Avaliação da adesão e do impacto do protocolo de higiene bucal na redução de pneumonia nosocomial em crianças e adolescentes em Unidade de Terapia Intensiva

Abstract

Dental care at the level of the intensive care unit would be beneficial to critically ill patients, due to the influence of the health status of hospitalized patients on the evolution of their clinical conditions. Researchers have demonstrated that oral hygiene protocols that associate the application of 0.12% chlorhexidine with mechanical removal of biofilm have been efficient in reducing cases of nosocomial pneumonia. There is a lack of studies that determine a better oral hygiene protocol for pediatric populations. The present study aims to determine the impact of the application of an oral hygiene protocol (POP nº46/HPSCZO) in a pediatric population admitted to the ICU of a public hospital in the state of Amazonas. This is a prospective cohort, in which 152 patients aged 0 to 18 years underwent the protocol, implemented in the hospital in 2023. The variables studied were: geographic area of residence; reason for ICU admission; hospital-acquired pneumonia infection rates; use of mechanical ventilation; adherence of nursing professionals and nursing technicians to protocol; clinical course; oral alterations and culture laboratory test results. A questionnaire was developed to record the patients' sociodemographic and clinical/laboratory data, as well as questions related to protocol adherence. Hospital-acquired pneumonia rates were used to compare the year 2022, prior to the implementation of POP nº46/HPSCZO, and the year 2023, referring to its implementation. Of the 152 patients evaluated, most were male (61.2%). The most predominant age group was under 1 year of age (43.4%). 19.7% died. In addition, 90.6% used mechanical ventilation. A clinical improvement in periodontal alterations, mucosal lesions and bleeding at hospital discharge was observed after the application of the protocol. It was observed that adherence to the protocol was significantly higher in the evaluation of patients leaving the ICU compared to the evaluation of admission (p=0,001). When comparing the annual rate of nosocomial pneumonia between 2022 and 2023, a value of 15.57% was found for 2022 and 8.66% for 2023. The microorganism most frequently associated with the development of hospital-acquired pneumonia was Klebsiella pneumoniae. An improvement in the oral health conditions of patients at ICU discharge was evidenced, and a positive adherence of health professionals to the application of SOP No. 46/HPSCZO. There was a decrease in the rates of nosocomial pneumonia in the ICUs of the HPSCZO in 2023.