The effect of a daily application of a 0.05% chlorhexidine oral rinse solution on the incidence of aspiration pneumonia in nursing home residents: a multicenter study
Identifieur interne : 000040 ( Main/Exploration ); précédent : 000039; suivant : 000041The effect of a daily application of a 0.05% chlorhexidine oral rinse solution on the incidence of aspiration pneumonia in nursing home residents: a multicenter study
Auteurs : Vanessa R. Y. Hollaar ; Gert-Jan Van Der Putten ; Claar D. Van Der Maarel-Wierink ; Ewald M. Bronkhorst ; Bert J. M. De Swart ; Nico H. J. CreugersSource :
- BMC Geriatrics [ 1471-2318 ] ; 2017.
Abstract
Dysphagia and potential respiratory pathogens in the oral biofilm are risk factors for aspiration pneumonia in nursing home residents. The aim of the study was to examine if the daily application of 0.05% chlorhexidine oral rinse solution is effective in reducing the incidence of aspiration pneumonia in nursing home residents with dysphagia. Associations between background variables (age, gender, dysphagia severity, care dependency, medication use, number of medical diagnoses, teeth and dental implants, and wearing removable dentures) and the incidence of aspiration pneumonia were also examined.
This study is a multicenter study in which for 1 year participants with dysphagia in the intervention group received the usual oral hygiene care with the addition of a 0.05% chlorhexidine oral rinse solution, whereas participants in the control group received only oral hygiene care.
Data of 103 participants in 17 nursing homes were analyzed. Survival analysis showed no significant difference in the incidence of pneumonia between both groups (Cox regression, HR = 0.800; 95% CI [0.368–1.737],
Chlorhexidine oral rinse solution 0.05% as an adjunctive intervention in daily oral hygiene care was not found to reduce incidence of aspiration pneumonia. The requested number of participants to achieve sufficient power was not established and high drop-out rate and non-structural compliance was present. The power was considered to be sufficient to analyze the associations between the background variables and the incidence of pneumonia in the included nursing home residents with dysphagia. Dysphagia was found to be a risk factor for aspiration pneumonia.
Registration in The Netherlands National Trial Register
Url:
DOI: 10.1186/s12877-017-0519-z
PubMed: 28629318
PubMed Central: 5477106
Affiliations:
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Box 6960, Nijmegen, GL 6503 The Netherlands</nlm:aff><wicri:noCountry code="subfield">GL 6503 The Netherlands</wicri:noCountry></affiliation><affiliation><nlm:aff id="Aff2">BENECOMO, Flemish-Netherlands Geriatric Oral Research Group, Ghent, Nijmegen Belgium</nlm:aff><wicri:noCountry code="subfield">Nijmegen Belgium</wicri:noCountry></affiliation><affiliation><nlm:aff id="Aff3"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0444 9382</institution-id><institution-id institution-id-type="GRID">grid.10417.33</institution-id><institution>Department of Oral Function and Prosthetic Dentistry,</institution><institution>Radboud University Nijmegen Medical Centre,</institution></institution-wrap>P.O. Box 9101, Nijmegen, HB 6500 The Netherlands</nlm:aff><wicri:noCountry code="subfield">HB 6500 The Netherlands</wicri:noCountry></affiliation></author><author><name sortKey="Van Der Putten, Gert Jan" sort="Van Der Putten, Gert Jan" uniqKey="Van Der Putten G" first="Gert-Jan" last="Van Der Putten">Gert-Jan Van Der Putten</name><affiliation><nlm:aff id="Aff2">BENECOMO, Flemish-Netherlands Geriatric Oral Research Group, Ghent, Nijmegen Belgium</nlm:aff><wicri:noCountry code="subfield">Nijmegen Belgium</wicri:noCountry></affiliation><affiliation><nlm:aff id="Aff3"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0444 9382</institution-id><institution-id institution-id-type="GRID">grid.10417.33</institution-id><institution>Department of Oral Function and Prosthetic Dentistry,</institution><institution>Radboud University Nijmegen Medical Centre,</institution></institution-wrap>P.O. Box 9101, Nijmegen, HB 6500 The Netherlands</nlm:aff><wicri:noCountry code="subfield">HB 6500 The Netherlands</wicri:noCountry></affiliation><affiliation><nlm:aff id="Aff4">Amaris Gooizicht, Paulus van Loolaan 21, Hilversum, SH 1217 The Netherlands</nlm:aff><wicri:noCountry code="subfield">SH 1217 The