Article

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: 1.29). 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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    • "In addition, it inhibits formation of dental plaque or decreases clustering of microorganisms in the mouth. As a result, chlorohexidine is known to have a strong effect in reducing the pneumonia pathogen.29 Yet, tooth brushing is more effective than use of gauze for removal of dental plaque. "
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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.
    Full-text · Article · Jan 2014 · Yonsei medical journal
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    • "The use of antiseptics is shown to be more effective in targeting localized sites and is not associated with the same incidence of bacterial resistance as drug therapy (Chan et al., 2007). Antiseptics are broad spectrum antibacterial agents that control plaque formation and inhibit the growth of bacteria (Grap et al., 2004), as opposed to antibiotics which are bactericidal . In addition to the use of antiseptics, mechanical tooth brushing is also a method to reduce bacteria in the buccal cavity. "
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    ABSTRACT: This article evaluates the evidence for and efficacy of the use of mechanical hygiene and chlorhexidine in the prevention of ventilator-associated pneumonia (VAP). Inclusion criteria: primary research articles; randomized controlled trials; systematic reviews. Exclusion criteria: quasi-experimental trials; opinion articles. Search Engines: PubMed; CINAHL; and EBSCO. 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. 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. 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.
    Full-text · Article · May 2013 · Nursing in Critical Care
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    • "The use of antiseptics is shown to be more effective in targeting localized sites and is not associated with the same incidence of bacterial resistance as drug therapy (Chan et al., 2007). Antiseptics are broad spectrum antibacterial agents that control plaque formation and inhibit the growth of bacteria (Grap et al., 2004), as opposed to antibiotics which are bactericidal . In addition to the use of antiseptics, mechanical tooth brushing is also a method to reduce bacteria in the buccal cavity. "

    Full-text · Dataset · Apr 2013
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