Conventional and comprehensive oral hygiene procedures using Chlorhexidine 0.2% in patients with mechanical ventilator
DOI:
https://doi.org/10.18203/2320-6012.ijrms20195532Keywords:
Intensive care unit, Mechanical ventilators, Oral hygiene, Oropharyngeal bacteriaAbstract
Background: Ventilator-Associated Pneumonia (VAP) in the intensive care unit patients is related to the oropharyngeal bacteria colonization. The purpose of this study was to compare the number of oropharyngeal bacterial colonies after conventional and comprehensive oral hygiene procedures in patients with mechanical ventilators.
Methods: This study uses an experimental design on 32 subjects with mechanical ventilators. Conventional group/K group (n=16) used 0.2% chlorhexidine gluconate antiseptic conventionally using a sterile gauze while the comprehensive group/L group (n=16) used 0.2% chlorhexidine gluconate antiseptic comprehensively using a toothbrush every 12 hours. Bacterial Isolation is done using swab technique. The number of bacterial colonies and bacterial identification before and after oral hygiene procedure was examined. The data were statistically analyzed using the Wilcoxon test and the Mann Whitney test using SPSS 19.0 software.
Results: There was a significant decrease in the number of oropharyngeal bacterial colonies before and after oral hygiene both in the conventional group (p=0.002) and comprehensive group (p=0.002). However, there was no significant difference between the number of bacterial colonies in the two groups before (p=0.269) and after the oral hygiene procedure (p=0.295). The most common bacterium in the conventional and comprehensive group are Enterobacter gergoviae and Escherichia coli, respectively. Klebsiella pneumonia have decreased the most after conventional oral hygiene while Pseudomonas aeruginosa has decreased the most after comprehensive oral hygiene.
Conclusions: Conventional and comprehensive oral hygiene significantly reduces the number of oropharyngeal bacterial colonies. Both techniques can be used as oral hygiene techniques with relatively similar results.
References
Clare M, Hopper K. Mechanical ventilation: indications, goals, and prognosis. Compendium on continuing education for the practicing veterinarian. 2005;2:195-207.
Koenig SM, Truwit JD. Ventilator-associated pneumonia: diagnosis, treatment, and prevention. Clini Microbiol Rev. 2006;19(4):637-57.
Chen YY, Chen LY, Lin SY, Chou P, Liao SY, Wang FD. Surveillance on secular trends of incidence and mortality for device associated infection in the intensive care unit setting at a tertiary medical center in Taiwan, 2000-2008: A retrospective observational study. BMC Infect Dis. 2012;12(1):209.
Bénet T, Allaouchiche B, Argaud L, Vanhems P. Impact of surveillance of hospital acquired infection on the incidence of ventilatorassociated pneumonia in intensive care unit: a quasi-experimental study. Crit Care. 2012 Aug 21;16(4):R161.
Hunter JD. Ventilator associated pneumonia. Postgrad Med J. 2006;82(965):172-8.
Luna CM, Blanzaco D, Niederman MS, Matarucco W, Baredes NC, Desmery P, et al. Resolution of ventilator-associated pneumonia: prospective evaluation of the clinical pulmonary infection score as an early clinical predictor of outcome. Crit Care Med. 2003;31(3):676-82.
SARI Working Group. 2011. Guideline for the preventing of VAP in Adults in Ireland. Available at: www.hpsc.ie. Accessed 1 June 2019.
Charles MP, Kali A, Easow JM, Joseph NM, Ravishankar M, Srinivsan S, et al. Ventilator associated pneumonia. Australas Med J. 2014;7(8):334-44.
Weinstein RA, Bonten MJ, Kollef MH, Hall JB. Risk factors for ventilator-associated pneumonia: from epidemiology to patient management. Clini Infect Dis. 2004;38(8):1141-9.
Munro CL, Grap MJ, Jones DJ, McClish DK, Sessler CN. Chlorhexidine, toothbrushing, and preventing ventilator-associated pneumonia in critically ill adults. Am J Crit Care. 2009;18(5):428-37.
Atay S, Karabacak Ü. Oral care in patients on mechanical ventilation in intensive care unit: literature review. Int J Res Med Sci. 2014;2(3):822-9.
Keyt H, Faverio P, Restrepo MI. Prevention of ventilator-associated pneumonia in the intensive care unit: a review of the clinically relevant recent advancements. Ind J Medica Res. 2014;139(6):814-21.
Diaconu O, Siriopol I, Poloșanu LI, Grigoraș I. Endotracheal Tube Biofilm and its Impact on the Pathogenesis of Ventilator-Associated Pneumonia. J Crit Care Med. 2018;4(2):50-5.
Cerpa F, Cáceres D, Romero-Dapueto C, Giugliano-Jaramillo C, Pérez R, Budini H, et al. Suppl 2: M5: Humidification on Ventilated Patients: Heated Humidifications or Heat and Moisture Exchangers?. Open Respiratory Med J. 2015;9:104-11.
Divatia JV, Bhowmick K. Complications of endotracheal intubation and other airway management procedures. Indian J Anaesth. 2005;49(4):308-18.
Hamilton VA, Grap MJ. The role of the endotracheal tube cuff in microaspiration. Heart Lung. 2012;41(2):167-72.
Ali R, Abbas A. Comparing the Effects of Matrica and Chlorhexidine on the Prevention of Ventilator-Associated Pneumonia. Mod Care J 2015;12(3):114-18.
Hebl JR. The importance and implication of aseptic technique during regional anesthesia. Reg Anesth Pain Med. 2006;31(4):311-23.
Palmer Jr RJ. Composition and development of oral bacterial communities. Periodontol 2000. 2014;64(1):20-39.
Gupta A, Gupta A, Singh TK, Saxsena A. Role of oral care to prevent VAP in mechanically ventilated Intensive Care Unit patients. Saudi J Anaesth. 2016;10(1):95-7.
Mori H, Hirasawa H, Oda S, Siga H, Matsuda K, Nakamura M. Oral care reduces incidence of ventilator-associated pneumonia in ICU populations. Intensive Care Med. 2006;32(2):230-6.
Sona CS, Zack JE, Schallom ME, McSweeney M, McMullen K, Thomas J, et al. The impact of a simple, low-cost oral care protocol on ventilator-associated pneumonia rates in a surgical intensive care unit. J Intensive Care Med. 2009;24(1):54-62.
Soh KL, Ghazali SS, Soh KG, Raman RA, Abdullah SS, Ong SL. Oral care practice for the ventilated patients in intensive care units: a pilot survey. J Infect Develop Count. 2012;6(04):333-9.
Klompas M, Branson R, Eichenwald EC, Greene LR, Howell MD, Lee G, et al. Strategies to prevent ventilator-associated pneumonia in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35(8):915-36.
