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Impact of a dental care intervention on the hospital mortality of critically ill patients admitted to intensive care units: A quasi-experimental study

Published:January 29, 2022DOI:https://doi.org/10.1016/j.ajic.2022.01.022

      Highlights

      • 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.

      Background

      We aimed to evaluate the impact of providing dental care to critically ill patients on their risk of death and ventilator-associated pneumonia (VAP).

      Methods

      A quasi-experimental study was conducted in 2 intensive care units (ICU) from 2016 to 2019. The intervention consisted of implementing routine dental care, focusing on oral hygiene and periodontal treatment, at least 3 times a week, for patients admitted to the study units. In the pre-intervention period, routine oral hygiene was provided by the ICU nursing staff. The primary and secondary study outcomes were mortality, evaluated at the end of the ICU stay, and VAP incidence density, respectively. Data were analyzed using the ARIMA (autoregressive integrated moving average) time series model in R software.

      Results

      During the intervention period, 5,147 dental procedures were performed among 355 patients. The time series showed that ICU mortality was 36.11%, 32.71%, and 32.30% within the 3 years before the intervention, and 28.71% during the intervention period (P = .015). VAP incidence density did not significantly change during the study period (P = .716).

      Conclusion

      A dental care intervention focused on oral hygiene and periodontal treatment regularly provided by dentists to critically ill patients may decrease their risk of dying in the ICU. Randomized clinical trials should be performed to confirm these findings.

      Trial registration

      WHO-affiliated Brazilian Clinical Trials Registry. RBR-4jmz36. Registered 7 October 2018, before first patient enrollment.

      Key Words

      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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