Oral care and the risk of bloodstream infections in mechanically ventilated adults: A review

University of Texas Health Science Center at Houston School of Nursing, 6901 Bertner Avenue, #660, Houston, TX 77030, USA. <>
Intensive and Critical Care Nursing 07/2008; 24(3):152-61. DOI: 10.1016/j.iccn.2008.01.004
Source: PubMed


Bacteraemia, defined as the presence of viable bacteria in the circulating blood can result in bloodstream infection, which is one of the most frequent and challenging hospital-acquired infections. Bacteraemia occurs in healthy populations with manipulation of the oral mucosa, including toothbrushing. Oral care is commonly administered to mechanically ventilated patients, it is important to determine whether this practice contributes to the incidence of bacteraemia. This paper reviews the literature on the link between the manipulation of the oral cavity and the development of bacteraemia in mechanically ventilated adults.
Searches were conducted using Medline, CINAHL, and the Cochrane Library databases. Article inclusion criteria were (1) a focus on mechanical ventilation and critical illness, (2) human subjects, (3) adult subjects, and (4) publication in English (or available English translation).
Nine articles met inclusion criteria and were critiqued. All relied upon clinical data as outcome measures; many were retrospective. The three organisms most often associated with nosocomial bloodstream infections were Staphylococcus aureus, coagulase negative staphylococci, and Enterococcus species. Establishing the origin of bacteraemia was problematic in most studies.
Additional research is needed to understand the relationship of oral care practices to bacteraemia in mechanically ventilated adults.

Download full-text


Available from: Cindy Munro, Jul 31, 2014

  • Progress in brain research 02/1996; 109:1-27, xvii. DOI:10.1016/S0079-6123(08)62084-1 · 2.83 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: It is shown that the dynamics of N-solitons of the Korteweg-de Vries (KdV) equation can be reduced to the Toda lattice equations for the temporal positions of the solitons when the solitons are nearly identical and widely separated in time. Invariants of the KdV equation map to corresponding invariants of the Toda lattice, and the map exists in the limit N→∞. These invariants form analogue channels for the communication of data in which an exact memory of the initial conditions is preserved, even though the KdV wavetrain itself is evolving dynamically. It follows that there exist channels which are immune to the effects of the interpulse dynamics in the KdV wavetrain
    Ultra-Wideband Short-Pulse Electromagnetics 4, 1998; 02/1998
  • [Show abstract] [Hide abstract]
    ABSTRACT: Endotracheal (ET) tubes accumulate a biofilm during use, which can harbor potentially pathogenic microorganisms. The enrichment of pathogenic strains in the biofilm may lead to ventilator-associated pneumonia (VAP) with an increased morbidity rate in intensive care units. We used quantitative PCR (qPCR) and gene surveys targeting 16S rRNA genes to quantify and identify the bacterial community to detect fastidious/nonculturable organisms present among extubated ET tubes. We collected eight ET tubes with intubation periods between 12 h and 23 d from different patients in a surgical and a medical intensive care unit. Our qPCR data showed that ET tubes were colonized within 24 h. However, the variation between patients was too high to find a positive correlation between the bacterial load and intubation period. We obtained 1263 near full-length 16S rRNA gene sequences from the diverse bacterial communities. Over 70% of these sequences were associated with genera of typical oral flora, while only 6% were associated with gastrointestinal flora. The most common genus identified was Streptococcus (348/1263), followed by Prevotella (179/1263), and Neisseria (143/1263) with the highest relative concentrations for ET tubes with short intubation periods, indicating oral inoculation of the ET tubes. Our study also shows that even though potentially pathogenic bacteria existed in ET tube biofilms within 24 h of intubation, a longer intubation period increases the opportunity for these organisms to proliferate. In the ET tube that was in place for 23 d, 95% of the sequences belonged to Pseudomonas aeruginosa, which is a bacterial pathogen that is known to out compete commensal bacteria in biofilms, especially during periods of antibiotic treatment. Harboring such pathogens in ET biofilms may increase the chance of VAP, and should be aggressively monitored and prevented.
    International journal of medical microbiology: IJMM 11/2010; 300(7):503-11. DOI:10.1016/j.ijmm.2010.02.005 · 3.61 Impact Factor
Show more