Oral Care and Nosocomial Infections in Non-ABI Participants

Author/Year/ Country/Study design/PEDro Score/N





Lam et al.

Population: Stroke.
Treatment: Patients randomized to one of three groups: 1) oral hygiene instruction (OHI) only; 2) OHI and mouth rinse (0.2% chlorhexidine twice per day); or 3) OHI, mouth rinse and assistance with tooth brushing twice weekly. Outcomes assessed at baseline and at 3wk.
Outcome Measure: Oral bacteria levels.

  1. Of the 102 patients, 72.8% were found to have oral anaerobic gram-negative bacilli at the baseline period.
  2. Pathogen counts were stabilized in each of the groups regardless of the oral care they were performing.

Prendergast et al. (2011)

Population: Stroke (78.7%).
Treatment: Patients were randomly assigned to a tooth brushing program with either an electric toothbrush (treatment group) or a manual toothbrush (control group). Oral care was conducted twice a day by trained nurses.
Outcome Measure: Intracranial pressure (ICP), cerebral perfusion pressure (CPP).

  1. No significant between group differences were found in ICP values (p=0.72) or CPP values (p=0.68). 
  2. When looking at the two groups together, results showed ICP levels increased before and during oral care (p=0.001), and decreased from during care to after oral care was completed (p<0.001).

Cabov et al.

Population: Neoplasms (61.7%), Head trauma (28.3%), Polytrauma (10%).
Treatment: Patients were randomized to either the chlorhexidine group or the placebo group. Those in the chlorhexidine group had antiseptic decontamination of dental plaque and the oral mucosa by applying the gel to their oral cavity. The gel was not rinsed off after application.
Outcome Measure: Rate of infections, Plaque score.

  1. The plaque score significantly increased in the placebo group and decreased in the chlorhexidine (p<0.05).
  2. Post treatment results indicate that the placebo group acquired nosocomial infections, including nosocomial pneumonia, more often than in the chlorhexidine group.
  3. Mortality in the treatment group was lower (3.3% vs 10%), as was the length of stay (5.1±1.6  vs. 6.8±3.5, p=0.0187), compared to the placebo group.

Yoneyama et al. (2002)


Population: Nursing home patients.
Treatment: Patients either received oral care (n=184) or did not receive oral care (n=182).
Outcome Measure: Pneumonia, febrile days, death from pneumonia, Activities of Daily Living Scale, Mini Mental State Exam.


  1. Pneumonia was more common in those who did not receive oral care, compared to those that did (34 cases vs. 21 cases).
  2. Scores on the activities of daily living scale and the mini mental state examination improved in those receiving oral care.
  3. During follow up 54 (29%) patients had febrile days in the non-oral care group, and 27 (15%) in the oral care group.
  4. Of those who had pneumonia, 30 (16%) in the non-oral care group, and 14 (7%) in the oral care group died.

Fourrier et al.


Population: Intensive Care Unit patients.
Treatment: Chlorhexidine 0.2% (dental gel) group or the control group where dental care consisted of rinsing the mouth with bicarbonate isotonic serum, followed by oropharyngeal sterile aspiration 4x/day.
Outcome Measure: The development of nosocomial infections, Caries-Absent-Occluded Index.

  1. The rate of nosocomial infection acquired in the ICU was significantly higher for the control group (p=0.018).
  2. The chlorhexidine was found to be effective in reducing the risk of nosocomial infections.
  3. Those in the treatment groups also had a reduced ICU stay compared to the placebo group.

PEDro = Physiotherapy Evidence Database rating scale score (Moseley et al., (2002).