Netherlands</wicri:noCountry></affiliation></author><author><name sortKey="Van Der Maarel Wierink, Claar D" sort="Van Der Maarel Wierink, Claar D" uniqKey="Van Der Maarel Wierink C" first="Claar D." last="Van Der Maarel-Wierink">Claar D. Van Der Maarel-Wierink</name><affiliation><nlm:aff id="Aff2">BENECOMO, Flemish-Netherlands Geriatric Oral Research Group, Ghent, Nijmegen Belgium</nlm:aff><wicri:noCountry code="subfield">Nijmegen Belgium</wicri:noCountry></affiliation><affiliation><nlm:aff id="Aff5">Center for Special Care in Dentistry, Gustav Mahlerlaan 3004, Amsterdam, LA 1081 The Netherlands</nlm:aff><wicri:noCountry code="subfield">LA 1081 The Netherlands</wicri:noCountry></affiliation></author><author><name sortKey="Bronkhorst, Ewald M" sort="Bronkhorst, Ewald M" uniqKey="Bronkhorst E" first="Ewald M." last="Bronkhorst">Ewald M. Bronkhorst</name><affiliation><nlm:aff id="Aff6"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0444 9382</institution-id><institution-id institution-id-type="GRID">grid.10417.33</institution-id><institution>Department of Preventive and Restorative Dentistry,</institution><institution>Radboud University Nijmegen Medical Centre,</institution></institution-wrap>P.O. Box 9101, Nijmegen, HB 6500 The Netherlands</nlm:aff><wicri:noCountry code="subfield">HB 6500 The Netherlands</wicri:noCountry></affiliation></author><author><name sortKey="De Swart, Bert J M" sort="De Swart, Bert J M" uniqKey="De Swart B" first="Bert J. M." last="De Swart">Bert J. M. De Swart</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="ISNI">0000 0000 8809 2093</institution-id><institution-id institution-id-type="GRID">grid.450078.e</institution-id><institution>Department of Neurorehabilitation,</institution><institution>HAN University of Applied Sciences,</institution></institution-wrap>P.O. Box 6960, Nijmegen, GL 6503 The Netherlands</nlm:aff><wicri:noCountry code="subfield">GL 6503 The Netherlands</wicri:noCountry></affiliation><affiliation><nlm:aff id="Aff7"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0444 9382</institution-id><institution-id institution-id-type="GRID">grid.10417.33</institution-id><institution>Department of Rehabilitation, Division Speech Therapy,</institution><institution>Radboud University Nijmegen Medical Centre,</institution></institution-wrap>P.O. Box 9101, Nijmegen, HB 6500 The Netherlands</nlm:aff><wicri:noCountry code="subfield">HB 6500 The Netherlands</wicri:noCountry></affiliation></author><author><name sortKey="Creugers, Nico H J" sort="Creugers, Nico H J" uniqKey="Creugers N" first="Nico H. J." last="Creugers">Nico H. J. Creugers</name><affiliation><nlm:aff id="Aff3"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0444 9382</institution-id><institution-id institution-id-type="GRID">grid.10417.33</institution-id><institution>Department of Oral Function and Prosthetic Dentistry,</institution><institution>Radboud University Nijmegen Medical Centre,</institution></institution-wrap>P.O. 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Y." last="Hollaar">Vanessa R. Y. Hollaar</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="ISNI">0000 0000 8809 2093</institution-id><institution-id institution-id-type="GRID">grid.450078.e</institution-id><institution>Department of Neurorehabilitation,</institution><institution>HAN University of Applied Sciences,</institution></institution-wrap>P.O. Box 6960, Nijmegen, GL 6503 The Netherlands</nlm:aff><wicri:noCountry code="subfield">GL 6503 The Netherlands</wicri:noCountry></affiliation><affiliation><nlm:aff id="Aff2">BENECOMO, Flemish-Netherlands Geriatric Oral Research Group, Ghent, Nijmegen Belgium</nlm:aff><wicri:noCountry code="subfield">Nijmegen Belgium</wicri:noCountry></affiliation><affiliation><nlm:aff id="Aff3"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0444 9382</institution-id><institution-id institution-id-type="GRID">grid.10417.33</institution-id><institution>Department of Oral Function and Prosthetic Dentistry,</institution><institution>Radboud University Nijmegen Medical Centre,</institution></institution-wrap>P.O. Box 9101, Nijmegen, HB 6500 The Netherlands</nlm:aff><wicri:noCountry code="subfield">HB 6500 The Netherlands</wicri:noCountry></affiliation></author><author><name sortKey="Van Der Putten, Gert Jan" sort="Van Der Putten, Gert Jan" uniqKey="Van Der Putten G" first="Gert-Jan" last="Van Der Putten">Gert-Jan