Journal of Isfahan Medical School

Journal of Isfahan Medical School

Comparison of Effects of Chlorhexidine Mouthwash versus Stop-Snoring Mouthwash in Prevention of Ventilator-Associated Pneumonia

Document Type : Original Article (s)

Authors
Sayed Taghi Hashemi 1
Babak Alikiaii 1
Mohammad Ali Fallah-Medvari 2
Fatemeh Karimi 2
Abolfazl Fallah-Medvari 2
1 Assistant Professor, Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
2 Student of Medicine, Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
10.22122/jims.v36i471.9728
Abstract
Background: Ventilator-associated pneumonia (VAP) is a prevalent infection occurs in intensive care unit (ICU) accompanied with increased complications and mortality. In this study, effects of chlorhexidine mouthwash versus herbal stop-snoring mouthwash on VAP among ICU admitted patients have been compared.Methods: 86 patients admitted at ICU were randomly divided to two equal groups including; group C treated with chlorhexidine mouthwash and group S treated with stop-snoring mouthwash. Patients of both groups were similarlytreated for three times a day (including amount, technique and times of mouth washing). Time of incidence and frequency of VAP were compared in two groups.Findings: 74.41% of group S and 62.79%of group C presented VAP (P-value = 0.353). 22.22% of patients presented VAP in first-5-days and 77.77% after 5 days and in group S while 6.25% of patients of group C presented VAP in first-5-days and 93.75% after 5 days(P-value = 0.126).Conclusion: Time of VAP incidence or frequency of VAP was not different using chlorhexidine mouthwash versus herbal stop-snoring mouthwash for prevention of VAP.
Keywords
Chlorhexidine
Mouthwashes
Ventilator-associated pneumonia
  1. Cecil RLF, Goldman L, Ausiello DA. Cecil Medicine. Philadelphia, PA: Saunders; 2008.
  2. Safdar N, Crnich CJ, Maki DG. The pathogenesis of ventilator-associated pneumonia: its relevance to developing effective strategies for prevention. Respir Care 2005; 50(6): 725-39.
  3. Tsai HH, Lin FC, Chang SC. Intermittent suction of oral secretions before each positional change may reduce ventilator-associated pneumonia: a pilot study. Am J Med Sci 2008; 336(5): 397-401.
  4. Rathod A, Soni S, Patel K, Vegad MM, Kumari M, Gandhi P. Prevalence of various bacterial pathogens causing ventilator associated pneumonia (VAP) isolated from ICU in tertiary care hospital. Natl J Integr Res Med 2017; 8(2): 28-30.
  5. Mandell GL, Bennett JE, Dolin R, Douglas RG. Mandell, Douglas, and Bennett's principles and practice of infectious diseases. 7th ed. London, UK: Churchill Livingstone; 2010.
  6. Hutchins K, Karras G, Erwin J, Sullivan KL. Ventilator-associated pneumonia and oral care: a successful quality improvement project. Am J Infect Control 2009; 37(7): 590-7.
  7. Kollef MH. The prevention of ventilator-associated pneumonia. N Engl J Med 1999; 340(8): 627-34.
  8. Basharzad N. Incidences of ventilator-associated pneumonia in patients in intensive care units in Masih Daneshvari Hospital [PhD Thesis]. Tehran, Iran: Shahid Beheshti University of Medical Sciences; 2007 [In Persian].
  9. Panchabhai TS, Dangayach NS, Krishnan A, Kothari VM, Karnad DR. Oropharyngeal cleansing with 0.2% chlorhexidine for prevention of nosocomial pneumonia in critically ill patients: an open-label randomized trial with 0.01% potassium permanganate as control. Chest 2009; 135(5): 1150-6.
  10. Grap MJ, Munro CL, Hamilton VA, Elswick RK, Jr., Sessler CN, Ward KR. Early, single chlorhexidine application reduces ventilator-associated pneumonia in trauma patients. Heart Lung 2011; 40(5): e115-e122.
  11. Li Y. Progress on the Modern Nursing of Pneumonia Pathogenic Bacteria of Ventilator-associated Pneumonia. Journal of Nursing 2018; 5(4): 7-9.
