Does oral care with chlorhexidine reduce ventilator-associated pneumonia in mechanically ventilated adults?

Jackson, Laura; Owens, Melissa

doi:10.12968/bjon.2019.28.11.682

Cited by 18 publications

(16 citation statements)

References 33 publications

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“…In 2014, Zhang et al compared the effects of various concentrations of CHX and concluded that 0.12% CHX was the best option with respect to cost, adverse reactions, drug resistance, and VAP prevention [53]. However, in 2019, Jackson and Owens pointed out that, although CHX shows a clear effect in preventing VAP in ICU patients, standard guidelines, such as the usage and frequency of CHX use, have not yet been established [54]. CHX demonstrates an almost 75-90% antibacterial effect even if it is applied in the oral cavity for 15 s [55].…”

Section: Application Of Chxmentioning

confidence: 99%

“…Many studies have shown the effectiveness of oral hygiene management, including the application of CHX, for respiratory disease prevention in ICU patients [6,11,21,41,47,48,51,53,54,56,60,61,[67][68][69][70][71][72][73][74][75][76]. In 2013, Hillier et al reported that the education of nurses on oral care, including CHX application and other oral care methods, reduced the incidence of VAP [3].…”

Section: Outcomes Of Oral Management Of Icu Patientsmentioning

confidence: 99%

“…In particular, when oral intubation is performed, the risk of VAP occurrence is high because it serves as a passage through which microorganisms in the oral cavity can be transferred into the airways. Therefore, these patients should receive thorough oral hygiene management [54]. In addition, not only CHX gel application, but also brushing should be performed to reduce VAP occurrence during the mechanical ventilation period [62].…”

Section: Outcomes Of Oral Management Of Icu Patientsmentioning

confidence: 99%

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Hospital Dentistry for Intensive Care Unit Patients: A Comprehensive Review

Jun

Kim

et al. 2021

JCM

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This study aimed to review the oral hygiene status, oral care guidelines, and outcomes of oral care in intensive care unit (ICU) patients from a dental perspective for effective oral care. A literature search using the keywords “Hospital dentistry” OR “Oral care” OR “Intensive care unit” OR “Hospital inpatient” OR “Hospitalization” OR “Emergency service” AND “Oral health” OR “Oral hygiene” OR “Dental plaque” was conducted in PubMed, Medline, and Google Scholar to identify publications reporting on the oral care of the patients admitted to ICUs. A total of 17,400 articles were initially identified. Of these, 58 were selected and classified into three categories for critical review. Seven of these studies evaluated the oral status of ICU patients, and most of the studies indicated that ICU patients had poor oral hygiene or required active dental treatment. Thirty-three of these studies evaluated oral care methods for ICU patients, and in general, oral care methods using chlorhexidine as adjuncts along with tooth brushing were recommended. However, there were insufficient studies to evaluate oral hygiene through effective assessment tools from a dental perspective. In 36 studies on the outcomes of oral care in ICU patients, interventions by dental professionals showed effective results in preventing hospital-acquired infection. This review highlights the importance of establishing guidelines for the evaluation of oral status in ICU patients and summarizes data that may be useful for future studies. Further studies on maintaining good oral hygiene among ICU patients are needed.

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Section: Application Of Chxmentioning

confidence: 99%

Section: Outcomes Of Oral Management Of Icu Patientsmentioning

confidence: 99%

Section: Outcomes Of Oral Management Of Icu Patientsmentioning

confidence: 99%

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Hospital Dentistry for Intensive Care Unit Patients: A Comprehensive Review

Jun

Kim

et al. 2021

JCM

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“…Its use for oral hygiene in patients under mechanical ventilation reduces the risk of VAP ( 16 - 19 ). As a mouthwash, CHX reduces bacterial colonization in the oral cavity ( 20 , 21 ). However, the presence of a biofilm on the surface of the teeth limits the action of any mouthwash ( 22 ).…”

