Oral Biologists to Test if Better Oral Hygiene in the ICU Can Prevent or Reduce Incidence of Potentially Lethal Pneumonia

BUFFALO, N.Y. -- An intervention that may reduce the incidence of hospital-acquired pneumonia in ventilated patients in intensive-care units by up to 50 percent is being tested by researchers from the University at Buffalo, supported by a $1.69 million grant from the National Institute of Dental and Craniofacial Research.

The three-year longitudinal, double-blind study will involve 250 patients whose mouths will be swabbed with a bactericide to see if it can protect them from this potentially deadly infection, said Frank Scannapieco, D.D.S., Ph.D., the study's principal investigator, who is professor and associate chair of the Department of Oral Biology in the UB School of Dental Medicine.

"Studies have shown that poor oral hygiene and periodontal disease may foster colonization of respiratory pathogens in the mouth and throat, particularly in hospitalized patients," he noted. "If these pathogens are breathed into the lungs, they can cause pneumonia."

Pneumonia contracted in the hospital often is more serious than pneumonia acquired elsewhere. Sick patients have lowered immune function and pathogens found in hospitals are likely to be more virulent than those found in the community.

"Pneumonia is the second most frequently acquired infection in hospitalized patients, and the most lethal," said Scannapieco. "Depending on the hospital, as many as 25 percent of all patients admitted to the ICU who are ventilated will get pneumonia. We hope this intervention will reduce the rate of pneumonia by 50 percent, as suggested by previous, smaller-scale studies."

Patients entered in the study will be randomized into one of three groups. One group will receive two applications each day of the active bactericide. Another group will get two applications a day of a placebo wash, while the final group will get one active and one placebo application of the mouthwash each day. The intervention will continue as long as patients are in the ICU, and their condition will be followed for 48 hours after leaving the ICU.

To determine the intervention's effectiveness, the researchers will assess the number and amount of respiratory pathogenic bacteria in the mouth in each group and monitor all patients for the development of pneumonia.

Other members of the research team are Joseph Mylotte, M.D., professor of medicine, and Krishna Raghavendran, M.D., assistant professor of surgery, both from the UB School of Medicine and Biomedical Sciences, and Alan Hutson, Ph.D., associate professor of social and preventive medicine, UB School of Public Health and Health Professions.