  12. DeRiso AJ, Ladowski JS, Dillon TA, Justice JW, Peterson AC. Chlorhexidine gluconate 0.12% oral rinse reduces the incidence of total nosocomial respiratory infection and nonprophylactic systemic antibiotic use in patients undergoing heart surgery. Chest 1996; 109(6): 1556-61.
  13. Houston S, Hougland P, Anderson JJ, LaRocco M, Kennedy V, Gentry LO. Effectiveness of 0.12% chlorhexidine gluconate oral rinse in reducing prevalence of nosocomial pneumonia in patients undergoing heart surgery. Am J Crit Care 2002; 11(6): 567-70.
  14. Berry AM, Davidson PM, Masters J, Rolls K. Systematic literature review of oral hygiene practices for intensive care patients receiving mechanical ventilation. Am J Crit Care 2007; 16(6): 552-62.
  15. Segers P, Speekenbrink RG, Ubbink DT, van Ogtrop ML, de Mol BA. Prevention of nosocomial infection in cardiac surgery by decontamination of the nasopharynx and oropharynx with chlorhexidine gluconate: a randomized controlled trial. JAMA 2006; 296(20): 2460-6.
  16. Chlebicki MP, Safdar N. Topical chlorhexidine for prevention of ventilator-associated pneumonia: A meta-analysis. Crit Care Med 2007; 35(2): 595-602
  17. Craven DE. What is healthcare-associated pneumonia, and how should it be treated? Curr Opin Infect Dis 2006; 19(2): 153-60.
  18. Lindhe J, Karring T, Lang NP. Clinical periodontology and implant dentistry. 3rd ed. Copenhagen, Denmark: Munksgaard; 1997.
  19. Tang HJ, Chao CM, Leung PO, Lai CC. An Observational Study to Compare Oral Hygiene Care With Chlorhexidine Gluconate Gel Versus Mouthwash to Prevent Ventilator-Associated Pneumonia. Infect Control Hosp Epidemiol 2017; 38(5): 631-2.
  20. Kanafani ZA, Kara L, Hayek S, Kanj SS. Ventilator-associated pneumonia at a tertiary-care center in a developing country: incidence, microbiology, and susceptibility patterns of isolated microorganisms. Infect Control Hosp Epidemiol 2003; 24(11): 864-9.
  21. Zand F, Zahed L, Mansouri P, Dehghanrad F, Bahrani M, Ghorbani M. The effects of oral rinse with 0.2% and 2% chlorhexidine on oropharyngeal colonization and ventilator associated pneumonia in adults' intensive care units. J Crit Care 2017; 40: 318-22.
  22. Ghazvini K, Ghanaat J, Malek Jafarian M, Yazdan Panah M, Lrani N. incidence of nosocomial pneumonia and bacterial agents causing this infection in intensive care unit in Ghaem Educational Hospital in Mashhad. J Ilam Univ Med Sci 2005; 13(4): 55-61. [In Persian].
  23. Genuit T, Bochicchio G, Napolitano LM, McCarter RJ, Roghman MC. Prophylactic chlorhexidine oral rinse decreases ventilator-associated pneumonia in surgical ICU patients. Surg Infect (Larchmt) 2001; 2(1): 5-18.
  24. Grap MJ, Munro CL, Elswick RK, Jr., Sessler CN, Ward KR. Duration of action of a single, early oral application of chlorhexidine on oral microbial flora in mechanically ventilated patients: A pilot study. Heart Lung 2004; 33(2): 83-91.
  25. Fourrier F, Dubois D, Pronnier P, Herbecq P, Leroy O, Desmettre T, et al. Effect of gingival and dental plaque antiseptic decontamination on nosocomial infections acquired in the intensive care unit: a double-blind placebo-controlled multicenter study. Crit Care Med 2005; 33(8): 1728-35.
  26. Shi Z, Xie H, Wang P, Zhang Q, Wu Y, Chen E, et al. Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. Cochrane Database Syst Rev 2013; (8): CD008367.
  27. SafarAbadi M, rezaei K, Ghaznavirad E. Comparing the effect of Echinacea and chlorhexidine mouthwash on oral health in patients hospitalized in intensive care units .Complement Med J Fac Nurs Midwifery 2012; 2(3): 222-34. [In Persian].
Journal of Isfahan Medical School
Volume 36, Issue 471 - Serial Number 471
January and February 2018
Pages 227-232

  • Receive Date 27 February 2018
  • Revise Date 13 April 2022
  • Accept Date 06 April 2022