Section: Introductionmentioning

confidence: 99%

Combination of toothbrushing and chlorhexidine compared with exclusive use of chlorhexidine to reduce the risk of ventilator-associated pneumonia: A systematic review with meta-analysis

Silva

Paranhos

Meneses-Santos

et al. 2021

Clinics

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This study aimed to compare the effectiveness of 0.12% chlorhexidine alone and 0.12% chlorhexidine in combination with toothbrushing to prevent ventilator-associated pneumonia (VAP) in mechanically ventilated patients. The Embase, Latin American and Caribbean Health Science Literature, PubMed, Scientific Electronic Library Online, Scopus, LIVIVO, Web of Science, Cochrane Library, OpenThesis, and Open Access Thesis and Dissertations databases were used. Only randomized controlled trials without restrictions on the year or language of publication were included. Two reviewers assessed the risk of bias using the Joanna Briggs Institute Critical Appraisal Tool. A meta-analysis using a random-effects model estimated the combined relative risk (RR). The Grading of Recommendations, Assessment, Development and Evaluations approach was used to assess the certainty of the evidence. Initially, 2,337 studies were identified, of which 4 were considered in the systematic review and 3 in the meta-analysis (total sample: 796 patients). The studies were published between 2009 and 2017. All eligible studies had a low risk of bias. The meta-analysis revealed that the risk of VAP was 24% lower in patients receiving chlorhexidine combined with toothbrushing than in those receiving chlorhexidine alone (RR: 0.76; 95% confidence interval: 0.55-1.06), with moderate certainty of evidence and without statistical significance. In conclusion, considering the limitations of this study, a standard protocol for the prevention of VAP is not yet recommended. More studies with larger sample sizes are needed to draw strong conclusions. However, considering that toothbrushing is a simple intervention, it should be a common practice in mechanically ventilated patients, especially among patients with coronavirus disease.

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“…However, it is necessary to consider the negative effects that will be experienced by patients. Antibiotic resistance and risk of aspiration are some of the effects that can be fatal in patients [2], so it is necessary to find alternatives in oral care regimens.…”

Section: Introductionmentioning

confidence: 99%

Risk Prevention of Ventilator-Associated Pneumonia Thorough Oral Hygiene: A Literature Review

Musdalipah

Syam

Tahir

2021

JELS

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Ventilator-Associated Pneumonia (VAP) is a type of nosocomial infection that mostly occurs in intensive care units, generally occurring 48 hours after intubation. Endotracheal intubation and the use of a mechanical ventilator are invasive measures by patients, having a therapeutic effect. This paper aimed to identify the use of oral hygiene materials for the incidence of pneumonia related to the use of a ventilator. The research design was by searching literature in five databases, namely PubMed, Proquest, Science Direct, Wiley Online Library, and Google Scholar, by taking all databases in English and Indonesian, published in the last ten years (2010-2020). There were six articles about the effectiveness of using oral hygiene as risk prevention for Ventilator-Associated Pneumonia (VAP) with various concentrations and volumes. Several oral health assessment tools that can be used are Oral Assessment Guide, Beck Oral Assessment Scale, or Mucosal-Plaque Score. Comprehensive implementation of oral hygiene can improve the oral health of patients with mechanical ventilation, so bacterial colonization that causes VAP can be prevented. Therefore, nurses need to understand and apply oral assessment instruments as a basis for giving intervention.

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Does oral care with chlorhexidine reduce ventilator-associated pneumonia in mechanically ventilated adults?

Cited by 18 publications

References 33 publications

Hospital Dentistry for Intensive Care Unit Patients: A Comprehensive Review

Hospital Dentistry for Intensive Care Unit Patients: A Comprehensive Review

Combination of toothbrushing and chlorhexidine compared with exclusive use of chlorhexidine to reduce the risk of ventilator-associated pneumonia: A systematic review with meta-analysis

Risk Prevention of Ventilator-Associated Pneumonia Thorough Oral Hygiene: A Literature Review

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