Cochrane · intervention · CD012416
Oral care measures for preventing nursing home‐acquired pneumonia
Cao, Y, Liu, C, Lin, J, et al. · Cochrane Database of Systematic Reviews · 2022 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
9
current version
GRADE rated
3
No studies
2
Included studies
6
as reported
No studies 2 · 22.2%Ungraded 4 · 44.4%Very low 1 · 11.1%Low 2 · 22.2%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Residents of any age in nursing homes and other long‐term care facilities (e.g. rehabilitation units, medical care facilities), regardless of oral health status (e.g. edentulous or dentate, with or without dentures, with or without physical or intellectual disabilities, with or without mechanical ventilation, with or without alternative feeding route). We excluded participants with pneumonia or respiratory infection at baseline. | 6244 randomised participants (not including 14 participants excluded as not meeting eligibility criteria after cluster randomisation). 5976 participants available for analysis after exclusions. Mean age ranged from 79 to 88 years in four studies that reported demographics, and the proportion of males ranged from 21% to 40%. |
| Intervention | Oral care measures versus no treatment, placebo, usual care, or any other oral care measure (head‐to‐head trials) for prevention of NHAP. Intervention group: participants receiving one or more clearly defined oral care measures, such as professional oral care (dentists, dental hygienists, nurse‐assisted tooth brushing), oral rinse, or swab and topical decontamination with antiseptics, regardless of frequency, dosage, or formulation. | Professional oral care (n=6) |
| Comparison | Placebo/No treatment/Usual care (including self‐care)/Any other oral care measure (or combination or oral care measures) | Usual oral care (n=6) |
| Outcomes | Incidence, incidence proportion, or prevalence of NHAP of any severity; Mortality (pneumonia‐associated); Mortality (all‐cause); Change in systemic antibiotic use; Adverse reactions to interventions (both local and systemic); Incidence or prevalence of fever; Change in data on economics (costs or cost‐effectiveness) and quality of life; Oral health indices | Incidence rate of NHAP (n=1); Incidence proportion of NHAP (n=1); Hazard ratio for NHAP (n=3); Mortality pneumonia‐associated (n=3); Mortality all‐cause (n=3); Adverse reactions to interventions (n=1); Incidence or prevalence of fever (n=2); Change in data on economics and quality of life (n=1); Oral health indices (n=2) |
| Study designs | Parallel randomised controlled trials (RCTs) assessing the effects of oral care measures in residents of nursing and other long‐term care facilities. We included cluster‐RCTs, for which the unit of randomisation was the care facility. We excluded cross‐over studies. | NR |
| Timing | Not specified | 8‐month follow‐up (n=1); 18‐month follow‐up (n=1); 24‐month follow‐up (n=3); Variable follow‐up with mean 1.13 years (n=1) |
Search date: 12 May 2022. Databases: Cochrane Oral Health's Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE Ovid; Embase Ovid; CINAHL EBSCO; US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov; World Health Organization International Clinical Trials Registry Platform
Questions and results
Show all 3 versionsProfessional oral care vs Usual oral care
Population: Residents of nursing homes and other long-term care facilities
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality (all-cause) 12-30 months | All-cause mortality, follow-up 12-30 months, 3764 (3 studies), Very low. Not pooled. Adachi RR 0.80 (0.40 to 1.58; 88); Juthani-Mehta HR 1.16 (0.88 to 1.53; 834); Zimmerman adjusted IRR 0.83 (0.61 to 1.12; 1606).… | 3 studies · 3764 participants | Very low Downgraded: risk of bias, imprecision |
Adverse effects of interventions | Measured in only 1 study (834 participants), which reported no serious events and 64 non-serious events, the most common of which were oral cavity disturbances (not defined) and dental staining. | 1 study · 834 participants | Ungraded |
Mortality (pneumonia-associated) 24 months | RR 0.43 [0.25, 0.76] 165 per 1000 vs 71 per 1000 | 2 studies · 454 participants | Low Downgraded: risk of bias, inconsistency |
Incidence of NHAP 8-30 months | Incidence of NHAP, follow-up 8-30 months, 5018 (5 studies), Low. Not pooled (individual and cluster-randomised designs, varying effect measures and follow-up). Component estimates: Bourigault HR 0.65 (0.29 to 1.46;… | 5 studies · 5018 participants | Low Downgraded: risk of bias, imprecision |
Incidence or prevalence of fever 24 months | RR 0.49 [0.33, 0.75] | 1 study · 366 participants | Ungraded |
Change in data on economics and quality of life 24 months | MD 1.5 [0.32, 2.68] | 1 study · 322 participants | Ungraded |
Oral health indices 24 months | RR 2.81 [1.39, 5.69] | 1 study · 199 participants | Ungraded |
Change in systemic antibiotic use | No studies measured change in systemic antibiotic use. | 0 studies | No studies |
Oral care vs No oral care
Population: Residents of nursing homes and other long-term care facilities
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | No studies evaluated oral care versus no oral care. | 0 studies | No studies |