Van Der Putten</name><affiliation><nlm:aff id="Aff2">BENECOMO, Flemish-Netherlands Geriatric Oral Research Group, Ghent, Nijmegen Belgium</nlm:aff><wicri:noCountry code="subfield">Nijmegen Belgium</wicri:noCountry></affiliation><affiliation><nlm:aff id="Aff3"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0444 9382</institution-id><institution-id institution-id-type="GRID">grid.10417.33</institution-id><institution>Department of Oral Function and Prosthetic Dentistry,</institution><institution>Radboud University Nijmegen Medical Centre,</institution></institution-wrap>P.O. Box 9101, Nijmegen, HB 6500 The Netherlands</nlm:aff><wicri:noCountry code="subfield">HB 6500 The Netherlands</wicri:noCountry></affiliation><affiliation><nlm:aff id="Aff4">Amaris Gooizicht, Paulus van Loolaan 21, Hilversum, SH 1217 The Netherlands</nlm:aff><wicri:noCountry code="subfield">SH 1217 The Netherlands</wicri:noCountry></affiliation></author><author><name sortKey="Van Der Maarel Wierink, Claar D" sort="Van Der Maarel Wierink, Claar D" uniqKey="Van Der Maarel Wierink C" first="Claar D." last="Van Der Maarel-Wierink">Claar D. Van Der Maarel-Wierink</name><affiliation><nlm:aff id="Aff2">BENECOMO, Flemish-Netherlands Geriatric Oral Research Group, Ghent, Nijmegen Belgium</nlm:aff><wicri:noCountry code="subfield">Nijmegen Belgium</wicri:noCountry></affiliation><affiliation><nlm:aff id="Aff5">Center for Special Care in Dentistry, Gustav Mahlerlaan 3004, Amsterdam, LA 1081 The Netherlands</nlm:aff><wicri:noCountry code="subfield">LA 1081 The Netherlands</wicri:noCountry></affiliation></author><author><name sortKey="Bronkhorst, Ewald M" sort="Bronkhorst, Ewald M" uniqKey="Bronkhorst E" first="Ewald M." last="Bronkhorst">Ewald M. Bronkhorst</name><affiliation><nlm:aff id="Aff6"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0444 9382</institution-id><institution-id institution-id-type="GRID">grid.10417.33</institution-id><institution>Department of Preventive and Restorative Dentistry,</institution><institution>Radboud University Nijmegen Medical Centre,</institution></institution-wrap>P.O. Box 9101, Nijmegen, HB 6500 The Netherlands</nlm:aff><wicri:noCountry code="subfield">HB 6500 The Netherlands</wicri:noCountry></affiliation></author><author><name sortKey="De Swart, Bert J M" sort="De Swart, Bert J M" uniqKey="De Swart B" first="Bert J. M." last="De Swart">Bert J. M. De Swart</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="ISNI">0000 0000 8809 2093</institution-id><institution-id institution-id-type="GRID">grid.450078.e</institution-id><institution>Department of Neurorehabilitation,</institution><institution>HAN University of Applied Sciences,</institution></institution-wrap>P.O. Box 6960, Nijmegen, GL 6503 The Netherlands</nlm:aff><wicri:noCountry code="subfield">GL 6503 The Netherlands</wicri:noCountry></affiliation><affiliation><nlm:aff id="Aff7"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0444 9382</institution-id><institution-id institution-id-type="GRID">grid.10417.33</institution-id><institution>Department of Rehabilitation, Division Speech Therapy,</institution><institution>Radboud University Nijmegen Medical Centre,</institution></institution-wrap>P.O. Box 9101, Nijmegen, HB 6500 The Netherlands</nlm:aff><wicri:noCountry code="subfield">HB 6500 The Netherlands</wicri:noCountry></affiliation></author><author><name sortKey="Creugers, Nico H J" sort="Creugers, Nico H J" uniqKey="Creugers N" first="Nico H. J." last="Creugers">Nico H. J. Creugers</name><affiliation><nlm:aff id="Aff3"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0444 9382</institution-id><institution-id institution-id-type="GRID">grid.10417.33</institution-id><institution>Department of Oral Function and Prosthetic Dentistry,</institution><institution>Radboud University Nijmegen Medical Centre,</institution></institution-wrap>P.O. Box 9101, Nijmegen, HB 6500 The Netherlands</nlm:aff><wicri:noCountry code="subfield">HB 6500 The Netherlands</wicri:noCountry></affiliation></author></analytic><series><title level="j">BMC Geriatrics</title><idno type="eISSN">1471-2318</idno><imprint><date when="2017">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Dysphagia and potential respiratory pathogens in the oral biofilm are risk factors for aspiration pneumonia in nursing home residents. The aim of the study was to examine if the daily application of 0.05% chlorhexidine oral rinse solution is effective in reducing the incidence of aspiration pneumonia in nursing home residents with dysphagia. Associations between background variables (age, gender, dysphagia severity, care dependency, medication use, number of medical diagnoses, teeth and dental implants, and wearing removable dentures) and the incidence of aspiration pneumonia were also examined.