PURPOSE: Ventilator-associated pneumonia (VAP), will develop in 10-20% of patients who are mechanically ventilated for more than 48 hours. Chlorhexidine (CHX) mouthwash, has found favor as part of VAP prevention strategies. Our aim was to test the efficacy of an oral decontamination protocol using chlorhexidine in the prevention of VAP.
METHODS: This was a prospective, randomized study conducted over 1 year. Eighty-two adult inpatients that were newly intubated were included. Patients were excluded if they were previously intubated during the same admission or under controlled circumstances, unable to sign consent, or extubated within 24 hours. The patients were randomized to the control or CHX group. Both received the hospital's standard protocol of care for intubated patients. The control group received Biotene® oral care (hospital protocol). The treatment group received 2 mL of chlorhexidine gluconate 0.12%, applied to the oral cavity twice daily. Posterior orophayngeal swab cultures were taken post-intubation at baseline and on subsequent days. The clinical characteristics of each patient were also recorded.
RESULTS: Baseline characteristics for both groups were similar. There was no significant difference in the incidence of VAP between the groups, with control and CHX group having 21.6% and 17.8% incidence, respectively (p=0.66). Relative risk of VAP was 0.82 in the CHX versus control groups (95% confidence interval, 0.34, 1.98). The time to extubation was significantly different between the two groups (9.46 vs. 5.11 days, p=0.01). Bacterial load was significantly decreased on Day 3 in the CHX group, with only 55.5% showing growth compared to 82.1% in the control group (p=0.03).
CONCLUSION: Although the reduction in the incidence of VAP was statistically insignificant in the CHX group, we found significant reduction in the number of ventilation days and bacterial load. These are fundamental factors in the development of VAP and should be taken into account in prevention strategies. Ventilation days are associated with increased morbidity and mortality in other studies.
CLINICAL IMPLICATIONS: Oral decontamination with chlorhexidine can be part of an effective VAP-reduction strategy.
DISCLOSURE: Darlene Tad-Y, No Financial Disclosure Information; No Product/Research Disclosure Information