Assessment of oral hygiene and cuff pressure optimization on the burden of ventilator associated pneumonia in Africa and Middle East 2019 – 2024 - A Systematic Review

Background. Patient under mechanical ventilator for longer than 48 hours are susceptible to the nosocomial infection known as ventilator-associated pneumonia (VAP). This systematic review assessed the impact of endotracheal cuff pressure optimization and good oral hygiene habits on the prevalence of VAP in intensive care units in Africa and Middle East during 2019–2024. Methods. A team of three members implemented a systematic review during the period of January 2019 to September 2024 in accordance with PRISMA guidelines. Their working language was English; they agreed on their research question and inclusion and exclusion criteria. They set the keywords and embarked on search of articles relevant to their research question through PUBMED as a database engine. They retrieved an initial sample of 2349 published articles and included in their study 4 articles fulfilling inclusion criteria. The data were summarized in tabular form for qualitative assessment and graphically as a forest plot to assess the quality and risk of bias across the retrieved publications. Results. The team retrieved an initial sample of 2349 articles related to their research question. They removed 736 articles, which were duplicated. The team screened 1613 articles. After applying their inclusion criteria, they ended by included in their systematic review a final sample of 4 articles which fulfil their inclusion criteria. The findings revealed that compliance with oral hygiene practices using a 0.5% chlorhexidine solution was absent in both medical and surgical intensive care units. The prevalence of VAP in patients in emergency, surgery and reintubation was estimated to be 19.7%. VAP developed in patients under mechanical ventilator in 3 to 18 days with mean duration of 7.50 days ± 5.07. The use of povidone-iodine in providing oral health care to patients under ventilator reduced the length of stay in ICU and consequently the mortality rate. Conclusion. In intensive care units, throughout Africa and Middle East, oral cleanliness and cuff pressure optimization are still underutilized. The adoption of evidence-based VAP prevention measures should be top priority policy to be implemented in health care services including ongoing staff training.