Does Oral Health a Day Keep the Infection Away?

Author(s):
Chelsea Guy-Frank; Kayli Quinton; Sophia Syed; James Klugh; Shawn Adibi; Lillian Kao

Background:

Oral hygiene care is routine in surgical intensive care units (ICUs) and is associated with reduced ventilator-associated pneumonias. Other evidence suggests that perioperative oral care can reduce surgical site infections after abdominal surgery. However, little is known regarding whether baseline oral health status is associated with hospital-acquired infections (HAIs), which is further limited by a lack of a standardized oral health score.

Hypothesis:

We hypothesize that poor oral health, as graded by the Oral Health Risk Assessment Value Index (OHRAVI), is associated with more HAIs in critically injured trauma patients.

Methods:

A prospective observational study was performed of dentulous adult trauma ICU patients without severe orofacial trauma at a level 1 trauma center. Patients were seen within 72 hours of admission and scored 0-3 (best to worst) in 8 OHRAVI categories to obtain an index (average) score. The primary outcome was a composite of HAIs: ventilator-associated pneumonia, central line-associated bloodstream infection, catheter-associated urinary tract infection and surgical site infection. Univariate and multiple logistic regression analyses were performed to evaluate associations between Index score, periodontal disease, and HAIs.

Results:

Of the 62 patients, most were male (74%), white (40%), bluntly injured (77%) with a median injury severity score of 22. Fifty percent went for an emergency operation and overall, 82% required an operation.  Half were intubated when scored. Twenty patients (32%) had an HAI and over half had more than one (31 HAIs total). Univariate analysis found increasing age and lack of daily brushing/dental visits associated with increasing index score. Patients with any periodontal disease had a higher frequency of HAIs (35%) versus no disease (18%). On logistic regression analysis worsening periodontal disease had a higher odds of a HAI (OR 1.93 95% CI [0.77,4.82]), but a higher index score did not (OR 0.31 [0.06,1.74]).

Conclusions:

The presence of periodontal disease on trauma ICU admission appears to be associated with a higher odds of HAI. Surprisingly, no association was demonstrated between index OHRAVI score and HAI. This may be due to OHRAVI being designed in the dental outpatient rather than ICU setting.  Development of a validated assessment tool for oral health evaluation in the ICU may be useful in determining the effectiveness of oral care interventions in patients at high risk for HAIs.