Review: enhanced oral hygiene prevents respiratory infection in elderly people in hospitals and nursing homes.

ED FROM Sjögren P, Nilsson E, Forsell M, et al. A systematic review of the preventive effect of oral hygiene on pneumonia and respiratory tract infection in elderly people in hospitals and nursing homes: effect estimates and methodological quality of randomized controlled trials. J Am Geriatr Soc 2008;56:2124– 30. Correspondence to: Dr P Sjögren, Oral Care AB, Göteborg, Sweden; [email protected] Source of funding: no external funding. c Clinical impact ratings: Elderly care 5/7; General/internal medicine 5/7; Infectious disease 4/7 Enhanced oral hygiene care v placebo or usual care (control) to prevent respiratory infection in elderly people in hospitals and nursing homes* Interventions Type of patients (n) Follow-up Outcomes Intervention Control RRR (95% CI) NNT (CI) Preoperative and postoperative oral rinse with chlorhexidine Patients having heart surgery (353) To discharge Respiratory infection 2.9% 9.4% 69% (22 to 88) 16 (9 to 61) Oral care by caregiver after every meal and weekly professional oral care Nursing home residents (366) 2 years Pneumonia 11% 19% 39% (0 to 63) Not significant Death from pneumonia 7.6% 16% 54% (17 to 75) 12 (7 to 45) Weekly professional oral care Nursing home residents (88) 2 years Death from pneumonia 5.0% 17% 70% (216 to 93) Not significant *Abbreviations defined in glossary. RRR, NNT, and CI calculated from data in article. C O M M EN TA R Y C onsistent and thorough mouth care should be provided to all elderly people in hospitals and institutions who are not able to provide their own oral hygiene. There has been recent interest in the effect of oral hygiene on preventing ventilatorassociated pneumonia. Although seemingly intuitive, there is a dearth of evidence available on this aspect of nursing care for other populations, including the elderly. The review by Sjögren et al is interesting because the authors are dental care professionals and researchers, some of whom are employed by a Swedish dental care company. The review included studies published between 1996 and 2006 in 10 different scientific journals and originating in 6 countries; the search included studies in 8 different languages. Although comprehensive, the researchers may have missed some studies in their literature search by omitting more familiar nursing key words such as ‘‘mouth care.’’ The review is valuable because it highlights the need for more nursing and interprofessional research into the effects of oral hygiene on preventing pneumonia and possibly improving quantity and quality of life. However, interpretation of the results is difficult because of a lack of consistency in the definition of ‘‘oral care’’ (including ‘‘professional care’’). As well, some suggested interventions (povidone iodine scrubbing of the pharynx and chlorhexidine oral rinse) sound unpleasant and may not be acceptable to some patients. Risk of aspiration with these rinses is possible in some debilitated patients. The implication for practice is that mouth care may act as an early detection system for other serious health problems. If mouth care, which has been ‘‘considered basic and potentially non-essential nursing care,’’ is consistently provided, then other essential aspects of care may also be optimised. Mouth care is not a luxury but an essential part of patient care. The need for interprofessional research into the barriers to providing this important aspect of nursing care has been highlighted by this systematic review. Cindy Doucette, RN, MN, GNC(C) Trillium Health Centre Mississauga, Ontario, Canada 1. Berry AM, Davidson PM, Masters J, et al. Systematic literature review of oral hygiene practices for intensive care patients receiving mechanical ventilation. Am J Crit Care 2007;16:552–62. Treatment EBN April 2009 Vol 12 No 2 55 on 3 July 2009 ebn.bmj.com Downloaded from