Early, single chlorhexidine application reduces ventilator-associated pneumonia in trauma patients

Grap, Mary Jo; Munro, Cindy L.; Hamilton, V. Anne; Elswick, R. K.; Sessler, Curtis N.; Ward, Kevin R.

doi:10.1016/j.hrtlng.2011.01.006

Cited by 50 publications

(62 citation statements)

References 31 publications

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“…In both of these studies, no mouthwash was used in the control group. In the current study, the VAP infection rate on the 4th day in the CHX group (30.6%) was close to that of reported in the study by Grap et al (33.3%) (38). It is possible that the inclusion of a third group in the study whose oral care was not based on any mouthwash, CHX would look more effective in VAP prevention.…”

Section: Discussionsupporting

confidence: 88%

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The Effect of Ozonated Water and Chlorhexidine Gluconate on Prevention of Ventilator-Associated Pneumonia: A Double-Blind, Randomized, Clinical Trial

Hanifi¹,

Masoumi²,

Jamshidi³

et al. 2017

Iran Red Crescent Med J

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Background:The relationship between the oral care and ventilator-associated pneumonia (VAP) was confirmed in patients undergoing ventilation. Objectives: The current study aimed at investigating the effects of chlorhexidine gluconate (CHX) and ozonated water on the prevention of VAP. Methods: The current double-blind, randomized, clinical trial with the experimental and control groups was conducted in Iran in 2014. In the current study, 75 inpatients undergoing ventilation were grouped through the convenience sampling method and randomly allocated into 2 groups based on the inclusion criteria. In the experimental group (39 patients), oral care provided by ozonated water, while in the control group (35 patients), oral care was provided via CHX. Clinical pulmonary infection score (CPIS) was used to examine the rate of VAP infection. Results: According to the results of the current study, the occurrence rate of VAP in the experimental and control groups were 2.4% and 8.3%, respectively that was equal until the 3rd day (P value = 0.339). However, on the 4th day, the VAP occurrence rate in the experimental group (14.6%) was significantly lower than that of the control group (30.6%) (P value = 0.02). Conclusions: Based on the results, ozonated water was more effective to prevent VAP than CHX. Ozone water can be used as a suitable alternative mouthwash in patients undergoing mechanical ventilation.

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Section: Discussionsupporting

confidence: 88%

“…Grap et al also reported that CHX was effective in VAP prevention, observing a VAP infection occurrence of 33.3% in the experimental group compared with 55.6% in the control group (38). In both of these studies, no mouthwash was used in the control group.…”

Section: Discussionmentioning

confidence: 97%

The Effect of Ozonated Water and Chlorhexidine Gluconate on Prevention of Ventilator-Associated Pneumonia: A Double-Blind, Randomized, Clinical Trial

Hanifi¹,

Masoumi²,

Jamshidi³

et al. 2017

Iran Red Crescent Med J

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“…In the classic studies, 9-11 as well as in our previous work, 3,6 the control groups received no CHX postoperatively, whereas the experimental groups continued to receive CHX postoperatively. Th ese prior studies demonstrated the value of CHX begun prior to admission and continued throughout the hospital stay, but the contribution of the preintubation dose of CHX to the reduction in nosocomial infections was not determined.…”

Section: Discussionmentioning

confidence: 90%

“…4,5 We also found that early application of a single dose of CHX (immediately aft er intubation) reduced earlyonset VAP. 6 A Cochrane review concluded that chlorhexidine, either as a mouthwash or as a gel, is associated with a 40% reduction in the odds of developing VAP in critically ill adults. 7 However, studies have failed to show that oral CHX is associated with a diff erence in patient outcomes such as mortality, duration of mechanical ventilation, or duration of ICU stay.…”

mentioning

confidence: 99%

Preintubation Application of Oral Chlorhexidine Does Not Provide Additional Benefit in Prevention of Early-Onset Ventilator-Associated Pneumonia

Munro

Grap

Sessler

et al. 2015

Chest

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BACKGROUND: Daily application of oral chlorhexidine gluconate (CHX) following intubation to reduce the risk of ventilator-associated pneumonia (VAP) is now the standard of care in many ICUs. Th is randomized clinical trial evaluated the benefi t of adding a preintubation CHX dose to the known benefi t of postintubation CHX to reduce the risk of early-onset VAP. A secondary aim was to test the effect of a preintubation oral application of CHX on early endotracheal tube (ETT) colonization.

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“…Among these antiseptics, chlorhexidine gluconate has attracted considerable attention, as evidenced by numerous randomized controlled clinical trials that have investigated the effect of oral chlorhexidine use in VAP prevention. [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] Results from the aforementioned randomized controlled trials and meta-analyses [26][27][28][29][30] that analyzed the effect of oral care with chlorhexidine on VAP prevention are conflicting. Discrepant findings may have resulted from differences in study populations, diagnostic criteria for VAP, chlorhexidine concentration, and frequency of use.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Intraoral Chlorhexidine Protocols in the Prevention of Ventilator-Associated Pneumonia: Meta-Analysis and Systematic Review

et al. 2016

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BACKGROUND: Ventilator-associated pneumonia (VAP) is common in critical patients and related with increased morbidity and mortality. We conducted a systematic review and meta-analysis, with intention-to-treat analysis, of randomized controlled clinical trials that assessed the effectiveness of different intraoral chlorhexidine protocols for the prevention of VAP. METHODS: Search strategies were developed for the MEDLINE, EMBASE, and LILACS databases. MeSH terms were combined with Boolean operators and used to search the databases. Eligible studies were randomized controlled trials of mechanically ventilated subjects receiving oral care with chlorhexidine or standard oral care protocols consisting of or associated with the use of a placebo or no chemicals. Pooled estimates of the relative risk and corresponding 95% CIs were calculated with random effects models, and heterogeneity was assessed with the Cochran Q statistic and I 2 . RESULTS: The 13 included studies provided data on 1,640 subjects that were randomly allocated to chlorhexidine (n ‫؍‬ 834) or control (n ‫؍‬ 806) treatments. A preliminary analysis revealed that oral application of chlorhexidine fails to promote a significant reduction in VAP incidence (relative risk 0.80, 95% CI 0.59 -1.07, I2 ‫؍‬ 45%). However, subgroup analyses showed that chlorhexidine prevents VAP development when used at 2% concentration (relative risk 0.53, 95% CI 0.31-0.91, I 2 ‫؍‬ 0%) or 4 times/d (relative risk 0.56, 95% CI 0.38 -0.81, I2 ‫؍‬ 0%). CONCLUSIONS: We found that oral care with chlorhexidine is effective in reducing VAP incidence in the adult population if administered at 2% concentration or 4 times/d.

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Early, single chlorhexidine application reduces ventilator-associated pneumonia in trauma patients

Cited by 50 publications

References 31 publications

The Effect of Ozonated Water and Chlorhexidine Gluconate on Prevention of Ventilator-Associated Pneumonia: A Double-Blind, Randomized, Clinical Trial

The Effect of Ozonated Water and Chlorhexidine Gluconate on Prevention of Ventilator-Associated Pneumonia: A Double-Blind, Randomized, Clinical Trial

Preintubation Application of Oral Chlorhexidine Does Not Provide Additional Benefit in Prevention of Early-Onset Ventilator-Associated Pneumonia

Effectiveness of Intraoral Chlorhexidine Protocols in the Prevention of Ventilator-Associated Pneumonia: Meta-Analysis and Systematic Review

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