</p></sec><sec><title>Methods</title><p>This study is a multicenter study in which for 1 year participants with dysphagia in the intervention group received the usual oral hygiene care with the addition of a 0.05% chlorhexidine oral rinse solution, whereas participants in the control group received only oral hygiene care.</p></sec><sec><title>Results</title><p>Data of 103 participants in 17 nursing homes were analyzed. Survival analysis showed no significant difference in the incidence of pneumonia between both groups (Cox regression, HR = 0.800; 95% CI [0.368–1.737], <italic>p</italic> = 0.572). Cox regression analysis for Functional Oral Intake Scale (FOIS)-level showed a significant risk of the incidence of pneumonia (HR = 0.804; 95% CI [0.656–0.986], <italic>p</italic> = 0.036). After adjustment for Group and FOIS-level, Cox multivariate proportional hazard regression analysis showed that the variables age, gender, Care-dependency Scale-score (CDS) number of diseases, medication use, number of teeth, and the presence of dental implants or removable dentures were not significantly associated with the incidence of pneumonia.</p></sec><sec><title>Conclusions</title><p>Chlorhexidine oral rinse solution 0.05% as an adjunctive intervention in daily oral hygiene care was not found to reduce incidence of aspiration pneumonia. The requested number of participants to achieve sufficient power was not established and high drop-out rate and non-structural compliance was present. The power was considered to be sufficient to analyze the associations between the background variables and the incidence of pneumonia in the included nursing home residents with dysphagia. Dysphagia was found to be a risk factor for aspiration pneumonia.</p></sec><sec><title>Trial registration</title><p>Registration in The Netherlands National Trial Register<bold>:</bold> TC = 3515. Approval for the study was obtained from the Medical Ethical Committee of the Radboud University Medical Center (NL. nr:41,990.091.12).</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Mylotte, Jm" uniqKey="Mylotte J">JM Mylotte</name></author><author><name sortKey="Goodnough, S" uniqKey="Goodnough S">S Goodnough</name></author><author><name sortKey="Naughton, Bj" uniqKey="Naughton B">BJ Naughton</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Shariatzadeh, Mr" uniqKey="Shariatzadeh M">MR Shariatzadeh</name></author><author><name sortKey="Huang, Jq" uniqKey="Huang J">JQ Huang</name></author><author><name sortKey="Marrie, Tj" uniqKey="Marrie T">TJ Marrie</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Nakagawa, N" uniqKey="Nakagawa N">N Nakagawa</name></author><author><name sortKey="Saito, Y" uniqKey="Saito Y">Y Saito</name></author><author><name 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uniqKey="Cras P">P Cras</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list></list><tree><noCountry><name sortKey="Bronkhorst, Ewald M" sort="Bronkhorst, Ewald M" uniqKey="Bronkhorst E" first="Ewald M." last="Bronkhorst">Ewald M. Bronkhorst</name><name sortKey="Creugers, Nico H J" sort="Creugers, Nico H J" uniqKey="Creugers N" first="Nico H. J." last="Creugers">Nico H. J. Creugers</name><name sortKey="De Swart, Bert J M" sort="De Swart, Bert J M" uniqKey="De Swart B" first="Bert J. M." last="De Swart">Bert J. M. De Swart</name><name sortKey="Hollaar, Vanessa R Y" sort="Hollaar, Vanessa R Y" uniqKey="Hollaar V" first="Vanessa R. Y." last="Hollaar">Vanessa R. Y. Hollaar</name><name sortKey="Van Der Maarel Wierink, Claar D" sort="Van Der Maarel Wierink, Claar D" uniqKey="Van Der Maarel Wierink C" first="Claar D." last="Van Der Maarel-Wierink">Claar D. Van Der Maarel-Wierink</name><name sortKey="Van Der Putten, Gert Jan" sort="Van Der Putten, Gert Jan" uniqKey="Van Der Putten G" first="Gert-Jan" last="Van Der Putten">Gert-Jan Van Der Putten</name></noCountry></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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