Effectiveness of 0.12% Chlorhexidine Gluconate Oral Rinse in Reducing Prevalence of Nosocomial Pneumonia in Patients Undergoing Heart Surgery

Abstract

• Background Decreasing the levels of bacteria in the oropharynx should reduce the prevalence of nosocomial pneumonia. • Objectives To test the effectiveness of 0.12% chlorhexidine gluconate oral rinse in decreasing microbial colonization of the respiratory tract and nosocomial pneumonia in patients undergoing open heart surgery. • Methods A prospective, randomized, case-controlled clinical trial design was used. Peridex (0.12% chlorhexidine gluconate) was the experimental drug, and Listerine (phenolic mixture) was the control drug. A total of 561 patients undergoing aortocoronary bypass or valve surgery requiring cardiopulmonary bypass were randomized to an experimental (n = 270) or a control (n = 291) group. Nosocomial pneumonia was diagnosed by using the criteria established by the Centers for Disease Control and Prevention. • Results The overall rate of nosocomial pneumonia was reduced by 52% (4/270 vs 9/291; P = .21) in the Peridex-treated patients. Among patients intubated for more than 24 hours who had cultures that showed microbial growth (all pneumonias occurred in this group), the pneumonia rate was reduced by 58% (4/19 vs 9/18; P = .06) in patients treated with Peridex. In patients at highest risk for pneumonia (intubated >24 hours, with cultures showing the most growth), the rate was 71% lower in the Peridex group than in the Listerine group (2/10 vs 7/10; P = .02). • Conclusions Although rates of nosocomial pneumonia were lower in patients treated with Peridex than in patients treated with Listerine, the difference was significant only in those patients intubated more than 24 hours who had the highest degree of bacterial colonization.

Oral care for intubated patients: a survey of intensive care unit nurses

“…The use of chlorhexidine particularly in instances where toothbrushing is not possible has been recommended by Ransier et al (1995). The potential role of chlorhexidine to prevent VAP in mechanically ventilated patients has also been evaluated and the effectiveness of this anti-plaque agent in reducing VAP incidence was apparent (Houston et al, 2002;Koeman et al, 2006;Chlebicki and Safdar, 2007;Tantipong et al, 2008;Özçaka et al, 2012). More interestingly, while the use of chlorhexidine in otherwise healthy gingivitis patients is considered adjunctive to mechanical plaque control methods, its use in intubated patients, on the other hand, has been shown to be more important and superior than toothbrushing in decreasing the risk of VAP (Munro et al, 2009;Scannapieco and Binkley, 2012).…”

Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient:

“…169 Optimizing oral health with chlorhexidine mouthwashes twice daily was shown in 2 studies to reduce respiratory infection and nosocomial pneumonia in patients undergoing heart surgery. 170,171 While studies evaluating use of chlorhexidine in general ICU populations have shown little outcome effect, 2 studies in which chlorhexidine oral care was included in bundled interventions showed significant reductions in nosocomial respiratory infections. 172,173 Other steps to decrease aspiration risk would include reducing the level of sedation/analgesia when possible, minimizing transport out of the ICU for diagnostic tests and procedures, and moving the patient to a unit with a lower patient:nurse ratio.…”

Effects of combination oral care on oral health, dry mouth and salivary pH of intubated patients: A randomized controlled trial

“…17 The frequency of the intervention was based on the result of four randomized controlled trials regarding the effects of oral care using chlorhexidine in an ICU. [18][19][20][21] Interventions were provided at 5 am and 5 pm each day by research assistants according to the research protocol.…”