Duration of action of a single, early oral application of chlorhexidine on oral microbial flora in mechanically ventilated patients: a pilot study.

Adult Health Department of the School of Nursing, Virginia Commonwealth University, Richmond 23298-0567, USA.
Heart and Lung The Journal of Acute and Critical Care (Impact Factor: 1.32). 03/2004; 33(2):83-91. DOI: 10.1016/j.hrtlng.2003.12.004
Source: PubMed

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: Aim: This article evaluates the evidence for and efficacy of the use of mechanical hygiene and chlorhexidine in the prevention of ventilator-associated pneumonia (VAP). Search strategies: Inclusion criteria: primary research articles; randomized controlled trials; systematic reviews. Exclusion criteria: quasiexperimental trials; opinion articles. Search Engines: PubMed; CINAHL; and EBSCO. Background: VAP is the commonest infection found in critically ill patients who are mechanically ventilated. It is associated with increased mortality, increased length of stay in intensive care and increased costs. Relevance to clinical practice: VAP is a health care-associated infection consistent with the presence of an endotracheal tube and mechanical ventilation for greater than 48 h. Efforts aimed at reducing infection rates include oral decontamination and mechanical hygiene to control the bacteria responsible, since there is an association between changes in bacteria found in the oropharynx and its development. Tooth brushing and the use of an oral antiseptic such as chlorhexidine gluconate are increasingly recommended in ventilator care bundles. Conclusion: While there have been a number of studies conducted evaluating the efficacy of both approaches, there is limited evidence to support their use. The frequency of oral decontamination and mechanical hygiene interventions have not been established and chlorhexidine 2% seems to be more effective compared to weaker concentrations, but data is mainly confined to patients following cardiothoracic surgery. Key words: chlorhexidine gluconate • critical care nursing • effectiveness of health care intervention • infection prevention • oral care • oral decontamination • oral hygiene • tooth brushing • ventilator-associated pneumonia
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    ABSTRACT: PURPOSE: To test the effectiveness of oral care with 0.12% chlorhexidine in decreasing ventilator-associated pneumonia in critically ill children. METHODS: Prospective, randomised, controlled, double-blind clinical trial performed in a paediatric critical care unit at a university hospital. The sample was composed of 96 mechanically ventilated children randomly allocated to the chlorhexidine group (oral care with a toothbrush and an antiseptic gel twice a day) and the placebo group (oral care with a toothbrush and a non-antiseptic gel twice a day). Microbiological analyses of oropharyngeal and tracheal secretions were performed 24, 48 and 96h after intubation. Chi-square, Fischer's exact and Mann-Whitney tests were applied (p≤0.05). RESULTS: The chlorhexidine group was composed of 46 children, and the placebo group consisted of 50 children. Within these samples, 15 (32.6%) children in the chlorhexidine group and 16 (32.0%) children in the placebo group developed ventilator-associated pneumonia (p=0.949). Children in the chlorhexidine group without potentially pathogenic microflora in their oropharynx 24h after mechanical ventilation presented with fewer episodes of ventilator-associated pneumonia (p=0.019). The pathogen colonization profile of children with ventilator-associated pneumonia in the chlorhexidine group included Klebsiella pneumoniae, Escherichia coli, and Pseudomonas aeruginosa. In the placebo group, Pseudomonas aeruginosa and Escherichia coli were the predominant potentially pathogenic microorganisms. The intervention did not influence paediatric intensive care unit mortality (p=0.425), hospital length of stay (p=0.143), or paediatric intensive care unit length of stay (p=0.177). CONCLUSIONS: The use of 0.12% chlorhexidine did not significantly modify the VAP incidence in a sample of mechanically ventilated children.
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