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The Effectiveness of Chlorhexidine 0.2% Mouthwash vs. Chlorhexidine 0.2% Mouthwash and Toothbrush in Preventing Ventilator Associated Pneumonia a Randomized Controlled Trial

  • Nita Karki

Asian Journal of Medicine and Health, Page 1-13
DOI: 10.9734/ajmah/2023/v21i1785
Published: 2 January 2023

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Abstract


Background: Intensive care unit patients are fragile and highly susceptible to infections. Respiratory infections, especially ventilator-associated pneumonia, are the most frequent infectious complications in critically ill patients. Evidence-based patient care treatment practices have been developed by the Center for Disease Control and Prevention to decrease ventilator-associated pneumonia cases. Sixty percent of cases of ventilator-associated pneumonia have been reduced by simple oral routine care.


Aims: To compare the effectiveness of 0.2% chlorhexidine mouthwash solution and chlorhexidine mouth wash with tooth brush and their association in demographic variables in patient admitted in critical care unit.


Methodology: A RCT was conducted from November 2020 to February 2021 in the patient under mechanical ventilation. Ethical clearance and written consent were obtained before collecting information. 30 participants in each control and experimental group were selected by applying the convenient sample technique method. Data was collected using the self-created Performa and the main tool, the Clinical Pulmonary Infection Score, to detect ventilator-associated pneumonia.


Analysis: The data gathered were analyzed and interpreted according to the objective of the study using SPSS version 20. Descriptive statistics were used to find out the demographic result, and the non-parametric Chi-square test was used to compare the data.


Results: Out of 60 participants, majority of patient belongs to 51-60 years, i.e. 11 (36.67%) in control group and 61-70 years, i.e. 13 (43.33%) experimental group. Patients who received chlorhexidine with tooth brushing intervention had higher Clinical pulmonary Infection Score values and higher rate of Ventilator Associated Pneumonia occurrence in experimental group 3(10%) than in control group 1(3.33%).


Conclusion: Combining tooth brushing with 0.2% chlorhexidine did not provide additional benefits over 0.2% chlorhexidine alone. There is no significant reduction in the rate of ventilator-associated pneumonia by applying 0.2% chlorhexidine with toothbrushing.


Keywords:
  • Chlorhexidine
  • ventilator associated pneumonia
  • mechanical ventilation
  • toothbrushing
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How to Cite

Karki, N. (2023). The Effectiveness of Chlorhexidine 0.2% Mouthwash vs. Chlorhexidine 0.2% Mouthwash and Toothbrush in Preventing Ventilator Associated Pneumonia a Randomized Controlled Trial. Asian Journal of Medicine and Health, 21(1), 1-13. https://doi.org/10.9734/ajmah/2023/v21i1785
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References

Koenig SM, Truwit JD. Ventilator-associated pneumonia: diagnosis, treatment, and prevention. Clinical Microbiology Reviews. 2006;19(4):637–657.

DOI:https://doi.org/10.1128/CMR.00051-05

Xie J, Yang Y, Huang Y, Kang Y, Xu Y, Ma X, et al. The current epidemiological landscape of ventilator-associated pneumonia in the intensive care unit: a multicenter prospective observational study in China. Clin Infect Dis. 2018;67(Suppl 2):S153–61.

Mathai A, Phillips A, Isaac R. Ventilator-associated pneumonia: A persistent healthcare problem in Indian Intensive Care Units! Lung India. 2016;33(5):512– 6.

Patil HV, Patil VC. Incidence, bacteriology, and clinical outcome of ventilator-associated pneumonia at tertiary care hospital. J Nat Sci Biol Med. 2017;8(1):46–55.

David D. M. Rosario, Anitha Sequeira. Incidence of ventilator associated pneumonia in tracheostomised and non tracheostomised patients. Int J Res Med Sci. 2018;6(8):2754.

Mohanty D, Routray SS, Mishra D, Das A. Ventilator associated pneumonia in a ICU of a tertiary care Hospital in India. J Contemp Med Res. 2016;3:1046- 1049.

Srinivasan R, Asselin J, Gildengorin G, Wiener-Kronish J, Flori HR. A prospective study of ventilator-associated pneumonia in children. Pediatrics. 2009;123:1108-1115.

Koeman M, van der Ven AJ, Hak E, Joore HC, Kaasjager K, de Smet AG, et al. Oral decontamination with chlorhexidine reduces the incidence of ventilator-associated pneumonia. Am J Respir Crit Care Med. 2006;173(12):1348– 1355.

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.
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