Gmür Claudius, Irani Sarosh, Attin Thomas, Menghini Giorgio, Schmidlin Patrick R
Department of Pneumology, Canton Hospital Aarau, 5001 Aarau, Switzerland.
Schweiz Monatsschr Zahnmed. 2013;123(5):394-409.
Five to ten percent of all hospitalized patients are treated in intensive care units. The risk of nosocomial infections is inherent in the latter, especially in cases of intubation. In this context, impaired oral hygiene may play a pivotal role. Therefore, the purpose of this survey among representative Swiss intensive care units was to assess the standards and measures taken in this patient collective with reduced oral hygiene. To this end, a questionnaire was sent to 25 institutions which represented all A- and University hospitals in Switzerland as well as all accredited intensive care units in the canton of Zurich according to the register of the Swiss Society of Intensive Medicine. Intensive care units from pediatric departments were excluded. Twenty-one questionnaires were received and evaluated (84%). Only one quarter of all respondents reported having protocols available for preventing ventilation-associated pneumonia (VAP). Systemic antibiotic regimens were never performed. Ninety percent reported cleaning the patients' teeth mechanically with a toothbrush. Sixty-seven percent used chlorhexidine as a disinfectant (81% in liquid form). Seventy-five percent of the responding hospitals performed routine oral cleaning procedures three times a day (90% immediately after intubation). In summary, oral prophylaxis was neither standardized nor consistently implemented in the evaluated Swiss intensive care units of the responding hospitals. Only a small proportion had protocols available for preventing VAP, which is in accordance with similar surveys conducted in the US and Europe. Additional and improved measures have to be determined to confirm or optimize prophylactic oral strategies and to create standards and guidelines for this at-risk patient collective.
所有住院患者中有5%至10%在重症监护病房接受治疗。医院感染的风险在后者中是固有的，尤其是在插管病例中。在这种情况下，口腔卫生受损可能起关键作用。因此，本次在瑞士代表性重症监护病房进行调查的目的是评估在口腔卫生状况较差的这类患者群体中所采取的标准和措施。为此，根据瑞士重症医学会的登记册，向代表瑞士所有A级医院和大学医院以及苏黎世州所有经认可的重症监护病房的25家机构发送了一份问卷。儿科重症监护病房被排除在外。共收到并评估了21份问卷（84%）。所有受访者中只有四分之一报告有预防呼吸机相关性肺炎（VAP）的方案。从未进行过全身性抗生素治疗方案。90%的受访者报告用牙刷对患者牙齿进行机械清洁。67%的受访者使用洗必泰作为消毒剂（81%为液体形式）。75%的受访医院每天进行三次常规口腔清洁程序（90%在插管后立即进行）。总之，在受访医院评估的瑞士重症监护病房中，口腔预防措施既未标准化也未得到一致实施。只有一小部分有预防VAP的方案，这与在美国和欧洲进行的类似调查结果一致。必须确定额外的和改进的措施，以确认或优化预防性口腔策略，并为这个高危患者群体制定标准和指南。
