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Oral hygiene with chlorhexidine in preventing pneumonia associated with mechanical ventilation.

Department of Basic Nursing. Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, SP, Brasil.
Jornal brasileiro de pneumologia: publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia (Impact Factor: 1.27). 10/2008; 34(9):707-14. DOI: 10.1590/S1806-37132008000900012
Source: PubMed

ABSTRACT Ventilator-associated pneumonia (VAP) is a common infection in intensive care units (ICUs), and oral antiseptic is used as a preventive measure. We reviewed meta-analyses and randomized clinical trials indexed in the Medical Literature Analysis and Retrieval System and Cumulative Index to Nursing and Allied Health Literature databases regarding the topical use of chlorhexidine in the prevention of VAP. Eight publications were analyzed. In seven (87.5%) chlorhexidine diminished the colonization of the oropharynx, and in four (50%) there was a reduction of VAP. Chlorhexidine seems to reduce colonization, thus reducing the incidence of VAP.

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    ABSTRACT: Oropharyngeal colonization of bacteria is one of the most important risk factors for ventilator associated pneumonia. One of the ways to prevent accumulation of bacteria in the throat is to use mouthwash. Among the oral rinse, chlorhexidine has been introduced as the gold standard but has a variety of side effects. The aim of this study is to determine and compare the antibacterial effects of persica® mouthwash 10% (miswak extract) and chlorhexidine gluconate 0.2% in mechanically ventilated patients in intensive care unit (ICU). In this double blind randomized clinical trial, 60 patients who were admitted in a surgical ICU and met the inclusion criteria were enrolled and were randomly divided in two equal intervention and one control groups. In the first intervention group, chlorhexidine gluconate mouthwash 0.2% was used, in the second one, the researchers used persica® herbal mouthwash 10% and finally in the control group, normal saline was used. In order to culture Staphylococcus aureus and Streptococcus pneumoniae, immediately before and after 6 minutes of mouth washing, saliva samples were taken without any stimulation. Data were analyzed using Chi-square and ANOVA tests in SPSS 17 software. Decrease of bacterial counts was significant in all three groups after intervention (p<0.001). Unlike normal saline, chlorhexidine and persica® mouthwashes had significant antibacterial effects on Staphylococcus aureus (respectively p <0.001 and P = 0.008) and Streptococcus pneumoniae (p <0.001 and p <0.001). The findings of this study indicated that herbal persica® mouthwash can be considered as an alternative for chlorhexidine in ICU patients due to high resistance of the bacteria to synthetic mouthwashes and side effects of these drugs.

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