconteudo/publicacoes/servicosdesaude/notas-tecnicas/nota-tecnica-no-03-2019-gvims-ggtes-anvisa.pdf/view.
- Severe periodontal disease increases acute myocardial infarction and stroke: a 10-year retrospective follow-up study.J Dent Res. 2021; 100: 706-713
- How strong is the link between periodontitis and stroke?.Evid Based Dent. 2021; 22: 10-11
- Periodontal disease, atrial fibrillation and stroke.Am Heart J. 2021; 235: 36-43
- Periodontitis is associated with cardiovascular diseases: a 13-year study.J Clin Periodontol. 2021; 48: 348-356
- Hospital dentistry for intensive care unit patients: a comprehensive review.J Clin Med. 2021; 10: 3681
- Oral mucositis as a pathway for fatal outcome among critically ill patients exposed to chlorhexidine: post hoc analysis of a randomized clinical trial.Crit Care. 2019; 23: 1-3
Funding: The study was supported by research grants from Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP), process no. 2017/19166–7 and 2018/17531–2, and Fundação de Apoio ao Ensino, Pesquisa e Assistência do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FAEPA). The funding agencies had no participation in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.
Conflicts of interest: All authors report no conflict of interest concerning this submission.
Author contributions: I.L.A.R. was responsible for study execution planning; training of nursing staff; patient care; data collection; data analysis; interpretation of results; writing the manuscript draft; critical revision of the final version for publication. W.T.B.R. was responsible for study conception and design; study execution planning; training of nursing staff, training of dental surgeons; patient care; data collection; data analysis; interpretation of results; critical revision of the final version for publication. MGM was responsible for training of nursing staff; patient care; data collection. L.M.A.R.I., A.T.D.M., L.D.M. were responsible for study implementation planning, patient care; data collection. F.B.J. was responsible for study execution planning; data engineering; data collection; critical analysis of the final version for publication. H.C.C.S. was responsible for data analysis; interpretation of results; writing of the article, critical analysis of the final version for publication. MGM was responsible for study design; study execution planning; data collection. A.P.S.P. was responsible for patient care; data collection. G.G.G., A.S., C.H.M., W.J.L., M.L.P., A.B.F. were responsible for study execution planning. F.B.R. was responsible for Study conception and design; study execution planning; supervision of the whole study team; interpretation of results; writing of the manuscript; critical analysis of the final version for publication.
Ethical approval: This study was approved by the HC FMRP-USP Research Ethics Committee (REC) under protocol no. 2689618 and CAAE 88892918.9. 0000.5440. During the course of the study, the researchers followed the principles of good clinical research practices, ethical guidelines, and norms governed by the National Health Council. The project was also submitted to the Brazilian Clinical Trials Registry of REBEC on October 7, 2018, and approved under the protocol RBR-4jmz36 (https://ensaiosclinicos.gov.br/rg/RBR-4jmz36) before the first patient enrollment. An informed consent form (ICF), which contains all the information about the study, was written in simple language. This ICF was signed by all patients or their respective legal guardians and a copy was given to each of them.
Consent for publication: Not applicable.
Availability of data and materials: The data used in the present study are available for consultation by the researchers.