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: 1.02). 10/2008; 34(9):707-14. DOI: 10.1590/S1806-37132008000900012
Source: PubMed


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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    ABSTRACT: Nosocomial pneumonia, especially ventilator-associated pneumonia, is a common infection in ICUs. The main etiologic factors involve colonizing and opportunistic bacteria from the oral cavity. Oral hygiene measures, including the use of oral antiseptic agents, such as chlorhexidine, have proven useful in reducing its incidence. The objective of this article was to review the literature on the importance of the oral environment in the development of nosocomial pneumonia.
    Jornal brasileiro de pneumologia: publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia 11/2009; 35(11):1116-24. DOI:10.1590/S1806-37132009001100010 · 1.02 Impact Factor
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    ABSTRACT: HHC. Patients profile under intensive care with nosocomial pneumonia: key etiological agents. Rev Odontol UNESP. 2010; 39(4): 201-206. Resumo O ambiente hospitalar é inevitavelmente um grande reservatório de patógenos virulentos e oportunistas, que podem ser transmitidos ao indivíduo por via endógena e, assim, desencadear infecções respiratórias, principalmente a pneumonia, que acomete comumente os pacientes submetidos à ventilação mecânica em Unidade de Terapia Intensiva (UTI). No período de janeiro de 2009 a janeiro de 2010, foram acompanhados 73 pacientes com pneumonia nosocomial internados nas UTIs – adulto, pediátrica e Centro de Queimados – do Hospital Metropolitano de Urgência e Emergência (HMUE), em Belém -PA, com o objetivo de avaliar o perfil desses pacientes e os principais agentes infecciosos envolvidos na infecção respiratória. Após o estudo, verificou-se uma idade média de 38,7 anos, sendo 87,7% do gênero masculino. A partir do lavado broncoalveolar, da hemocultura e da secreção traqueal, foram obtidas culturas positivas e 17 tipos de bactérias diferentes foram isolados, sendo Staphylococcus aureus o agente infeccioso mais frequente nas infecções nosocomiais (30,7%). Considerando que na microbiota normal, patógenos potencialmente respiratórios – como Staphylococcus aureus, Pseudomonas aeruginosa e alguns bacilos gram-negativos – podem colonizar o biofilme bucal, pode-se ressaltar que os cuidados odontológicos em pacientes sob terapia intensiva são essenciais como parte integrante da saúde geral, evitando agravos sistêmicos. Palavras-chave: Infecção respiratória; terapia intensiva; microbiota bucal. Abstract The hospital environment is inevitably a large reservoir of virulent and opportunistic pathogens, which can be transmitted via the individual endogenous. Which in turn can trigger respiratory infections, especially pneumonia, which commonly affects patients undergoing mechanical ventilation in the Intensive Care Unit (ICU). From January 2009 to January 2010 were followed 73 patients with nosocomial pneumonia hospitalized in ICU adult and pediatric burn center of the Metropolitan Hospital Emergency and Emergency-HMUE Belém -Pará in order to evaluate the profile of these patients and main infectious agents involved in respiratory infection. After the study it was found that the average age was 38.7 years and 87.7% were males. From broncoalveolar lavage, blood culture and tracheal aspirate positive culture was obtained and 17 kinds of different bacteria were isolated, Staphylococcus aureus the most frequent infectious agent in nosocomial infections (30.7%). Whereas the normal flora potential respiratory pathogens such as Staphylococcus aureus, Pseudomonas aeruginosa and some gram-negative bacilli can colonize the oral biofilm, may be noted that dental care for patients under intensive therapy is essential as part of general health, preventing systemic diseases.
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