Table 3.

Summary of high-quality non-randomized studies on toothbrushing for ventilator-associated pneumonia prevention

Study	Type of trial	Patient characteristics	Methods	Results
Mori et al. [24] (2006)	Non-randomized trial with historical controls (case control)	Medical-surgical ICU; 1,666 adult patients requiring MV ≥48 hours	Study compared two groups: (a) historical controls (n = 414) who received no systematic oral care and (b) intervention group (n = 1,252) that received oral care three times a day. A written protocol directed oral care that included toothbrushing and rinses with povidone-iodine three times daily.	Incidence of VAP (per 1,000 ventilator days) in the oral care group was significantly lower than that in the non-oral care group (3.9 versus 10.4). Results showed decreased incidence of VAP in the oral care group.
Garcia et al. [25] (2009)	Pre/post-intervention observational study	Medical ICU; 1,538 adult patients requiring MV ≥48 hours	Study compared two groups: (a) controls (n = 779): before the intervention had no oral procedures (for example, oral assessments, suctioning of subglottic space, or toothbrushing) and (b) intervention (n = 759): during the intervention period had oral care techniques. Oral care consisted of oral assessment, deep suctioning every 6 hours, oral cleaning every 4 hours, and toothbrushing twice daily.	Incidence of VAP (per 1,000 ventilator days) in the oral care group was significantly lower than that in the non-oral care group (8 versus 12). Results showed decreased incidence of VAP in the oral care group. Mortality and length of ICU stay were also reduced significantly.
Sona et al. [26] (2009)	Pre/post-intervention observational study	Surgical ICU; 1,648 adult patients requiring MV	Study compared (a) controls (n = 777): during the preintervention period and (b) intervention (n = 871): after institution of oral care interventions. Oral care protocol included toothbrushing for 1 or 2 minutes at 12-hour intervals with sodium monofluorophosphate 0.7% paste. Used stock toothbrush. Applied 15 mL of 0.12% chlorhexidine solution.	Incidence of VAP (per 1,000 ventilator days) in the oral care group was significantly lower than that in the non-oral care group (2.4 versus 5.2). Results showed decreased incidence of VAP in the oral care group.

ICU, intensive care unit; MV, mechanical ventilation; VAP, ventilator-associated pneumonia.