Duration of action of a single, early oral application of chlorhexidine on oral microbial flora in mechanically ventilated patients: a pilot study.
ABSTRACT The purpose of this study was to describe the effect of an early post-intubation oral application of chlorhexidine gluconate on oral microbial flora and ventilator-associated pneumonia.
Thirty-four intubated patients were randomly assigned to chlorhexidine gluconate by spray or swab or to control group. Oral cultures were done at study admission, 12, 24, 48, and 72 hours, whereas the Clinical Pulmonary Infection Score (CPIS) was documented at study admission, 48, and 72 hours.
Reductions in oral culture scores (less growth) were only found in the treatment groups (swab and spray); no reduction was found in the control group. There was a trend for fewer positive cultures in the combined treatment groups. The mean CPIS for the control group increased to a level indicating pneumonia (4.7 to 6.6), whereas the CPIS for the treatment group increased only slightly (5.17 to 5.57).
Trends in the data suggest that use of chlorhexidine gluconate in the early post-intubation period may mitigate or delay the development of ventilator-associated pneumonia.
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ABSTRACT: Purpose The effects of an oral hygienic care program (OHCP) have been reported in several diseases. However, no study exists investigating the influence of an OHCP on stroke patients or patients in the intensive care unit (ICU) has been reported, thus we sought to investigate the potential effect of an OHCP. Materials and Methods Fifty-six consecutive stroke patients who were admitted to the ICU were randomly assigned to two groups: the intervention (29 patients) and control groups (27 patients). The OHCP included tooth brushing with an inter-dental brush and tongue cleaner and cleaning with chlorhexidine was administered to patients by one dentist once per day during admission in the ICU (mean, 2.2 weeks). The plague index, gingival index, clinical attachment loss, and colonization degree of candida albicans were assessed. Results After OHCP, the plaque index, gingival index, and colonization degree of candida albicans in saliva showed a significant decrease in the intervention group compared to those of the control group (p<0.05). However, no significant difference was observed in clinical attachment loss and the colonization degree of candida albicans on the tongue (p>0.05). Conclusion Our OHCP was effective in improving the oral hygienic status and periodontal health of stroke patients during their stay in the ICU. Therefore, we recommend administration of the OHCP for stroke patients during their stay in the ICU.Yonsei medical journal 01/2014; 55(1):240-6. DOI:10.3349/ymj.2014.55.1.240 · 1.26 Impact Factor
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ABSTRACT: Aims To determine the attitudes, current practice, knowledge and education of paediatric critical care nurses regarding oral care. Background Treatment modalities used to support children experiencing critical illness and the progression of critical illness may result in dysfunction in the oral cavity. Poor oral health is linked to health care-associated infections, particularly ventilator-associated pneumonia. Critically ill children are dependent on health care workers to provide all aspects of their oral care. Design and methods A cross-sectional study was undertaken at two Australian children’s hospitals. A 33-item questionnaire was developed and distributed to registered nurses working within the paediatric intensive care and high dependency units. Results Of the 54 participants, the majority perceived oral care as being a high priority. There was substantial variation within the choice of oral care solution, device and frequency. The majority of nurses surveyed made the decision of treatment based on information learned from nursing colleagues or previous employment, felt unhappy with current practice and desired to learn more. Practice implications Paediatric critical care oral hygiene nursing practice needs to be better supported by implementation strategies including adequate resources, education and evidence.Neonatal, Paediatric and Child Health Nursing 03/2014; 17(1):12-18.
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ABSTRACT: Background/purpose Ventilator-associated pneumonia (VAP) is one of the most frequent causes of morbidity and mortality among mechanically ventilated patients in critical care. Previous meta-analyses demonstrated that oral chlorhexidine (CHX) is beneficial in preventing VAP. Several new studies on oral hygiene as a preventive measure for VAP have been published. Considering all the currently available evidence together, an updated meta-analysis was conducted to evaluate the efficacy of oral CHX in preventing VAP. Materials and methods A comprehensive literature search was conducted to identify clinical trials comparing oral hygiene care using CHX with conventional care in terms of the incidence of VAP. Two reviewers independently assessed each report to confirm that all reports met the inclusion criteria. The data from each trial were combined using the Mantel–Haenszel fixed-effects model to calculate the pooled relative risk and the corresponding 95% confidence intervals. Funnel plots were used to assess publication bias. Results Nine randomized controlled trials met our inclusion criteria. Overall, 1623 patients received oral hygiene with CHX and 1662 received a placebo. The heterogeneity of the data was statistically refuted. Oral hygiene using CHX resulted in a reduced incidence of VAP (relative risk = 0.59; 95% confidence interval, 0.47–0.73; P < 0.001; I2 = 27.8%) according to a fixed-effects model. Publication bias was not apparent in the funnel plots. Conclusion The analysis showed that oral CHX decontamination significantly reduced the incidence of VAP but not the mortality rate.Journal of dental sciences 12/2013; 8(4):348–357. DOI:10.1016/j.jds.2012.11.004 · 0.47 Impact Factor